So you just made your first therapy appointment. Maybe it’s your first session ever. Or maybe you’ve talked to someone in the past but now you’re about to meet with a new therapist. Even though you know you’re taking a positive step, you may still feel apprehensive.
“It’s OK to be nervous! You’re meeting someone for the first time who is likely going to ask you some very personal and emotionally sensitive questions and you’re expected to be very honest and forthcoming with them,” Gina Delucca, a clinical psychologist in San Francisco, told HuffPost. “It’s a very unnatural and nerve-inducing type of situation, and as therapists, we try to be sensitive to this.”
To ease your pre-appointment jitters, we asked therapists to reveal what they typically bring up with clients during the first session. Below, they share what you need to know to start (or re-start) therapy on the right foot.
Questions You’ll Probably Be Asked
Before your first session, your therapist will likely send over some intake paperwork to fill out. One of those documents will probably be a questionnaire that asks for your medical history (including any medications you’re taking), mental health services you’ve received in the past, current issues or stressors, and what you hope to get out of therapy. The therapist will review your responses and may want you to elaborate on them during your initial session together.
Here are some of the questions you may be asked and why:
1. What prompted you to seek therapy now?
The therapist wants to know if there’s something going on in your life that pushed you to make the appointment when you did. It could be anything from a messy breakup to a conflict with a family member, unmanageable levels of anxiety, a sexual assault or some big life change like becoming a parent or starting a new career.
“We are interested in knowing what event or experience preceded you deciding to get some help to help us understand the nature of the problem and what you are wanting to work on,” said Kate Stoddard, a marriage and family therapist in San Francisco.
2. How have you been coping with the problem(s) that brought you into therapy?
Delucca asks her new clients this question to learn how they handle stressful situations and difficult emotions. Do they turn to something productive like meditation or spending time outside? Or do they rely on unhealthy habits like excessive drinking or drug use?
“I find it helpful to get a sense of my client’s current coping skills and resources so that we can utilize or build upon them in treatment,” she said. “Second, this allows me to assess whether my client is engaging in any unhealthy coping mechanisms that could be exacerbating the problem and may potentially impact treatment, like avoidance, substance use or self-injury.”
3. Have you ever done therapy before?
If you’ve talked to a therapist in the past, it’s likely this person did some things you liked and others you didn’t. Your current therapist can use this information to help treat you in the most effective way, explained Los Angeles-based marriage and family therapist Danny Gibson.
“If the experience was positive, why was it positive? If not, why was it a negative experience? What would you like to do differently?” he said. “The client drives the therapy session ― I act as the useful guide.”
If you answer no to this question, “the therapist can spend more time orienting you around the structure and process of therapy and how it works,” Stoddard said.
4. What was it like growing up in your family?
Many people enter therapy to gain a better understanding of themselves and how they relate to others. Learning about a client’s childhood and their family dynamics can offer insight into the person they are today, said Zainab Delawalla, a clinical psychologist in Atlanta.
“Although it is not a given that people will repeat the same roles they adopted during childhood, often the pattern of relating that they develop is tied to how they have internalized certain role expectations in the past,” she said.
5. Have you ever thought of harming yourself or ending your life?
For those who have experienced suicidal thoughts or harmed themselves in the past, these types of questions may bring up difficult emotions. But it’s crucial for your therapist to know this information from the get-go.
“Most clinicians will want to know if you’re struggling with thoughts of self-harm from the very first session so they can be sure they are recommending the appropriate level of care,” Delawalla said.
If you answer yes, Delucca said you can expect follow-up questions like: “Are you having current thoughts of suicide?” “Do you have a suicide plan?” “Do you intend to act on these thoughts?” and “Do you have the means to carry out the plan?”
6. How connected do you feel to the people around you?
Loneliness can have serious mental and physical health implications. So your therapist wants to know if you already have a solid support system in place. If not, they can help you work on building one.
“There is lots of research that documents the importance of social support in maintaining psychological well-being,” Delawalla said. “Having a good understanding of your social network will help your therapist know how to best use your social support resources to augment treatment and whether bolstering social support should be part of your treatment goals.”
