Your First Therapy Session

This article provides an informative overview of psychotherapy, which can be helpful to understand before your first session. The following sections cover how to prepare for your session, what types of therapy exist, the structure of therapy, and other key areas.

Key Takeaways:

• Your first therapy session is a great opportunity to share your goals and concerns, which helps develop the best treatment plan or outline. Taking the time to prepare results in the best possible session.

• Therapy is highly individualized to each person, whether it’s for specific mental health diagnoses, improved relationships, stress management, or simply understanding yourself better.

• Therapy sessions are a collaborative effort between therapist and patient. You generally get to set the pace and determine what is discussed and worked on.

Preparing for Your First Therapy Session

The first step in preparing for your first therapy session is choosing a psychologist or other therapist. There are many resources you can use to help find a therapist that aligns with your needs and goals. For example, you can: ^[1]

• Ask your doctor for a referral

• Ask trusted family or friends

• Search online websites

• Contact your local community health center

• Use a trusted online directory, such as from Psychology Today, ADAA, or APA

Once you’ve narrowed your list down, it can be helpful to talk with them over the phone and ask any questions you may have, such as about their experience, training, and specializations.

After you’ve selected a therapist and have scheduled an appointment, there are several things you can do to prepare for your first therapy session, such as: ^[1]

• Think about and write down your specific concerns and goals for therapy

• Make sure you have your ID, insurance info, medication, and any other necessary information, such as prior mental health records

• Check with your insurance plan to see what’s all covered

• Bring in any necessary form of payment

• Complete any necessary paperwork or documentation (if given beforehand)

• Make sure you know the location, and keep in mind the required travel time (if you’re doing in-person sessions)

• If doing virtual, make sure you have a good internet connection and functioning, fully charged device

• Write down any questions you may have for the therapist/psychologist

• Learn more about psychotherapy and what to expect

What Kind of Therapist Might I See?

The specific therapist you see depends on your specific concerns and goals. There are many types of therapists, including: ^[2]

• Psychologists

• Psychiatrists

• Licensed Clinical Social Workers (LCSW)

• Licensed Professional Counselors (LPC)

• Licensed Marriage and Family Therapists (LMFT)

Types of Therapy Sessions

There are many types of therapy sessions, which incorporate various techniques and modalities. Some therapy sessions are geared towards a specific mental health disorder or other concern, while other therapy sessions can be used for general mental wellness.

Sessions can be in a variety of formats too, such as:

• Individual

• Group

• Family

• Couples/Marital

Therapy Sessions for Diagnosed Conditions

Many therapy sessions are used to help with specific diagnosed conditions, such as anxiety, depression, or eating disorders. In these cases, the sessions are grounded in evidence-based methods and techniques to help manage or treat the symptoms of the specific mental health condition.

Listed below are examples of certain therapies for diagnosed conditions: ^{[1] [2] [3]}

• Cognitive-behavioral therapy (CBT): Focuses on identifying and changing any problematic thoughts, behaviors, and emotional responses that contribute to distress. Often used for people with depression, anxiety, substance use disorders, eating disorders, and relationship difficulties.

• Dialectical behavior therapy (DBT): Helps people regulate their emotions and take personal responsibility for their behaviors. Originally developed for borderline personality disorder (BPD), but also useful within depression, eating disorders, post-traumatic stress disorder, and others.

• Eye-movement desensitization and reprocessing (EMDR): Uses bilateral eye movements with a focus on specific memories to help individuals process trauma. Most often used for PTSD and trauma-related conditions, although it may also be useful for depression, panic, phobias, and several other conditions.

• Psychodynamic therapy: Centered around one’s past experience and unconscious feelings/processes to improve self-awareness and change deeply rooted patterns. Useful for many conditions, especially depression and personality disorders.

• Interpersonal therapy (IPT): Focuses on identifying and improving interpersonal skills, such as communication and conflict resolution. This form of therapy is most often used to treat depression.

Therapy Sessions for General Mental Health

Therapy sessions for general mental health are less specific, but still have some form of structure, identified goals, and treatment plan. These sessions often incorporate general techniques and practices to support mental wellness and personal growth, such as mindfulness, stress management, social-relational skills, problem-solving, and self-awareness. ^[3]

Sessions for general mental health can still incorporate CBT or other techniques too, however. It depends on the exact goals and needs of the individual.

Online and Telehealth Sessions

Online and telehealth sessions are becoming increasingly common. These types of sessions act as a nice option for individuals who are unable or unwilling to receive in-person therapy.

