A Beginners Guide to Therapy. Part 3: What to expect in the first few sessions

Jeff Guenther, MS, LPC on Sep 24, 2018

Part 1: How to find a therapist
Part 2: What to ask in the consult
Part 3: What to expect in the first few sessions
Part 4: How can you tell if therapy is working
Part 5: How to end therapy

Alright, let’s say you found a handful of therapists that could be a good match for you. You’ve had consultations with them. And now you’ve chosen a therapist. It’s time for your first official therapy session. Congratulations! You are entering what could be a life-changing relationship with your therapist. Very exciting. However, excitement isn’t the feeling you’re probably experiencing. It’s totally normal to be feeling anxious. Maybe even very anxious. You’re about to start spilling your guts to a stranger that you barely know and probably randomly found on the internet. That’s kind of a scary thing to do. You may even be thinking about not going in after all. I get it. I’m a therapist myself, but I’ve been to my fair share of therapists in the past. And even though I’m not a newbie to the counseling process, I still get anxious before the first meeting and kind of want to bail. I hope you don’t decide to do that. You should know that every therapist understands the nerves your feeling and they’ll try their best to soothe you and make you feel comfortable. And if all you want to talk about during that first session is how nervous you are or how much you don’t want to be there, then that’s totally fine. 

On the other end of the spectrum, you may be super excited about having your first session. Maybe you feel like you’ve been waiting for something like this forever. Hurray! I’m really happy you’re totally into it. 

Whether you’re full of nerves or can’t wait to start blabbing away on that couch, your new therapist will be ready for you and perfectly able to meet you where you’re at. 

It’s really hard to write this article

Every therapy session and every client and every therapist is different. So there is no formulaic way that early counseling sessions unfold. It depends on so many different things. Are you going for individual therapy or relationship counseling? What about family therapy or child therapy? Do you want to be there or are you being forced to be there? Is your problem about your fear of flying or because you can’t seem to maintain friendships? What kind of therapist do you have? Is your therapist strictly psychoanalytic, where you lay on a couch and they sit behind you and barely say a word? Or is your therapist sitting right across from you and asking a ton of questions? I could go on about all the possible variations. Suffice it to say, I would have to write separate articles for all the different types of situations that are possible. For now, this article is going to focus on one of the more popular circumstances for therapy. Which is individual therapy. Individual therapy is where an adult, most commonly, makes an appointment with a therapist to address a specific issue. And we are going to suppose that they willingly want to be there. Even if your situation is different, I urge you to keep reading because many of the things I mention in this article will still apply.

Everything you say is kept confidential. Well…almost everything. 

The one thing that will be the same no matter what therapist you visit is that your counselor will go over confidentiality with you. You’ll need to sign a form that outlines what is kept secret and never leaves the office and when a therapist must make a report to the authorities. Be sure to ask as many questions about confidentiality as you want. It’s very important that you understand the laws around when a therapist must break confidentially. The intent around the conversation about confidentially is to make sure you feel safe knowing that you can talk about anything that’s on your mind, while also letting you know that there are specific times, especially when it comes to you or someone else being in physical danger, that it is the therapist’s duty and legal responsibility to communicate with law enforcement to keep everyone safe.

What exactly are you experiencing?

Therapists don’t judge. They conceptualize. Whether you’re cheating on your partner, failing out of school or getting into fights with your mom, we won’t criticize you or make you feel bad about it. We just want to understand your emotional experience. It’s important, especially in the first few sessions, that the therapist really try to understand what you’re going through.

For example, if you’re married and having an affair with a co-worker, it’s important to know how you’re feeling about it. Do you feel guilty, happy, truly alive, embarrassed, scared or all of the above? Do you feel justified in your actions and want to continue the secret relationship guilt free? Or do you feel completely horrible and want to end the relationship as soon as possible? Do you want to tell your partner or would you rather keep it from them? No matter the answer, a therapist will not judge your behavior or emotional experience. But if a therapist doesn’t know exactly how you feel about it, then it can be difficult to treat the issue. 

Many times a client doesn’t really know how they feel about a situation. Especially with a topic as complicated as infidelity. There could be a ton of opposite and conflicting emotions happening at the same time and it takes a bit of work to sort it all out. The first sessions concentrate on digging in and really figuring out all the emotions that are on the surface and buried underneath. The therapist is like an archaeologist digging around and looking at all the findings with a compassionate, unbiased and scientific perspective.