7. What do you hope to accomplish in therapy?
“It’s helpful to explore this question in more depth during the first session to hear the client’s expectations for therapy and also to help them manage their expectations about how the process of change works through therapy,” Stoddard said.
When setting your therapy goals, be as specific as possible about what these improvements in your life might look like. Instead of just saying you want to be “more self-confident,” think about what some concrete markers of that change would be.
“For example, how would you know if you were more self-confident? What would you be doing differently if you were more self-confident?” Delucca said. “By having more observable and measurable goals, we will be better able to track your progress and know whether therapy is effective.”
Other Ways To Prepare For Your First Session
Now you know the types of questions you’ll likely be asked during your initial appointment. Hopefully, you’ve already filled out the intake paperwork (note that most therapists will make these documents available online to facilitate the process, Delawalla said).
If you want to feel more prepared walking into that first session, here are few other things to keep in mind, according to our experts:
Ask yourself what you’re looking for from a therapist.
Mental health professionals have different styles and approaches to therapy. Think about what you want your sessions to go. Then share this information with the therapist so they know how to best work with you.
“While the therapist is the paid professional, if you are someone who knows you want to come in and have a space for someone to listen to you, it’s important to communicate that to your therapist,” Stoddard said. “Alternatively, if you’re someone who feels like you want to be guided during your sessions and are not sure what to talk about, it’s important to let them know that as well.”
Be ready to talk a lot.
There’s a lot of ground to cover during the initial appointment so you can expect to spend a good chunk of that session talking, rather than listening.
“I ask a lot of open-ended questions during the first few sessions because I want clients to tell me what they feel comfortable telling me,” Delawalla said. “Unless it’s directly related to the issues a client wants to address in therapy, I tend to not ask very invasive questions during the first session because I don’t want clients to feel exposed.”
And remember, if there’s something you want your therapist to know, speak up. “Although we are highly trained, we are not mind readers,” Delawalla added.
But it’s OK if you’re not ready to bare your soul right away.
While you want to be as open and honest as possible during your first appointment, it’s understandable that you may need more time before delving into deeply personal issues or past trauma.
“We are aware that it can sometimes take a while to build a comfortable and trusting relationship with our clients,” Delucca said. “With that being said, don’t hesitate to let your therapist know if you do not feel ready to talk about a certain topic.”
Know that therapy is a place to feel heard ― not judged.
A therapist should never make you feel judged or criticized for what you’re thinking, feeling or going through. This person’s presence should put you at ease, not make you want to clam up.
“It’s important to pay attention to how you feel when you’re in the room with the therapist,” Delawalla said. “Whether you feel comfortable opening up to this person without fear of judgment, and whether you think their therapeutic style matches your personality.”
If you two are not a good fit, that’s OK, too. It may take some time to find a therapist who’s the right match for you.
Make a list of any questions you have for your therapist.
If you want to know more about the therapist’s philosophy, their educational background and credentials, or the length and frequency of the sessions, the first appointment is a great time to get that information, Gibson said.
You may feel worse before you feel better.
Therapy is not a quick fix. The therapeutic process takes time so be patient; many issues cannot be resolved in a session or two.
“Therapy may take the lid off and uncover certain thoughts and feelings that have been bottled up thus far and this may cause certain symptoms to temporarily worsen,” Delawalla said. “Ultimately, you should learn effective coping mechanisms in therapy, which will alleviate these symptoms.”
Are you in a crisis? If you need help, contact Crisis Services Canada at their website or by calling 1-833-456-4566. If you know someone who may be having thoughts of suicide, read this guide from the Centre for Addiction and Mental Health (CAMH) to learn how to talk about suicide with the person you’re worried about.
Taking care of your mental health is critical — but there’s still a stigma about seeking therapy to manage your own wellbeing. In our series, “This Could Help,” we’ll explore how to get started with therapy and fit it in to your life and your budget. We’ll answer the questions you’ve been wondering, and show you the ways therapy can benefit you and the people you love. Whether you’re struggling or just want to make sure you’re on the right track, support is available, and it really can help.