7 tips to help prepare you for your first therapy session
Starting therapy can be a nerve-wracking experience for many of us. Whether this is your first therapist or you had worked with one or more in the past. Starting therapy can bring up a lot of questions and worries. Even after scrolling through each potential therapist, finding someone, and scheduling an appointment, you might be stuck wondering "what are they going to ask me" or, "what if they aren't the "right therapist" or "what if I tell them something they have to report!" The anxiety before a first therapy session might make you wonder why you are beginning therapy in the first place! After all isn't this supposed to make you feel better?
While therapy has helped and will help many people move closer to their mental health goals, it is totally normal to feel nervous before starting this journey. Here are 7 tips to help you feel more confident and prepared to go into your first therapy appointment.
1. Try to set realistic expectations for yourself
This is the easy one to write but the hard one to put into action. Many of us are starting therapy because we have a deep desire for change in how we think, feel, and/or behave. This can put a lot of pressure on us to "do therapy right." If this applies to you, applaud yourself for the commitment but know that this may actually do more harm than good. Therapy is a process and it can often look way different from its initial stages. Once you get to know your therapist and start to better understand your goals, it can look very different. Many people even take years in therapy before talking about some aspects of their lives or their past!
Starting therapy is kinda like starting a new instrument or learning a new language. The beginning of the process can look much different than you expected and you may not immediately start to see the results. Worthwhile change often takes some time! If you are unsure about whether your therapist or therapy is the right fit, consider giving it a few sessions before you make this decision. It is very helpful for you to bring up these concerns in the room itself! Most therapists know therapy can be a challenging, anxiety-producing experience. They can help you work through these emotions or help you figure out if another therapist may be able to help you more. Still, many will tell you that, even though it took time, their relationship with their therapist became an important part of their self-improvement.
After all, therapy is not a shoe! You might have to take some time to figure out if it's a good fit.
2. You can share anything but you don't have to share everything
Your first session will most likely revolve around housekeeping subjects like payment, cancellation policies, and the like as well as general questions about your history and goals. This usually looks VERY different from your sessions in the future. Therapists will often ask about your family, work/school life, drugs/alcohol use, why you sought out therapy, and other parts of your life. While you are fully encouraged to be open and vulnerable, none of what you say needs to be set in stone. Your therapist is trained to be respectful of your own boundaries and wishes and you may wish to get to know them a little better after a few sessions (or more) before talking about certain topics.
Pay attention to your body and emotions. If you feel uncomfortable or anxious speaking about topics, you may feel better getting them out and building trust. However, if you feel overwhelmed or panic come up, feel free to tell your therapist you want to "talk about this more later" and move on to another subject. Many people have asked to take a short break to "reset" before continuing the session! You can also consider sharing just "the headline" of this subject where you describe things in the most matter-of-fact way without any detail. This can let both you and your new therapist know this is something to come back to but not something we need to talk about now. Therapy works best when you feel safe and comfortable so try to go at your own pace rather than what you might think you "should be doing."
But will it be kept private? What is confidential?
This is a big concern for a lot of people! Luckily, privacy and confidentiality are considered to be the basic foundations for most therapists. If you don't feel safe knowing that what you talk about will be kept between the two of you, how could you expect to feel comfortable? Therapists know this and will go to great lengths to keep your information private. In fact, if they do not do so they can be held legally responsible for breaches of your privacy. This extends to illegal actions like selling or consuming certain drugs.
Still, there are some limits to this. These laws differ by state and your therapist (as long as they are a real licensed professional) is mandated to not only follow these laws but describe them to you. "Breaking" confidentiality in the United States mostly falls ensuring people are kept safe from imminent harm. Your therapist will describe what this means for you during your sessions.
3. Think about what you want out of therapy! Write it down!
We all know how this goes. You have prepped for a test or a meeting or an interview. You have it all thought out. Then, when the time comes, Poof, it's gone. Right when you needed it!
This is common for many of us before our first therapy session. We have thought through all the things we want to change and everything we want to achieve in therapy. Then when you're actually meeting in a new room or online with essentially this stranger, you can't remember all these great goals you had for yourself. Take some time before your therapy session to write down some of the key points you want to discuss and focus on. Feel free to return to it during your session to make sure you hit each point. While you certainly don't need to hit every single possibility, you will likely feel like you got more out of your first meeting if you know at least the major areas you want to address.
Returning to therapy?
If you are coming back to therapy or moving to a new therapist, use this! Think about what you enjoyed about your earlier therapy sessions and what you were able to achieve! What did not work as well? Maybe there were things you wanted to focus on that you didn't get the chance. For example, maybe you spoke a lot about your relationship but want to spend more time managing your anxiety. This is a time for a fresh start where the two of you can come up with a clearer idea of what you want your therapy to look like.
