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The Process of Therapy: The First Session

 Whether this is your first time in therapy, or the first session with a new therapist, it’s often a good idea to have some goals in mind when you first go in.
Whether this is your first time in therapy, or the first session with a new therapist, it’s often a good idea to have some goals in mind when you first go in.
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Phase4 Photography/Shutterstock

NEW YORK — In the first three parts of this series, we discussed knowing when it’s time to seek therapy, what kinds of therapies and therapists there are and how to get connected with one.

In this article, DNAinfo will prepare you for the first therapy session. We’ll discuss how to get ready for the experience, what to expect in the first session and what to look for in trying to establish the all-important therapeutic alliance with your new therapist.

What to Prepare

Whether this is your first time in therapy, or the first session with a new therapist, it’s often a good idea to have some goals in mind when you first go in. These goals needn’t be incredibly specific, but it’s helpful if they are more detailed than “I just want to feel better.”

Your goals are going to reflect your ”presenting problem.”  The presenting problem is a clinical term that describes why you are seeking therapy at this time.

Some common goals include:

► To relieve depression, anxiety or other “mood” issues

► To communicate better with significant other or family

► To better navigate emotions around the loss of a loved one, friend or other close associate

► To better navigate emotions around the loss of a pet, job or a divorce/separation

► To resolve recent or past trauma

► To change negative behavior patterns (such as avoidance, passive-aggressive behavior, drug/alcohol use [not abuse], etc.)

► To relieve insomnia or other sleep disturbances

Although it's helpful for both you and the therapist to have goals in mind when you first come in, don’t feel pressured to have these goals completely figured out. In therapy, goal setting is a collaborative process between client and therapist, and goals tend to change over time.

It is common practice for a therapist to inquire about childhood, even if the presenting problem isn’t overtly connected to childhood experiences.  Be prepared to discuss certain elements of your family history, your relationship with parents, siblings, experiences in school, friendships and the like. 

While thinking about our childhood narrative can feel overwhelming,  It’s often helpful to my clients when I say, “We will have time to explore these experiences, but for now just give me the ‘headlines’ of what happened.” This relieves clients of the pressure of having to fully explain their lives, which is impossible in one session.

In addition to goals, bring in any pertinent health information, such as medications and dosage, or any chronic conditions, as you would with any other health practitioner.

What to Expect in the First Session

You’ve done your research, decided on what type of therapy and therapist you’d like to work with, and you’ve briefly spoken to the therapist over the phone.  Now you’re ready to begin the process.  Here’s what to expect on that first day.

Try to leave yourself an extra 15 minutes before your appointment. This allows you ample time to get acquainted with the neighborhood, the office building and the surroundings, and it leaves room for any unanticipated travel delays. Some therapists ask that you fill out a brief intake form, and this time prior to the session will allow you to fill in any information, without taking away from your session time.

 A common goal of therapy is to relieve depression.
A common goal of therapy is to relieve depression.
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Oleg Golovnev/Shutterstock

Once inside the therapy room, unless you are specifically attending psychoanalysis, you will not be lying down on a couch. You will most likely sit on a couch or in a comfortable chair. The therapist will then ask you (if you haven’t already discussed this over the phone) “what brings you in for therapy?”

It’s not important where you begin, and remember, you cannot discuss everything in one session.  But, this is where your preparation will come in handy.

Try and be open and honest about your life, and what you are looking to accomplish in therapy.  Ask the therapist how they think they can help you, and what the therapist sees as issues that can be addressed. A good assessment will take time, but a therapist can reflect back to you themes she is already observing.

Establishing the Therapeutic Alliance

In terms of the therapeutic alliance, Manhattan-based psychotherapist Alex Stadler said, “connecting with a therapist can be complex in light of our previous relationships. In our previous relationships, we may experience strong initial sensations of either like, dislike or neutrality.”

You will no doubt experience something like this with your new therapist, but it's important to stay open-minded about the person sitting across from you.

While it’s important to connect with your therapist, you are not establishing a friendship. It is a unique relationship that certainly requires intimacy, but the boundaries should be very clear.

“In general, give a therapist a chance to learn who you are, since who you are is complex, like the layers of an onion," Stadler said. "Over time, a therapist may reveal [herself] to be more than they appear initially.”

Many clients say that what they look for in a therapist is someone who is a good listener, kind, wise, supportive and insightful. You may not be able to tell all of that in the first session, but you’ll get a sense of who they are pretty quickly in the process.

Beyond the First Session

It’s important to have realistic expectations about therapy. Therapy is not a cure-all, and unless you are specifically seeking out short-term therapy, it takes time.

As you progress in your treatment, you will need to check in with your therapist around your progress (or lack thereof) toward your goals. You will also need to check in around the therapeutic relationship. Be honest about where things are at, your likes and dislikes with the therapist and any disappointments you may have. This is helpful for you and the therapist.

And, don’t be afraid of hurting your therapist’s feelings. Remember, the focus is on you.  Therapists are trained to depersonalize your experiences (to the best of their ability).

Most people find therapy to be a rewarding and helpful process. With the tools in this series, you will give yourself the best chance at having the best possible treatment.

While this is the end of this four-part series, the conversation is ongoing.  Feel free to comment on this page or email me with any questions you may have.