Making it to a first therapy session takes guts.
Really, it is an odd thing to sit in a waiting room wondering about this person, this random therapist you found on the internet or heard about from a friend, with whom you are about to share the intimate details of your life. If you’re like most people, these are thoughts and feelings which few people, if anyone, in the world knows about.
I hope this post can alleviate some of that waiting room anxiety.
So what does happen in a first session?
For me, a first session actually starts before the first session. I encourage my clients to complete a comprehensive welcome packet. In addition to telling my clients about myself, I have them fill out a pretty long questionnaire about their concerns, past experiences with therapy, recollections of themselves as a child etc. Why? Simple. Because this way I don’t have to spend precious minutes during the first session asking all these questions. Instead, by the time a client walks in my door, I at least know a little bit about them and why they are coming to see me.
The first thing I, and every therapist, talk about during a first session are the legal and practical details of therapy. I explain what confidentiality is and its limits. I make sure that I have explained my fee structure and cancelation policy.
And then it’s time to roll up our sleeves and get to work.
Often, the next thing I like to do is to create a laundry list— that is a list of all the things that, if they all were fixed, would tell us all that it was time to end therapy. With couples and with parent/child combos, I’ll be the note taker while the two talk together about what goes on the list. This gives me a chance to see where their skills are at the same time as we’re making the list.
As we have a pretty comprehensive list, I generally shift to talking some about what it will take to get from here to there. I might ask how long a client thinks it would take them to resolve everything on the list if they had great help doing so. Or, we might explore how if magically everything on the list was fixed when they woke up the next morning, how would my client know that everything had been fixed.
Sometimes with couples or parents and children at this point I also like to give each person a few minutes alone with me to check-in if their are any pieces they would like to add to the list which they weren’t comfortable talking about with their spouse/parent/teen in the room.
While many therapists like to use the first session for a lengthy history taking, I prefer to jump in and geting working. I already have the critical historical pieces on the paperwork. I’ve found that details relevant to therapy will come out on their own. And those that aren’t relevant– well, why would someone pay to tell me about something that isn’t going to help solve their problems or leave them feeling better.
“So, which item on the list do you want to start with?” I’ll usually ask. At this point, I may also have a something to put on the “agenda” for the session. Perhaps it’s teaching a skill where I noticed a glitch, or perhaps it’s infusing some optimism into what looks like an impossible situation. With an agenda laid out that incorporates what everyone wants to use the session for, it’s time to get to work.
By jumping in like this by the end of the first session not only have we created a clear road-map for treatment — fix everything on the list — we’ve also actually started helping things. Ideally, I’ve learned a lot about my clients and they are going home hopeful, not on blind faith, but because we’ve actually succeeded in moving forward on something from their list. Hopefully, as well, clients leaving from a first session are as clear as I am about what we’re going to do together, about how long it’s likely to take, and how this whole process is going to help them.
Dr. Abigail Hirsch 