Starting therapy: What happens in the first session?

Thinking about therapy can be overwhelming

You’ve been thinking about starting therapy for months, maybe years. 

You had a look at some therapists on various directories and felt overwhelmed by all the jargon. You spoke to some friends or family, or maybe a therapist you knew personally, who all had an opinion about what type of therapy to go for, where might be a good place to look, what helped them in the past. It all felt a bit overwhelming. 

You left it dormant for a few weeks, a few months.

And then you started thinking about booking that first session again. There was a lull in work or a quiet weekend where you had a proper search and landed on a couple of people who looked like a good fit. In a moment of energy you sent the first email, arranged an initial consultation and now have that first appointment booked in.

You’ve booked the first session - now what?

As a psychologist working in private practice, I look forward to starting with a new client. It is part of my bread and butter to book in that 15-minute consultation, schedule an initial assessment session, send over the onboarding email with directions on how to find my room. The moment between the buzzer ringing and the client climbing the steps to my room, for me, is filled with anticipation, curiosity and enthusiasm to meet someone with whom I’ll hopefully build a new working relationship with. Something that will help them get to where they want to be. Something that they will find useful.

Pressure to “get it right” 

I must remind myself that for the person walking up those stairs, the experience is likely to be very different. This is not a typical day for them, and this might not be something they have done before. New clients often bring with them a pressure to get it right, to say the right thing, to come across in a certain way.  To hit the important notes. To make that first session count. Sometimes, often, it can all be too much, and as soon as the housekeeping is out of the way the long built-up tears arrive.

To me, it is a privilege to be able to provide the space for those long held stories, questions and uncertainties. I have learnt that the first session must provide reassurance as well as the opportunity to slow down. I often find myself saying “take a breath… we have time”.

Breath is taken, tears are blotted, water is sipped. And we begin again…. “Tell me a bit about what’s brought you here today”.

How to prepare for your first therapy session

As an eternally early person, my initial thought is to get there on time, with some time to spare. There might not be a waiting room, but arrive and find out where the buzzer, knocker, door, is and then go and get a coffee or find a bench on which to sit still for a moment. Look at the sky, people watch, notice the street art on the walls, perhaps put your phone in your pocket. Notice those low-level nerves and give yourself a moment to decompress before you go and ring the doorbell.

It’s ok not to know what you want from therapy

Have a think about what you hope to get from therapy. It might not be a fully formed goal or intention, but an idea or a sense of how you’d like to use the time. You might not know how you want to use the time, and that could be what you start with – “I’m not sure how I want to use therapy, and I’m hoping we can work this out together”.

Look after yourself

Plan to look after yourself once that first session is done. Clear your diary straight after the appointment, go and get yourself a nice lunch, go for a walk in the park. Expect to feel some feelings, this is therapy after all.

And finally, perhaps notice if there is a feeling of pride or accomplishment for getting this far. It takes courage to make that first step.