Coming to your first psychology or psychotherapy appointment can be a daunting experience. You might be wondering how it will work, what sort of things you will be asked to talk about, and how it all works. Here we will discuss some frequently asked questions regarding starting therapy:
Every therapist works in slightly different ways – there isn’t a standard procedure for your first appointment. However, most therapists will use this appointment to cover a few things:
Most therapists offer an initial assessment to give you both the opportunity to see whether psychological therapy might be helpful for you at this time. This is also an opportunity for you to see whether your therapist is the right ‘fit’ for you. They will normally begin by introducing themselves and explaining how the session will work, for example, how much time you have together and what sort of things you might aim to achieve. In a first session, the aim is usually to get to know each other, to start to understand what has been causing you difficulties, and to reach a joint understanding of how to move forwards – be this either longer term therapy, a different type of service, or even no therapy at all.
Most therapists will want to use the first session to get to know you and your difficulties better. They might ask something like “what has brought you here today?”, which is an opportunity to discuss the problems that have been causing you difficulties. They will want to understand what you are seeking support for, and what your aims for therapy are.
Don’t worry if you don’t fully know the answers or can’t find the words to talk about things – therapy is a journey so part of the aim is to help you understand things more fully. It is often at this point that therapists may want to check if you are facing any risks in your life, so be prepared to answer some difficult questions around any thoughts you might have of self-harm or suicide – these are standard questions which are designed to keep you safe. Sometimes there will also be time to talk a little about you background, so you might expect questions about what life was like for you growing up, and any particularly significant life events or relationships that occurred. Some therapists might choose to focus on your back story less than others – it will in part depend on what your problem is and whether or not it feels helpful to talk about the past at this stage in the process.
Bear in mind that you are under no obligation to talk about anything that you don’t feel comfortable sharing, and most people find that it takes time to build up a trusting relationship with their therapist in which they feel able to share information of a personal or distressing nature. However, psychological therapies are by their nature talking therapies, so if you do not feel ready to talk about your difficulties at all then you may want to consider whether psychological therapies are the right source of support for you at the current time.
Anything you choose to share with your therapist is considered private and confidential; however, there are situations in which your therapist may be legally obliged to break this bond of confidentiality. Generally, this is when you share something that leads your therapist to believe you might be at risk of harming yourself or others around you. In these instances they will explain to you why they are breaking confidentiality with you before doing so, if this is at all possible.
You should also note that many therapists work within teams, and it is possible that information you share may be discussed within that team or with a senior colleague. This information sharing process is part of the checks and balances that exist in the profession to ensure that your therapist is offering you the best service possible, and rest assured that everyone is bound by the same code of confidentiality. Each service is a little different, so your therapist should explain this during your first session to enable you to make an informed choice about what you might want to share. If not, ask.
A really important aspect of your therapy is the relationship between you and your therapist. You might have opted to work in a psychodynamic way, which can mean your therapist stays a little ‘distant’ from you, you might work with a humanistic therapist, who may disclose a bit more about themselves and talk about the here and now more. CBT psychologists or therapists can be more action and thought driven. It’s not easy to know which therapy will suit you most, so it’s normal to need to try and few versions on before you find the right one. Remember it is your therapy and your wellbeing that is driving the process, so if something isn’t right or you just don’t ‘click’ with your therapist, talk about that with them and consider trying a different type.
That said, sometimes therapy can be a difficult and uncomfortable process – it’s very common to have weeks where you just don’t want to go or to have periods where you feel angry or upset with your therapist. Often this is when the best ‘work’ gets done, so try and stick with it and work through your feelings with your therapist – it is all part of the process.
The last ten minutes or so of your appointment will probably be used to bring the session to a close and make plans for the future. The therapist might summarise some of the things you have talked about, and may also ask you to comment on how you found it. It’s important to reflect on your feelings and to be honest about your experiences if you can, as this will enable your therapist to adapt to make the therapy as useful for you as possible going forward, and/ or to make helpful recommendations.
Similarly, if you have had therapy in the past they might ask you to draw upon these experiences so that you can agree on a way of working that is likely to be most beneficial to you. Don’t worry if you’ve not had therapy before, there will still be plenty opportunities to think about your goals, hopes, and expectations. You should leave with a clear understanding of what the next steps for you are; whether this means attending another appointment, awaiting feedback from your assessment, or accessing another source of support.
Remember, psychological therapy is always completely voluntary and at no point should you feel pressured to attend therapy or disclose something in a situation that does not feel safe. Nonetheless, therapy may at times feel uncomfortable, as you will be encouraged to reflect upon and challenge difficult thoughts, behaviours and/or emotions to create change. This should be a supportive and collaborative process with your therapist, so remember to ask if you have questions and be open about and worries or concerns: your therapist is there to support you.
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