Insider’s Guide to the First Counseling Session

Making the decision to seek help isn’t easy.  We don’t turn to strangers for help and guidance unless we are struggling in the first place.  Then there is the challenge of finding the right professional to consult with regarding our most personal feelings and concerns. Schedules, finances, location—these are all realities that impact the decision to start counseling with a therapist.  When you’ve worked through all those details and have your initial appointment set up, you will find yourelf wondering what should I expect at that first session?
Even if you’ve seen a therapist before, it is normal to have anxiety about your first session with a new counselor.

Will the counselor help me to feel at ease?  What if I see someone I know?  Will I be able to express what’s on my mind?  Is the therapist someone who can understand me?  What if I become upset and cry? Are my issues important enough to be taken seriously? What’s the first thing I should say?  Where do I begin to work on my issues? Will the therapist like me?

​ While you may feel awkward and uncomfortable in the therapist’s office, it can be reassuring to know that she or he is not!  Therapists are professionals who understand the discomfort and vulnerability that clients feel when they walk through the door; their job is to help you to feel at ease and safe.  An experienced clinician can provide structure to help you through your initial session or listen carefully to understand what you want to share. 
 To feel more prepared and to get the most out of your session it can help to ask yourself “What kind of help do I want from therapy?” or “What would I like to accomplish by the end of the first visit?”.  Some therapists feel it is helpful to cover specific areas in the first session and they can guide you through these areas.  Most therapists will have some topics they find important to cover in the first session.  These topics can include procedural items like confidentiality or availability after hours, or focus more on clinical topics such as how the issues that bring you to therapy are impacting your day to day life or any previous history of psychological problems.  
 Many people feel nervous just before their first session and notice their anxiety disappears quickly after walking into the therapist’s office, sitting down and beginning to talk.  Usually they are surprised at how quickly the time passes (a typical initial appointment is 45 minutes), so it’s important to make sure you bring up the things that you feel are significant well before the end of the appointment time. 
 What are some realistic expectations for how you should feel at the end of your first session?  Research suggests that the most important thing people want is to feel their therapist really understands their feelings.  While it takes several sessions to build the therapeutic relationship, it is reasonable to expect by the end of the first session to have a sense that the counselor is someone with whom you can feel comfortable and who can offer a helpful perspective on the challenges with which you have been struggling. In a word, I’d want my clients to feel more hopeful about change than when they walked into my office.  And to look forward to the next session feeling they have a partner working along with them.