What to Expect in the First Therapy Session

Feb 22, 2021

therapy

The first therapy session can be daunting, especially if you have never been before
Therapist Karin Blak offers an outline of how the first meeting between client and therapist might play out
If you want to start your therapy journey, let us help – start here

We made it! Knocking on the door or ringing the bell, we arrive at our chosen therapist’s practice. Or, today in lockdown, perhaps joining our online session from the comfort of our own home.

For most of us this is an uncertain time; even though we by now will have prepared ourselves for what to say and will have chosen this therapist based on the discipline and approach most suitable for us and our issues, we will still feel a little anxious about this personal journey that lies ahead. Questions whirl around the mind – perhaps we are filled with a mix of excitement and apprehension. What will therapy be like and what is the therapist like? Will they be taking notes as we talk, like on TV? What will be expected of us and how is our conversation going to help us?

In some ways it feels like a first date; we are venturing into the unknown with uncertainty, the questions we have and nervousness we feel are very similar.

The door opens and our therapist greets us. The door opens wider as they invite us inside. But there has been no handshake, no physical touching, and there are reasons for this. Touch can be misinterpreted, even a handshake. Think about the places we take handshakes for granted, the relationships we establish with a handshake. It can signify a kind of power play – how firm is the grip, is their hand on top or is ours? Books have been written on the interpretation of handshakes. In therapy a handshake will only be acceptable if it is the client’s hand that reaches out first.

As we nervously take a seat in the comfy chair that most therapists provide, we look for a sign that we should talk. Or we talk looking for a sign that we should stop. Any sign to let us know what is expected is gratefully received.

Most of my clients have been pretty nervous as they take a seat in that first session. Some have struggled to talk, not knowing how to express their thoughts in a linear manner, believing that a life story should be told as if reading a novel. Some find that snippets of memories jump from one situation to another, giving the impression that their hard drive has been scrambled. Others try hard to find the words for what they are longing to express yet struggle because words simply are not enough. Some have not been able to stop talking, spilling out every little bit that they have managed to keep locked away in the emotional cabinet of secrets and traumas for far too long. As they open the cabinet, everything comes tumbling out.

However we tell our story in that first session, we have done what needed to be done – we have opened the door, even if just a little, to this fascinating individual landscape that we will be travelling across with our therapist over the coming weeks and months.

It never mattered how my clients managed to deliver their experiences, how they told their story; what mattered was that they had found the courage to begin their journey.

The therapist carries on to the next stage of the first session, but we hardly hear it as our thoughts are turning over with our reasons for being there; wishes for a better life get mixed in with the therapist’s explanations of the rules and boundaries of therapy. How are we supposed to keep hold of all this information? We might begin to wonder what the therapist is expecting of us. Questions we hadn’t even thought about come tumbling in and blurs our focus.

In our daily lives we are used to knowing the protocol of behaviour, manners and routines, dos and don’ts. But here, in this therapeutic space, we have no idea. This isn’t the usual place of work, social gathering, shopping experience or the holiday destination where we know the expected and accepted behaviours. This is something completely different and it might be good to remember the following:

We are the one hiring the therapist, they are not hiring us. It is a collaboration between us and the therapist that we are paying for. This means we need to notice how we feel in this session and how well our stories are received. Bear in mind that this is not a friendship we are hiring either, it is a specially trained professional.
Don’t try to please. If we try to second-guess what our therapist’s reaction is going to be, what they are thinking of us, or focus on staying on the right side of them, we won’t be able to communicate our reason for being there. Trying to please others could be part of the reason we are seeking therapy. If this is so and we know about it, our therapist will want to hear us talk about it.
The therapist is not the expert on us, we are. The therapist has training in theory, interventions and methods, along with experience in working therapeutically with people
like us. They have knowledge about human behaviour that will assist us in moving on with our lives. They do not hold expert knowledge on our inner landscape, it is only us who have these architectural drawings and it is up to us to show our therapist this space.

Behaviour during therapy is very much guided by mutual respect. In this first session we will both be figuring out who we are and how we can interact. We establish a kind of unspoken contract as we get to know one another – this happens in all relationships, instinctively or intuitively we detect each other and begin to build a kind of knowledge of how to behave with one another. Our own behaviour can also be guided by our emotions, this therapeutic space is the perfect platform for us to express ourselves verbally. The physical expression of overwhelming emotions such as crying or using our tone of voice to express frustration or incredulity, for example, are also acceptable. What is not acceptable are any physically violent behaviours, threats to the therapist or insults and accusations. For the therapeutic space to feel safe, it needs to start from a basis of mutual respect and recognition that this is a space where we, the client, can feel secure in showing our vulnerabilities.

