What to expect in your first counseling session

By Anjana Shakeela Natarajan (she/her), Psychologist

Contemplating taking up psychotherapy itself can sometimes be exhausting or frightening, but at the same time empowering and hope-instilling. 

While it is difficult for most people to decide to take up professional help, this fear mostly stems from the fear of uncertainty: What to expect in the journey of therapy, particularly if it’s your first time going for counseling or psychotherapy. 

Here is something that you can have in your back pocket which will give you a blueprint of what to expect before you see a mental health professional for your first session. 

What usually happens in your first therapy session

Your first therapy session will usually cover these areas, feel free to ask questions about them if they don’t.

Comfort

Your comfort is important. Feel free to discuss what feels comfortable for you while you are in therapy. This includes how you want to physically be present in therapy. Are you more comfortable lying down, sitting up, or walking around? You may potentially discuss if lighting a cigarette or using rough language to put forth your thoughts and feelings is part of your comfort. 

It is also important that you respect your therapist’s boundaries in case they mention finding an alternative to something you’d want to do with yourself while you share the space with them.

Confidentiality clause

This is one of the initial things that will be clarified to you by your therapist in your first session. Anything and everything you discuss in therapy will be kept strictly confidential between your therapist and you. 

The circumstances under which this would need to be broken could be in case of you being an active and/or potential threat to yourself or others. Another circumstance under which the confidentiality clause would need to be broken is in case of any legal requirement. 

That being said, none of this can happen without your knowledge or behind your back. In case of a need to break the confidentiality clause, you must be informed by your therapist.

Your motivations for therapy

This is where you could discuss the reason that brought you to therapy. Therapists might frame these questions in different ways such as:

The intentions of all the above questions are the same.

  • Expectations from therapy and therapist

When you’re asked by your therapist about your expectations from therapy and your therapist, it is so they understand what it is that you’re looking for and what are some things that will or will not work for you.

Goal setting

Setting short-term, as well as long-term goals in therapy, is something that helps with the flow of therapy as well as facilitates functional and consistent growth in psychotherapy.  

  • Homework

Yes, you might get homework! The importance, frequency, scheduling, etc. of homework in therapy depends on the style of your therapist. It also depends on your discussion with your therapist about your needs. 

Remember, homework is one of the most important stepping stones to long-term and concrete progress in therapy.

  • Feedback

Feedback from you on what you found helpful in the session and anything that didn’t quite work for you is vital. This helps your therapist gain insight into what would be the most effective way to work along with you in therapy. 

How to prepare for your first therapy session

One of the biggest questions that might arise when we consider therapy could be “what should I be ready with before I go in for my first session with my therapist?” 

Here are some tips and notes to help you prepare for your first therapy session.

Healing takes time, but you will get there eventually. 

Like every other meaningful nourishment, our minds too need time. It takes care, patience, and conscious effort to move along the healing journey.  

Ensure you are comfortable with the process

If something doesn’t sit right with you, listen to your instincts. You could try to work it out with your therapist in your first session or the subsequent ones by talking about it. Your therapist will welcome this discussion.

If it still doesn’t help, ask for contacts/references for other professionals who could better suit you. 

Initial difficulty in relating to your therapist

Some individuals do find it difficult to get comfortable in the first therapy session(s). You are opening up to a previously unknown person and this is only natural to feel. 

It is important to keep in mind that at the heart of psychotherapy is a relationship, and relationships take work. It just becomes vital that one asks certain questions during and after their session/s like:

As above, please talk through any issues raised by these questions with your counselor.

 Mutual relationship and teamwork

It is a widely observed misconception that a therapist acts like an all-seeing God who’ll have all the answers, quick fixes, and solutions. This is not the case.

It has to be understood that in your therapy sessions, you, along with your therapist, would be navigating through your concerns as a team. Any roadblocks in therapy either from your end, or the therapist’s, will be addressed in sessions and worked on by both of you collectively.

Frustration in therapy

Gazing within through the looking glass can be a pretty intense endeavor. Sometimes it is only human to resent the person who enables the same, especially when what you’re looking at is not pleasant. 

It is possible that you will hit a place where you’re frustrated or irritated with some revelations that happen in therapy. While it might sound a bit ironic, interestingly, this is one of the most vital steps toward growth in therapy. 