The structure and overall format of therapy is the same online as it is in-person. Therefore, while you won’t be in the same physical room as the therapist, he or she will still implement the same therapeutic techniques, discussions, interventions, etc. ^[3]

Therapy Session Structure

While the exact details and specifics of the therapy session vary from patient to patient, most sessions follow a similar structure or outline. In addition, most therapy sessions last about 45 to 50 minutes. ^[1]

In your first therapy appointment, your therapist will introduce him or herself, and likely explain their background, expertise, and other important information, if this was not already discussed. Then, they’ll ask you a variety of questions to learn about your current concerns, goals, and specific problems you want to work on, as well as any relevant history (e.g. family, medical), and any factors that influence your overall well-being (e.g. social support, home life). ^[1]

Once your therapist has gathered enough information, he or she will work together with you to set goals and create a treatment plan or outline. After this, the more specific therapeutic work begins, which is typically in the following sessions.

The overall format of these next sessions typically includes the following elements:

• Beginning/intro: This part usually lasts 5 to 10 minutes and may involve discussion of how your treatment is going, and what your goals are for the current session.

• Middle/main work period: This is the main period lasting around 30 to 40 minutes, which involves the specific therapeutic techniques and strategies.

• End/closing: This part typically lasts 5 to 10 minutes, and involves discussion and reflection of what just happened, and a plan for what to do going forward outside of the session, and for the next session itself.

What Should I Talk to My Therapist About?

One of the benefits of therapy is that it’s highly individualized. Therefore, you get to set the pace and discuss what’s most important to you.

Most individuals find it best to talk to their therapist about their current problems they’re facing, or whatever main issues they’re having in their life. While it can be uncomfortable or nerve-wracking at first, it’s usually the most beneficial to be as open and honest as possible, including thoughts or feelings you may not have told anyone else. ^[1]

With that said, professional therapists will never make you talk about something you don’t want to. If you’re uncomfortable talking about a certain topic or problem, you can simply not discuss it, or wait until you’re more comfortable going over it.

Confidentiality

Psychologists and other therapists are required to maintain strict confidentiality. Therefore, you can be confident knowing that the information you share with your therapist is kept private and confidential. This is all based on the American Psychological Association’s Ethical Principles of Psychologists and Code of Conduct, as well as the HIPAA Privacy Rule. ^{[4] [5]}

Who Can My Therapist Discuss Our Sessions With?

Therapists do not disclose information from therapy sessions to other individuals unless it is necessary due to certain reasons, such as:

• The safety and well-being of yourself or others

• They may alert police, teachers, parents, or other relevant individuals

• Necessary information for court cases

• Suspected child abuse or neglect

• They will communicate with appropriate authorities, such as local police

Otherwise, your therapist will only discuss information with others if you give permission and written consent. For example, sometimes your therapist may want to communicate with your doctor or others involved in your overall treatment plan, but this decision is up to you.

Therapy and Medication

In some cases, you may be treated with therapy and medication. Typically, medication is only added onto therapy for more significant mental health issues, such as severe depression, bipolar disorder, schizophrenia, or severe anxiety. In these cases, combination therapy is typically more effective than either treatment alone. ^{[1] [2]}

It’s important to understand that these treatments differ significantly in how they work. Therapy focuses on the development of key skills and strengths that support mental well-being, whereas medications act on neurotransmitters involved in mood and mental health.

Should I Stop My Medication if Therapy is Helping?

You should only stop your medication if you receive your doctor’s approval. It may be tempting to stop your medication if you start feeling better after therapy, but abruptly stopping medications often leads to withdrawal and other significant consequences.

However, you certainly can discuss the possibility of coming off your medication with your treatment team. They will determine if it is a possibility, and what steps to take from there.

How Will I Feel After My First Therapy Session?

Feelings and responses after the first therapy session differ from person to person. Some people may have a lot of questions and still feel significant unease or uncertainty, while others may feel confident in their treatment plan and excited at what benefits may lie ahead. It’s important to not judge these feelings and responses, as there is no “wrong” way to feel after your first therapy session.

In any case, it’s best to talk to your therapist about how you’re feeling, and any thoughts you had about the session. The more you communicate with your therapist, the more they can understand how to help you best.

What to Do if You Feel Unsafe After Therapy?

If you feel unsafe after therapy, try to identify why this occurred. For example, if it was due to revealing a lot about yourself that left you feeling vulnerable, this doesn’t mean you can’t continue with your therapist. It may just mean you need some time to get used to the nature of therapy.

On the other hand, if your therapist did or said something directly that made you feel unsafe or uneasy, then it may be best to discontinue working with that therapist. It may also help to tell other trusted individuals about your experience and how it affected you.

Takeaway

Going to your first therapy session may seem uncomfortable or overwhelming, but it’s often the first step in the right direction towards a healthier, happier version of yourself. If you’re wondering if therapy may be beneficial for you, or what type of therapy is best, reach out to a mental health professional. They’ll guide you to the best possible decision.