What to Expect in Your First Therapy Session
You’ve probably already seen this meme of the woman who makes a PowerPoint presentation of her trauma for a new therapist. It’s funny because it points to something true:
starting with a new therapist is a daunting process.
Even after you’ve done a phone consultation, this is still a stranger. Not knowing what to expect can add to the pile of anxiety and overwhelm you’re already dealing with.
Starting any relationship requires vulnerability and risk. Therapy above all is a relationship: the same rules apply here. Feeling nervous at starting is normal. I want to give you an idea of what to expect to help ease some of anxiety of the unknown.
Where Should We Begin?
Unlike the meme, you do not need to download your entire history to a new therapist. The relevant parts of your past will unfold naturally as they relate to the present: knowing your family tree before I really know you doesn’t speed things along. I’m a fan of context, always.
So, start with where you are. This is true for the first session as well as the fiftieth. Name that you’re nervous. Acknowledge that you aren’t sure this will work or that you feel overwhelmed at starting something new. If that feels too personal or difficult, then you might start with how you’ve been feeling. Why are you seeking therapy right now?
My first session begins with reviewing paperwork and logistics to ease in. Then, I usually name a theme from the phone consultation:
You mentioned going back to school while working and that you check in on your mom a lot. That sounds like a lot to manage!
Then I turn it over to you and try to really understand what has been happening for you:
How has this been showing up in the last few weeks?
How have things been evolving since we talked last?
What’s today been like?
Your therapist wants to understand you, your life, and what you’re struggling with. That doesn’t begin with childhood experiences, but with what you’re experiencing right now.
How Can I Help?
Another goal of the first session is identifying what you want out of therapy.
Sometimes the problems are clear:
My anxiety is getting so bad that it’s harder to leave the house.
I analyze, over think, and ask for reassurance and it never stops.
In these cases, the goals are also clear:
I want to feel safer in my own skin.
I want to live my life without second guessing everything.
If you don’t know what your goals are yet, that’s okay too! You came to therapy because something isn’t working or you’re searching for something different. This might sound like:
I feel empty, exhausted, and lonely even though I do my work and see friends.
Everything is hard all the time and there must be more to life than this, right?
Then the work begins to understand what you want from therapy – and from life. I might ask:
What would it look like if things were working?
If you felt at peace or at ease or fully alive, what would change?
Often, people come to me when they’ve been white knuckling it for so long that they are burnt out and at their wits end. We start by untangling the short-term goals from the long-term. You need some mental space first. Once you are out of survival mode, we then address the context and history that led to the burnout in the first place. That’s when the deeper work begins.
The first few sessions are like I’m meeting you after you have been thrown overboard and are treading water. The immediate priority is to get you out of the water. You need to be able to breathe again. After that, we need to talk about how you found yourself in the middle of the ocean in the first place.
It's So Good to Meet You
Above all else, the first session is about building a relationship. A relationship that will:
contain you on your worst week,
help you finally look at that relationship you really don’t want to look at, or
be the safe space when you find out you’re autistic or have trauma.
So yes, your therapist wants to know what you’re struggling with and to understand your goals and dreams, but ultimately, your new therapist wants to get to know you.
New relationships all start somewhere. Work relationships begin with an interview. Friends and partners begin with a date. Therapy relationships begin with a first session. It is an opportunity to be the person you really want to be. Maybe you want to be:
really honest even when it’s hard,
speak vulnerably instead of using humor to deflect, or
allow moments of silence rather than rushing to over-explain.
You will likely never know your therapist’s story and life, but you will, over time, have a deep relationship and know how they show up with you. That starts with the first session. Show up as you are and – as clichéd as it is – trust the process.
You’re Ready for This
It’s often intimidating meeting someone new and sharing yourself. However, the first therapy session doesn’t have to be completely overwhelming. If you hear nothing else, hear this: be present in your therapy session. Be present with the nervousness. Be present with the newness and unknown. From that place, share how you have been struggling and begin to name what you really want.
You are likely coming to therapy feeling out of your depths and struggling for air. Allow your new therapist to give you a life raft. You can share the PowerPoint presentation later, when you’re wrapped in a towel, talking about how you landed in the water.