Pre and Post-therapy cushion time

It can understandably get intense when you’re in the process of unloading your emotional baggage. There are things that you might or might not have processed before you decided to take up therapy. This essentially has the potential to trigger a fight-flight-fawn-freeze response, which can release stress hormones in your body. 

Even after a very intense session, you must give yourself some time to sit with it and process everything. In both the aforementioned cases, you must keep a pocket of time aside both before and after your therapy sessions. 

Breaking down in therapy is okay

It might vary from individual to individual as to when one reaches a point in therapy where they are vulnerable while venting out. It could be the moment they sit down in therapy or after numerous sessions. 

Just understand that if or when you reach that point in therapy, it is absolutely okay to be upset. You are safe

Understanding rights, responsibilities, and ethics in therapy

There are rights and codes to protect and support your counseling journey. Understanding these can help you navigate this path successfully.

Your rights and responsibilities as a client

As a client, you have the RIGHT to:

  • Have a complete understanding of the qualifications and capabilities of your therapist. This includes details about their education, training, professional experience, specializations, strengths, and limitations.
  • Receive a consent form before the commencement of your first therapy session. This must not only include most of the aforementioned information and details, but also information about the fee structure, method of payment, and details about cancellation of therapy sessions (both, from your end or your therapist’s). 
  • Be treated with respect and dignity. 
  • Receive treatment that is helpful to you.
  • Ask any questions you might have about your treatment process.
  • Refuse to disclose any information that you’re not yet comfortable discussing.
  • Complete right to participate in the development of one’s treatment plan. 
  • Expect transparency in terms of your therapy; also reciprocate with transparency, as it is the cornerstone of a successful therapeutic relationship. 
  • Have prior knowledge of any procedure/treatment plan, that your therapist has for you. 
  • Object to or terminate your treatment. 
  • Criticize any concerns or grievances on your therapist’s part. 
  • Ask to see another mental health professional if your current therapist isn’t working for you. 

As a client, you have the following RESPONSIBILITIES:

  • Be as transparent as possible with your therapist for an effective course of treatment.
  • Have realistic expectations of your therapist and the therapeutic process.
  • Be punctual for the sessions, in case of cancellation, follow the protocol put in place by your therapist.
  • Flag up any type of fraud or wrongdoing on your therapist’s part. 
  • Try to adhere as best as possible to the treatment plan put in place, including any homework given to you. 

 Therapists’ ethical code 

  • A therapist must not breach the confidentiality clause under any circumstances except for the ones already mentioned to you in your informed consent form.
  • A therapist cannot under any circumstance suggest to you any sort of personal relationship outside the client-therapist relationship, including but not limited to sexual advances or romantic relationships. In case this happens, you must report this therapist so they don’t get any more referrals of clients.
  • Even in exceptional cases where disclosure of the information is necessary, it has to be discussed with the client first. Under no circumstances shall a mental health practitioner go behind their client’s back.
  • The therapy notes of any and all sessions shall be stored in an extremely confidential manner. 
  • A counselor shall be very clear about their fee structure before the commencement of sessions.
  • A psychotherapist shall stay unbiased, be non-discriminatory, care genuinely, and provide the best treatment to you as per their qualifications, and your requirements. 
  • Therapists must take any criticisms, grievances, and feedback from their clients seriously and work towards them to the best of their capabilities. 

The decision to take up therapy for the first time can pose a challenging one. At least getting clarity about what to anticipate when contemplating taking this step has the potential to decrease the uneasiness that comes with uncertainty. 

Hope this helped you gain at least a bit of clarity in your decision-making process.  

Happy healing! 

Bibliography

Your Patient Rights in Therapy, 2009. Your Patient Rights in Therapy. Available at: https://psychcentral.com/blog/your-patient-rights-in-therapy#1 

Patient Charter, 2021. https://www.nabh.co/Images/pdf/Patient_Charter-DMAI_NABH.pdf  [Blog] 

 Patient Bill of Rights, 2021. Available at: https://clinicalcenter.nih.gov/participate/patientinfo/legal/bill_of_rights.html

Client Rights & Responsibilities, 2021. Client Rights & Responsibilities. Available at: https://carleton.ca/health/about/client-rights-responsibilities/

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