What to Expect in a First Therapy Appointment

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When you see a therapist, it’s good to go in with goals in mind. Those goals can be big or small, broad or narrow. Some of my goals in the past have been “reduce depression”, “cope with anxiety”, “build a healthier relationship with food and lose weight”, “learn assertiveness skills”, “set firm boundaries with parents”, and “minimize psychotic episodes”. At your first therapy appointment, be ready to set one or more goals. Your therapist may ask you directly what your goals are, or they might let you direct the session. Either way, let them know what your goals for therapy are.

It’s important to see a therapist with whom you are comfortable, but most people are not comfortable with their therapist for the first handful of appointments with them. It’s perfectly normal to be nervous and uncomfortable in therapy at first. The hope is that you will gradually learn that you can trust your therapist. If you have a deep dislike or disrespect for your therapist right away, leave. But if you’re just nervous, awkward, or uncomfortable, then try giving them 4 sessions before you decide whether you need to find someone else. Therapy is awkward at first, especially if you grew up in an environment where it wasn’t okay to openly and honestly express emotions. If you grew up in an emotionally accepting family, therapy will be easier to dive in to. If you didn’t, then it might be a little hard to open up, but there is nothing you could say or express to a therapist that would be inappropriate or out-of-bounds. This is the one person who legally must keep your secrets and is not there to get anything out of your relationship other than employment. They are only there to help you, and they have chosen that as their life’s work.

You can say as much or as little as you want in a therapy session. I encourage you to talk about the things that are bothering you, whether it’s something that happened this morning or something that happened when you were five. Don’t worry about getting it all out at once. This is a journey that you take one session at a time. You can choose to tell your whole life story in the first session, or you can tackle small bits of your life over the course of a year or more. It’s up to you to prioritize your problems in whatever order you think you need to address them. This is your therapy. It’s literally all about you, and that’s a really great thing. It means you’re trying to take care of yourself, your mental health, your relationships, and your life. Going to therapy is a very adult and responsible thing to take on. You’re learning to be accountable for your life.

It’s normal to be apprehensive about your first session. It’s okay if you don’t know what to say. It’s okay if you get nervous and stutter or tremble. Hell, it’s even okay if you have a full-blown panic attack, because guess what? A therapist is absolutely the best person to have a panic attack with. They will know how to help you calm down and make you feel safe again. And this is the very worst case scenario for a first session. So the worst case scenario involves being in literally the best place possible for that circumstance. By the way, the idea of skipping to the worst case scenario of something and then figuring out how to make it okay is an idea called “coping ahead”, and is helpful to people who worry and catastrophize. The premise is that if you figure out what you would do to cope in the worst possible circumstance of a situation, you figure out what actions you would need to take to cope with it, and you reassure yourself that with those coping tactics you would make it through the situation just fine. It’s a skill I learned in therapy.

What is much more likely for your first session is that you’ll feel awkward for the first five minutes, and then you’ll start talking and get on a roll. You might even lose track of time because you just have so much to say. It can be surprising what comes out of our mouths when we feel like we’re allowed to have feelings and thoughts without being judged. I’m sure you have a lot to say. Say all of it. Therapy is the place where you learn to accept yourself and your hard thoughts and feelings.

Therapy can help anyone. Not every therapist is great, so again, I’ll remind you that if you deeply dislike or distrust your therapist, find a different one instead of giving up. Most therapists are really wonderful people. It kind of comes with the territory. I did once have a psychologist who seemed mean, and I didn’t go back after the first session. I also had a therapist that I trusted, but I didn’t feel like our sessions were that productive, so I asked her to recommend another therapist in her clinic who might be better suited to my needs. Her feelings were not hurt, because she was not my friend, she was my therapist, and she was a professional. That’s how I found the therapist I’ve had for the past 4 years. I plan on continuing therapy for years to come, because it has given me so many things that have improved my life.

You’re taking a wonderful step in your life by starting therapy. I hope you benefit from it as much as I have. Therapy has drastically improved my abilities to cope with the challenges in life, and it’s a cornerstone of my mental health treatment. Good luck!


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Thoughts? I will listen.