A Clinical Psychologist’s Guide to Starting Therapy: What to Expect and What Not to Expect
In Brief
Experiencing mixed emotions before your first therapy appointment is normal
Expect the initial sessions to be about getting to know you, your current problems and any relevant background
Don’t expect quick fixes or to unload everything right away
Building connection and trust can take time
Therapy is a collaborative, gradual process
Considering what you want to get out of therapy can enhance your first session
Over recent years, therapy has become a common place practice for all. A space to navigate and untangle the inevitable messes that life throws our way. Despite its popularity, it can be hard to know what to expect when starting therapy and if you feel uncertain or nervous, then this blog is for you. As a Clinical Psychologist with over a decades worth of clinical experience, I will demystify the process, provide tips on how best to prepare for your first therapy session and hopefully help to settle some of those nerves.
Nerves are the Norm
Whenever I ask new clients how they are feeling about starting therapy, the responses are always the same – nervous, anxious, worried, skeptical, hopeful, positive, optimistic, curious and excited. Mixed feelings are the norm, and if you are experiencing the sharp edge of any of the more difficult emotions, then know you are not alone.
First Time at Therapy
For many, starting therapy is completely new territory. Perhaps the closest contact you’ve had to a therapist is watching Harrison Ford on Shrinking or bingeing episodes of the Sopranos. And let’s be honest, these aren’t exactly the most accurate depictions of what happens in a therapy room.
If You’ve Been to Therapy Before
How you feel about starting therapy again will depend on your previous experience. A positive previous experience may bring about anticipation and excitement to get going again, as well as the nerves. However, if therapy was unhelpful then you may feel discouraged and hopeless that this time round, something will actually change.
Preparing for Your First Appointment
I send all my new clients an intake form to complete in advance of the first session. This helps both them and I prepare for our first meeting. Some of the questions I include are: What do you see as the main problems? What impact do they have on your life currently? Why are you coming to therapy now. Are there any barriers that may get in the way of therapy.
What to Expect
Housekeeping & Safety - I start the first session by letting clients know that I am taking notes and I explain the bounds of confidentiality. This is important as it provides reassurances that therapy is a safe place for you to explore your thoughts and feelings in the knowledge that your confidentiality will be respected. In order to keep you safe there are limits to confidentiality and this will also be explained.
Structure - If you don’t know where to start then don’t worry – you don’t have to. It’s your therapist’s job to help shape and structure the first session. They will help cue you in where to start and they will ask questions along the way to build a picture of where you are at, and keep things on track.
Questions - You will be asked many different questions about many different areas of your life. I often start by asking a bit about what your life looks right now and I’m also interested in what motivates and drives you in life. Of course, you don’t have to answer all the questions and we will go at your pace. There is always room for your own questions too.
Comfort & Connection - One of the main aims for the first session is to make clients feel at ease. Don’t be surprised if I use humour - therapy is not all dreary and dark. In fact, being able to talk about everyday topics and connect to the lighter side of life can really have its merits when used in a balanced way. I will also remind clients that I am human and as a result, I may not pick everything up accurately so I both invite and encourage open feedback.
Feedback - If, during the course of the assessment, it becomes clear that I am not best placed to provide you with the support that you need then I will feed this back to you. While this may feel disappointing, it is important that you get the right support from a therapist who is well-matched to your needs and ultimately, it will help in the long-term.
What Not to Expect
To get everything off your chest immediately - For many, starting therapy can be a long time coming. Perhaps you have been sitting on deep conflict, pain or distressing memories for years, if not decades. I get that it’s very tempting to offload everything at once. But exploring sensitive issues, particularly trauma, takes time. Early sessions are about getting to know each other and understanding the big picture, not diving into your deepest pain points. Your therapist will guide what’s safe to explore, and when. It’s a bit like climbing Everest - you have to complete the training and get the right kit to do so - any attempt to head straight up the mountain without this would be perilous.
Answers and Advice - A therapist’s job is not to tell you what to do with your life, nor is it about giving advice or sharing personal opinions. A therapist’s job is to create an environment where you can find the answers from within yourself. I always let my clients know that my ultimate goal is to put myself out of a job – that you become your own therapist in time.
Quick Fixes - Be prepared for therapy to be a process. If you are expecting a “magic wand” then you will very quickly become disappointed. Therapy is a collaborative and gradual process - it is not something that is done to you.
After Your First Session
Don’t be surprised if you feel like you have been at the gym after your first session. Therapy can be emotionally tiring and this is likely to effect how you feel physically. So, in the same way that you might warm down after a training session, you may also give yourself time to reflect and relax after your session.
Starting therapy is a brave step. Whether you're filled with nerves, hope, or both - you're not alone. Take your time, ask questions, and know that it’s okay to move at your own pace. If you are interested in therapy or would like to know more about the process please do reach out by email.