The therapeutic contract

Many therapists will have a written contract or agreement for therapy. This will include practical topics such as a confidentiality statement, cancellation policy, payment details and how holidays are managed. Some therapists will have other items that are important to them such as not turning up to sessions early because they have no waiting room available and what the expected behaviour will be if we should bump into each other socially. Our therapist might talk us through the details of their specific contract to make sure we have understood and agree with its content. This is a perfect time for us to let ourselves get comfortable and get familiar with the surroundings, while our thoughts and emotions settle themselves in preparation for talking about what we bring to therapy.

When I first started training as a therapist, I didn’t recognise the importance of that initial conversation about the therapeutic contract, taking some basic information about my client, and setting expectations. Instead I would steam straight into what I thought the client wanted – to talk about themselves, spilling out all their innermost, painful stories. I believed that this was the point of therapy. We would get to work, often forgetting to fill in the simple admin form, in a rush to get straight to the point of my client’s visit. For the client this must have felt like walking into a potato peeler; their outer layers being scraped off before they had time to get comfortable in their seat. I hadn’t appreciated the importance of setting boundaries and building up the trust clients needed in therapy so they could have those deeper conversations without feeling violated.

I soon adopted a gentler approach, treating the client and their troubles with the respect they deserved. Letting the client lead the way, letting their issues show their faces when they were ready. I later realised just how important this initial time was to build that all-important therapeutic relationship. Over time I developed a routine and initiation into therapy to include the more abstract expectations of the therapeutic relationship.

While a written contract will provide us with some guidance on the practical aspects of therapy, there are other expectations to be prepared for too – the emotional effects on us and the knock- on effect on the people close to us are inevitable. Although we won’t know exactly what these are, we need to be aware that changes to our life will reach further than simply a change in emotion or thought. These effects are part of therapy and not an adverse reaction to our therapeutic journey.

The health warning

All therapy ought to come with a warning label. It isn’t the kind of warning we read on leaflets accompanying medicine or on rides at the fun fair. It’s a warning designed to make us aware that therapy is likely to be challenging and perhaps even emotionally painful. It will certainly cause some kind of change that will include experiencing our emotions differently and changing our view of the world around us. Perhaps something similar to this:

It is a warning with a positive outcome. These are the kind of “risks” we willingly take to make life lighter and more content.

The first session continues

Following the conversation about the therapeutic contract, the therapist might take out a notebook or a form and write down our details: name, address, phone number and other admin information. By now we are beginning to feel a little more settled. Then the therapist asks us that question we’ve hopefully come prepared for: “So, what brings you to see me?”

This is our turn to talk, our turn to say what we have prepared for this first session. Perhaps we have our own notebook, or we might remember the details, but even if we don’t, our words will ease themselves out as we begin to talk about our situation and how it is affecting us.

This is the bit that will prove to us if the therapist is a good fit. Do we feel listened to? Is the therapist showing an interest in what we are saying? Are they asking further questions or clarifying their understanding of certain points in our story? Do we feel comfortable enough to answer?

Feeling comfortable is subjective. If we naturally feel uncomfortable talking about ourselves, or if opening up to a complete stranger seems odd to us, having this conversation might not be easy. That’s okay because we can take our time deciding whether we want to carry on in therapy with this therapist, this decision doesn’t have to happen straight away.

We talk, we think, we explain, our situation becoming clearer with every word we say. Or, we might find that what we say is making no sense at all. Either way we have started the process and, as we gradually crack open the door, the therapist engages with us in a way that we haven’t experienced in any other relationship. Their interest in our story, in us, is warm, genuine and encouraging. We cannot help but want to talk as we are guided into a deeper conversation.

When the session is close to finishing, the therapist will ask if this is a good time and day of the week for us to see them on a regular basis. Some therapists will finish this first session by talking about what they expect from us and what we can expect from them. They are setting the boundaries for therapy. Then seeing us out they say, “See you next week.” We leave feeling as if we have just been through a process of sorts, something is different but it’s too subtle to be able to tell what it is. Or, having finally opened up, we might feel so light we want to go skipping down the street. Again, whatever we feel is what we need to feel.

This first session will not usually be very deep or emotionally demanding. It will be an introduction to therapy, an opportunity for us to ask any questions about therapy and begin the conversation we might have longed to have, the first step in our journey. This is an exercise where we peek through a narrow opening at what has been kept hidden, the struggles we have had, and the confusions we have juggled with. Seeing the landscape of our past that we will be travelling across over the coming weeks, we can experience a mix of emotions. As we make our way home, we might feel lighter and easier or we could feel a sense of awkwardness about having shown someone a hidden part of us. But we know that our conversation will remain confidential and that the therapist will not judge us, so we need not fear, we are in safe hands.

Karin Blak is a therapist and the author of The Essential Companion to Talking Therapy. A discount code is available for welldoing.org readers, using code Wellbeing21 from https://www.watkinspublishing.com