What happens in the first therapy session?
You’ve picked a therapist you want to see, and you’ve booked your first appointment.
What to expect now?
I’m a counselling psychologist, and I offer in-person appointments in Edinburgh and online appointments for people across the UK. Therapists work differently, so I can’t speak for everyone, but I’ve tried to highlight main points I’ve used in first appointments.
This can change between clients as everyone’s unique.
Photo by SHVETS production: https://www.pexels.com/photo/crop-psychologist-taking-notes-during-appointment-7176026/
Before the first appointment
I send information out before the appointment, including the therapy agreement for you to review including information on confidentiality and paying for your session. We usually discuss the the agreement further in the first appointment, but this gives you a look beforehand. If you’re coming in-person, I send along a guide about accessing the venue.
What should I prepare?
Make some notes of things you really want to talk about, particularly what you’re looking to speak about in therapy. You might not be able to address all the things that day, but it could be noted for future discussion.
If there are documents you think are important for the therapist to be aware of then bring these to show them. This may be GP letters with medications or summaries of previous therapy. If you’re using insurance, you’ll likely have given details to the therapist already but if there is any other paperwork relevant to your insurance then bring this too.
If you’re seeing me for therapy as a trainee counselling psychologist where therapy is a mandatory requirement for the course, then I will need to be aware of any documentation to be signed or completed for fulfilment of this course requirement.
Getting ready to start
In-person: If you’re in a waiting area, please respect others privacy and confidentiality who may be using the space, use headphones if you’re listening to something, and take calls outside if you must. You might wish to use the time to orient to the surroundings or have some quiet time before the session. I usually ask people to arrive close to their start time to minimise contact with other people who may be using the space.
Online: For online appointments, I will have sent a link to our video call. Ensure you’re in a private comfortable space, where you will be undisturbed. Check the device you’re using is plugged in or has enough power and is resting or propped up on something. Ensure there is light so you can be seen. You may wish to use earphones for privacy. I would suggest having a few minutes to yourself before the appointment starts and getting things prepared as rushing to join might increase stress or nervousness.
What questions will I be asked (and why)?
The first appointment is when therapists start to gather information on what someone is seeking support with. I don’t expect people to tell me absolutely everything. I say to clients that there’s no need to go into detail about things they may feel uncomfortable about, such as traumatic experiences. They may use a ‘headline’ or name for this but that’s all such as ‘the accident’. If there are questions you don’t feel comfortable answering, it’s ok for you to say to the therapist that you’re not wishing to discuss it right now and revisit later in the therapy process.
“What brings you to therapy?”
This may have been covered in a consultation call, but I ask this to find out what you’re looking for help with and your focus for therapy such as what you hope to be different, like ‘I want to stop overthinking’ or ‘improving how I deal with anxiety’.
“Why are you seeking therapy now?”
I’m looking to find out why ‘now’? Have you experienced a recent situation that’s bringing you to therapy, or has something happened that’s identified longer term problems. It may be that now you have the time to engage with therapy. Or sometimes life transitions and coping with these are why someone seeks therapy.
“Tell me about a typical day for you?”
I use this to explore what day-to-day life is like for you, if there is a routine or structure, personal care, eating or nutrition and sleep patterns. It may be that the presenting problems have led to changes in these activities and I can use this for monitoring any changes during therapy. This can also lead onto the next questions.
Questions relating to previous therapy, your support network and coping resources
I’m looking to find out what has helped or been unhelpful before, such as therapy, or other types of support like groups or online courses. I’m also looking to see what resources you’re bringing with you such as interests, hobbies, or self-care activities that help your wellbeing. Knowing coping strategies can help me to see areas to build on or introduce other additional strategies including ways of thinking about things. It’s helpful for me to know if there are people around you that can be supportive during therapy such as friends, family or peer support communities.
Questions relating to risk
Therapists need to manage risk, and this includes knowing about past or current use of substances, alcohol and if there has been a history of self-harm or suicide attempts. It helps me determine appropriate support, look at safety plans if needed, and identify patterns leading to crises if this arises in future.
Is it normal to feel nervous?
Many people can feel nervous about their first therapy appointment, especially if they’ve had no therapy experience at all, or because they’re meeting someone new. I understand people can feel nervous and experience uncertainty about what to expect.
What if I cry or get upset?
It’s ok if you get upset as this is potentially the first time you’ve been able to talk about upsetting or distressing things, or connected to how you feel. It can be expected that people may get tearful or upset and the therapy space is a place where these emotional responses can be communicated and worked through. (It’s also ok if you don’t cry or get upset, this isn’t a necessity!)
Can I ask questions too?
Yes! Therapists do need to maintain professional boundaries, but if you have questions relating to your therapy and want to know how the therapist might approach this, then you can ask. This might include the therapeutic approach of your therapist, their experience treating certain problems, or their work experience.
Do I have to arrange another appointment?
I tend to view the first session as a mutual assessment - I’m carrying out an assessment, but it’s also a chance for you to see if you want to keep working with me. If it’s apparent you may be best placed with another therapist, such as something outside of my competence or expertise, then I will discuss this with you. We can agree on what we look at in the next session if this is helpful. You can book your next appointment with me at the end of the session, or think about returning and contact me.
There’s no definitive way to determine if a therapist is the right fit for you and it’s not always the case you know straight after one meeting. Some points to think about include if you felt comfortable speaking with them, felt listened to, and were able to provide feedback. Other things to look at include if the therapist was attentive to you, if they have experience with the focus for therapy, or a therapeutic approach you’re looking for, such as CBT.
After the first appointment
Once the appointment has ended and you leave the therapy space, you might wish to take a short walk before getting on with your day. You may have arranged some plans such as meeting a friend. If you’re meeting online, take a few minutes to yourself once you leave the online call, like a short relaxation activity, and try not to rush straight into emails or anything else. Doing these help transition from the therapy space back to daily life.