Six Ways to Prepare for Your First Therapy Session.

Congratulations! You’ve made contact with a therapist, had that awkward first conversation or email and agreed to meet for your first session. You may not know it, but you’ve just completed the most difficult part of therapy (apart from showing up for your session). At this point you might be thinking “what the heck am I going to talk about?” or “I’ve got so much to say, where the heck am I going to start from?” In this blog post I am going to suggest 6 things that will help your first session be less anxiety provoking.

1.      Know where you’re going and leave plenty of time to find the venue.

This may sound obvious, but as a therapy client myself, I know how easy it is to succumb to anxious, avoidant urges and set off for therapy at the last minute only to realise you’re not quite sure where the therapist’s office is, or how you’re going to get there. You’ll already be experiencing stress responses, so don’t do anything else that could add to this. Check Google maps for the best route, save it on your phone, and leave yourself at least 15 minutes grace time; you can always go for a walk before your session if you arrive too early (and this has the added bonus of burning off some of your stress hormones).

If you arrive late you’ll feel rushed, parts of your brain will go off-line which means it will be difficult to organise your thoughts, possibly leading to you missing a vital issue, and your therapist may also feel ungrounded and rushed too. The same rule applies to on-line work – check your tech is charged up and plugged in, that you’re somewhere private, and arrive in plenty of time. Your therapist will invite you in once the session starts, so you can chill with a drink, do some breathwork, or recap what you want to cover while you’re waiting.

2.      Take a list of questions you might want to ask your therapist about their experience or about therapy in general.

Popsugar lists some really good questions to ask your therapist in the first session. Don’t be shy about this, most therapists expect it. This can also serve as a good indicator of your therapist’s interpersonal style and whether any red flags start flying. Be wary of any therapist who avoids answering questions about their qualifications, theoretical orientation, experience of working with your problem, confidentiality and notes, and how they will know that therapy is working. If they ask “why do you want to know that?” then it’s time to find another therapist.

3.      Be aware that you may not cover everything in your first session and you may feel worse rather than better.

The first session is usually weighted towards “getting to know you” and basic administrative requirements – name, contact details, GP, emergency contact, demographic information, consent and so on. There will be forms because your therapist needs to know a bit about you to keep things safe. You might be asked to complete a clinical measurement of your mood to help the therapist to get a sense of what’s going on for you.

Usually, there’s time to discuss your problem(s) in broad details and I like to map this out in session one in a “formulation.” This helps us both to understand what might be driving the problem, and orientates you to the CBT model of working, and whether this chimes with you. The therapist may discuss a therapy contract with you – how the sessions will run, how many to contract for, home practice between sessions, payment, how to cancel, social media policies and what to do if you bump into each other in the frozen foods section of Sainsbury’s.  

A couple of questions to be aware of that you’ll be asked are “what would you like from today’s session/what has brought you here today?” at the start and “did you get what you feel you needed from the session today?” at the end.  We might also cover what you’d like from therapy and what your goals are too, but sometimes we spend the second session covering this. You can find more information about what happens in your first session at the BACP website.

4.      It may help to make a list of the problems you want to discuss in therapy.

If you’re anything like me you might have that horrible brain-freeze, blank experience in response to the question of what’s brought you to therapy. It can be helpful to write a bullet point list of the issues you want to discuss, and then you and your therapist can prioritise what to discuss now, and what to discuss in future sessions. Most people come to therapy because something has happened (or is happening) in their life that has made them realise it’s time to talk about it.

What stressors are triggering you?

Let your therapist know.

Don’t save the most important problem until the final minutes of the session as this will have to be carried over until next time. CBT therapy sessions start by setting an agenda, so it’s always good to have an idea of what you want to cover before you arrive.

5.      Be prepared for questions about risk.

Your therapist will ask you about current and previous risk issues – suicide, self harm, abuse, safeguarding, risk from other people and whether you are having thoughts of hurting someone else. Be prepared for this as these are important things to cover to make sure you are safe.

Your therapist will be used to asking such questions and will have heard a wide range of answers so don’t be afraid to let them know how you’re feeling. You will not be judged. It’s also important to remember that thoughts around risk are often part of the “landscape” of mental health and are much more common than you’d expect.

6.      Trust your gut instinct.

You’ve made it through the first session. You might be feeling excited, exhausted or exasperated. Check in with yourself as you are moving away from the office/screen.

How are you feeling? Better? Worse? Regulated? Relieved? Raw?

What is your body telling you about the process and about the therapist? Does your body feel light or heavy? Tense or released?

Do you feel safe with the therapist? Do you feel you could work with them?

Do you have an idea how the therapist will help? If not, what do you need from them in order to feel OK? Let your therapist know at the next session. Also what do you need to do for yourself to feel better?

Do you need to try a few other therapists before deciding who to work with?

Are you clear about how to book a further session?

If it feels right in your body then that’s usually a good sign, but pay attention to what’s happening for you and how you respond to the idea of attending a second session.

In conclusion, in this article we have explored six ways of preparing for your first therapy session to make it run as smoothly as possible. Initial sessions can be challenging, don’t forget that your therapist is also meeting you for the first time so it’s important that both participants do their best to make it work for you!

If that has been helpful, why not take the plunge and book a first session with a therapist? Get in contact with us at Rhizome Practice and start the ball rolling.