Question time

In order for the therapist to really get an idea of what’s going on and how you’re feeling, they may ask some common questions. These could include:

  • How long have you been experiencing the problem or issue?
  • What have you tried to cope with it?
  • What do you think the cause of it could be?
  • How often are you suffering from it?
  • What was your life like before this issue or problem was present?

There are many other questions that a therapist will ask once you start talking about your presenting problem. They’ll start out pretty general and get more detailed as the sessions move forward. You’ll be asked to really think about what’s going on and how you’re experiencing it. Some of it will feel really personal. A therapist needs to try and get to the bottom of certain issues in order to figure out how they can help. If you ever feel like you don’t want to answer a question quite yet, speak up and say so. 

Often, a therapist will ask you what your goal is for therapy. It’s helpful to figure that out upfront. However it’s also okay if you don’t have a specific goal. There won’t be any pressure to try and define it early on. 

Gathering history 

While the presenting issue that is bringing you in is often the focus for the first few sessions, there are times when it is set aside so the therapist can collect your full history. What this means is that a therapist will ask you a bunch of questions about your past, which could include your family, relationships, education, social life and employment history. This assessment could also focus on your past and current behaviors, thoughts and feelings. A therapist really wants to understand your personality and how your past has shaped you as a person. They want to know what messages and narratives you picked up along the way as you grew into who you are today. This will provide the therapist with important context regarding the issue you’d like to address in counseling. It will also provide the therapist with clues as to where the issue is rooted and how it formed. 

Keep in mind that a therapist isn’t trying to blame your past for your current issues. For example, a therapist would never try to convince you to resent your parents for creating a current problem in your life. While your parents and how you were raised can be a topic of discussion, and may have contributed to your current issues, a counselor will engage in curiosity with you only to explore possibilities of how your issue first developed. A therapist isn’t looking to judge your parents or make you turn against them.

Process work

You may want to enter into therapy just to process things that come up during the week. You may not have a specific issue in mind when you enter into therapy. You might just want an ally in your life who cares about you and compassionately challenges you to grow. In these cases there may not be a predictive script as to how the first few sessions start out. Many times these sessions are natural and organic and non-directive in nature. 

You can guide it

The first few sessions are super important and create a foundation for the therapeutic relationship. The therapist is trying to make sure that the client starts feeling comfortable and safe talking to the therapist as quickly as possible. Because of this, the therapist is trying their best to read your verbal and non-verbal signals. As the client, if you want to start sessions with something specific, then you should be encouraged to speak up. If you don’t want to talk about something because it feels too awkward or vulnerable, then you can change the subject and ask to table things. You, the client, can be the guide. Feel free to speak up about how you’d like sessions to go. It’s also 100% fine to ask the therapist to guide the sessions. If you don’t know what to talk about or where to start, then the therapist is perfectly capable and fully trained to take the lead. 

Want some advice? Too bad. 

It’s a common misconception that you can go to a therapist for professional advice. Therapists, however, are not advice givers. We are specifically trained not to give advice. Sorry for the let down. But I promise you’ll understand. Therapists want to help you figure out what you truly want to do about a situation and then encourage and empower you to do it. We would be of no real help if we just gave you advice and told you exactly what you should do. Plus, if we did give you advice and then our advice turned out to be horribly wrong, we would be on the hook for it. 

Sometimes it gets worse before it gets better

During the first few sessions, as you’re digging into emotions that you may not even know you have, you might feel worse than before. You should know this is a completely normal experience. A therapist will often help you identify and bump up against strong emotions with a goal of teaching you how not to get hijacked by them. A therapist will try to make sure you’re not completely overwhelmed by your feelings. You should know, however, that feeling difficult emotions is a good sign that you’re accessing important information. As you continue to talk to your therapist, you’ll eventually start feeling relief. And you’ll be happy to know that, with time and work, those difficult feelings might not pop up as often or manifest themselves in other unhealthy ways.

After a few sessions

After a few sessions, you’ll have a much better idea of what to expect from a session and if the therapist is a good match for you. And hopefully you’ll be settling into a trusting relationship that will help you grow and find more peace. Now the question is, how can you tell if therapy is really working?

Jeff Guenther is a Licensed Professional Counselor in Portland, OR.
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