You have finally made contact with a therapist and you are about to walk in to your first appointment...what should you expect?
1. Life History. The first session (and several after that) is focused on gathering information about your life. Your therapist may ask about your family, your family's mental health and medical history, your boyfriend or support system, what you eat, how often you sleep, and what stressors and symptoms you are currently experiencing. This process can take several weeks since most of us have rich histories with moves, school changes, marriages, etc.
2. Past mental health care. Your therapist will also want to know if you have sought mental health care before such as therapy, been admitted to a psychiatric hospital, as well as any medications you have taken for depression, anxiety, etc. It is helpful to know what medications you have been on as sometime this can help with a proper diagnosis and what other mental health professionals have treated you for. Your therapist may also be interested in what you worked on with your previous therapist, if you have one, and what worked and did not work during your relationship with them.
3. History of trauma. Abuse, being in a violent relationship, and sexual assault are of course significant events in your life that your therapist will want to inquire about. It is understandable to be anxious to discuss something like this during your first session so while you may disclose that you have experienced something like sexual abuse, it is absolutely not necessary to discuss details about the events until you are ready. It is important to communicate with your therapist about the pace of therapy you are comfortable with and they should understand if you are not ready to discuss events in detail or even at all! If your child is the client, they may inform them that if an incident has not been disclosed to proper authorities, they may need report the event to ensure safety of your child and others.
4. Treatment Goals. You and your therapist will work together to decide and prioritize treatment goals for your time together such as finding ways to manage your anxiety, better communication skills, safety measures in a relationship, or managing suicidal thoughts. While you are the expert in your life and knows what feels the most pressing, your therapist may encourage you to start with goals that focus on your safety such as to decrease suicidal ideations or self harm behaviors.
5. Consent for Treatment. Consenting to treatment is important and you will sign a piece of paper that discusses in detail what this means. It is important to remember that there are limitations to therapy as well as benefits and risks that go along with the treatment process. Therapy won't always feel good because often you are working through old hurts or really challenging yourself to new ways of thinking about yourself and the world. There is no guarantee to the success of therapy; the real work happens when you leave the therapy office.
6. Confidentiality. Many of the subjects you will discuss in therapy are not things you want your friends or sometimes even your family members to know about. Confidentiality is in place to protect you so that you can fully explore and engage in the therapeutic process. However, in the event that you cannot keep yourself safe and are you are threatening to hurt yourself or someone else, it is a therapists job to intervene either through engaging a mobile crisis hotline or the police. Your safety is our utmost priority and if we cannot guarantee that safety, we are obligated to try and find ways to get you to a safe place.
7. Rapport Building. I enjoy getting to know my clients on a more personal level - not just what is "wrong" with them. I may ask you what music you like, what your hobbies are, what your favorite shows are, or where you enjoy eating. I also may share those things as well so we can share some common interests. Making therapy personal is important to me and I strive to be as transparent about myself as ethically appropriate.
I hope this decreased some fears about coming in for your first appointment! Some clients leave the first appointment feeling like they have a ton of weight off their shoulders while others may feel vulnerable. Be prepared for either reaction and talk with your therapist about it at your next appointment.