But what if I don't exactly know what I want yet?
That's okay too! It's actually part of your therapist's job to help you figure out what your actual goals are. Still, in the days before your first session, you have an opportunity to identify some personal goals that can help guide the whole therapeutic process. Even if you are starting out with "I want to feel better" or "I want to reduce stress" you are already in a great place.
Most therapy engages with thoughts, feelings, and behavior. Think of how you want your life to be. How do you want to think differently about things like yourself, your job, or the people around you? What feelings do you want to experience more from day to day? How do you want to act towards yourself and other people? Often times we get stuck in how we "don't want to feel" or "don't want to do." While it's completely normal to start therapy with a broad goal like 'fix my depression" it is easier to achieve your goals as a client when you have an idea of what you want to work toward!
4. Try to have any money-related questions answered before your therapy session!
It's never a comfortable thing to move from trying to dive into our inner world and improve our mental health to trying to figure out credit card issues and copays with your therapist. Before you step foot in the therapist's office (whether it's real or virtual), try to figure out any questions or billing issues that could come up and sort them out before diving into your first session.
Going through insurance?
You probably get frustrated trying to figure out your insurance or end up arguing with your insurance company and you are not alone! It can be complicated but you can set yourself up for success by getting these questions out of the way quickly. While you can ask your therapist questions, they might not be able to answer all of your questions. Your therapist may not know much more than what they need to do to get reimbursed. If you have questions as to what is covered or if you need to document things, try to send your insurance an email or give them a call. Therapy is not unlike most other major healthcare providers so if you have experience using your insurance you shouldn't expect to run into too much trouble.
Paying on your own?
While this has its own benefits and drawbacks for clients, it is much easier for therapists. This makes your financial relationship solely between you and them and they can answer and figure out many different options with you. If you worry about affording therapy in the long run, make sure to ask them if they offer a "sliding scale." This is where therapists may reduce their price for an appointment depending on need.
5. Prep any questions about your therapist and how they work
Therapy is a wonderful, amazing resource that has helped so many people. You can say a lot of great things about therapy but this does not include "jargon-free." There are a bunch of terms that can be hard to keep track of. You may have heard different acronyms like CBT, DBT, EMDR online, in media, or through friends, so it might not surprise you to hear there are many different types of therapists out there!
If you haven't already, look up some information about your therapist. Perhaps they have a "Psychology Today" webpage or a personal website. Look to see any descriptions of how they practice and what their experience is. Find out if they list any specific kinds of therapy practices they ascribe to like "psychodynamic therapy" or "person-centered therapy." Perhaps they have a specific degree or license. Some, with a Ph.D. or a Psy.D, may be called a licensed clinical psychologist. Others may be licensed marriage and family therapists or social workers. Take some time to look up what these mean and ask what this means for your treatment.
Also, look for any specific training or professional associations they belong to. This can tell you much more about a therapist's training and experience. They may have specific training in areas like trauma, eating disorders, or grief. You may also wish to ask them about their experience with certain areas as well. You may wish to see their experience working with gender identity, a specific mental illness (ADHD, Generalized Anxiety Disorder, etc.), or those with different cultural backgrounds. Having these conversations early can often help you set the stage for what you want your therapy to look like!
6. Give yourself space before and after your therapy sessions
While therapy is great, it can also be emotionally exhausting. By scheduling a therapy session you have already taken a huge step in improving your mental health! Keep this self-care momentum going by also giving yourself some space before and after your first therapy appointment. While not everyone has this option, if you are able to, space out at least an hour before and an hour after your appointment when you have some time that can be flexible.
Therapy is great and people often feel better after they have an appointment but it's not always a relaxing kind of good. Some people call it "therapy fatigue" or a "therapy hangover," where they feel kinda groggy after a heavy period of self-reflection. This is probably more likely at the beginning when you are still getting used to therapy and comfortable talking to your therapist. It might not be the best idea to have something that takes a lot of mental energy after your first session. Give yourself a bit of time to "reset" so you can approach the rest of your day.
You also deserve to have your first therapy session in the spotlight. It might be hard to remember what you want to talk about or feel connected if you are worried about if you're going to be late to your friend's party or if you have to get to the DMV before it closes. Try to take care of these tasks before your first appointment so you can focus on your well-being and not traffic or if that one store is still open.
7. Ask about mental health diagnoses
If you are like me, you have already diagnosed yourself several hundred times. If not, good job! This is a process that takes training and qualifications and probably should be left to a professional who is informed by your life experience. However, many therapists have different opinions and feelings about diagnosis. Some take the process very seriously and will discuss it at length while others may feel like it's less relevant to your needs as a client and your treatment plan. At your first appointment, ask your therapist what they think about this subject, how many sessions they typically take to figure it out, and what they consider when figuring it out.
