How To Be New to Therapy

Have you ever found yourself thinking about starting therapy? Have you wondered if seeing a psychotherapist could be helpful for you? Are you curious and do not know where and how to begin? The goal of this article is to provide you with a well-rounded idea of what to expect (and not expect) from your very first session.

What to expect in your first session

I remember my first therapy session more than 20 years ago. I was having boyfriend issues; dating the wrong guy. I knew it, he knew it, but I ‘couldn’t’ get out of it. I did not think he would end it; he was actively trying to change me and thought he would succeed (he did not). Nonetheless, I could not figure out exactly what was stopping me from getting out. I was not afraid: he was kind and harmless (though manipulative), mostly insecure. Although every part of my body and mind knew this person was not the right fit for me in the present, with extraordinarily little potential for a meaningful future, I could not muster up the strength to leave. I realized I needed someone (not a friend) to help me make sense of my thoughts and inaction; someone without bias or knowledge of my idiosyncrasies and unhealthy habits. Enter therapy.

My very first session was a positive experience. My therapist was a warm woman in her early sixties with an inviting smile and large, flowing dresses and a tidy desk. She felt like a cup of tea. Her office was on the third floor of a large building and my chair was beside a large window with a side table and plant. When I saw where I would be sitting, I knew I would be able to breathe. She had a way of immediately making me feel welcome, asking me to take a seat and motioning with her arm like a fairy godmother towards my chair. She enjoyed her job, and I did not feel like a nuisance (at that time in my life I always felt like a nuisance, I could not accept space).

I remember feeling nervous and unsure of what to talk about. The challenge would not be to open to this stranger; it would be to take what she said and put it into action. And that is exactly what happened; by the end of the session, I liked her so much, I invited myself back on a weekly basis for an entire year. Thankfully, I was a student at the time, and this was included in the cost of my tuition. It took me one year of weekly, sometimes bi-weekly sessions to get to where I needed to go. More than thirty sessions later, by the end of the school year, I had turned my words into action and ended the toxic relationship. I was immediately back to myself again: much happier, freed, full of energy. I was also hooked on therapy.

What I liked most about this therapist was her warmth. She had a way of inviting me to experience therapy at my own pace and in my own way. Her short curly hair gave me grandma vibes, and her office was tucked away just enough from the everyday reality of academia I was in my own space. I even remember at one point thinking to myself ‘I think I could enjoy a career as a therapist one day.’ It was in this very first office where my idea to become a psychotherapist myself was born.

My therapist created a vibe of acceptance, one where I would not be judged. This allowed me to open and gain the strength and courage to make the decision I knew I needed to make. What I came to learn over that year in therapy was why I had difficulty letting people go, how this related to my childhood, and the value I placed on relationships. I had learned so much about myself, which is why the day she told me she was retiring, I was gutted. Devastated. All the information and stories I had shared, gone. I was happy for her but sad for me. I decided to use this opportunity to take a break from therapy and eventually find a new therapist, someone who would suit me in the next stage of my life. I was only one year away from graduation and had plans to travel anyway. This is exactly what happened, I traveled for two years, came home, found a new therapist, and continued my journey. A good therapist will do this for you too; they will help you continue your path. They will do their best to help you feel welcome, invited into the room in a way that works for you, not them.

Not all Therapists are Created Equal

Before we dive into what you can expect in your first session, I must preface with something. Unfortunately, not every therapist is going to behave professionally and ethically. If this is to happen, you are well within your rights to try someone new (and if your therapist does not explain this to you in the first session, I would suggest you consider your options).

Informed Consent

Your ability to enter and leave the therapeutic relationship at any time is known as informed consent. It is up to you and no one else to make the best decision for you. Bottom line: you are not bound by the therapist you choose at any given point in time, and this means you are free to leave at your will. And if you ever feel harmed by your therapist, you are well within your right to file a complaint to the College of Registered Psychotherapists or CRPO.

In the first session, your therapist may tell you to take your time and think about how the session felt before deciding. I tend to do this with most of my clients to ensure they do not feel put on the spot to decide if they would like to collaborate with me. I also believe in quiet reflection which comes after an experience has ended. When we take time and space to reflect, we can make an informed decision without distractions or pressure.

What Does Informed Consent Sound Like?

Your therapist might say something like, “If you choose to collaborate with me after this session is completed, I would be happy to as well (you have my consent). We will both be entering a therapeutic relationship which includes professional, ethical conduct as well as the ability for you to ask questions at any time. Feedback about the process is always invited and welcomed, as my focus will always be to ensure this is working for you. If at any point, you feel this is not the correct fit, I will be happy to provide you with a list of external and internal referrals to help you make the best decision for yourself and ensure you are not out of therapy. Please do not let this experience be the reason you are out of therapy in the future. It is my job not to take anything personally and to always consider your best interests.”

Sidenote: keep in mind, if you are entering therapy in acute grief, high stress, or with risk of harm, your therapist will conduct a risk assessment in this first session. If a therapist believes you are at risk of harming yourself or someone else, their priority will be to ensure you, and others are safe and receive the help you need.

Risks and Benefits

Your therapist will want to ensure you understand the benefits and risks of therapy. A few benefits include improved relationships, self-esteem, and communication skills. A few risks and limitations include therapy is not a magic wand, changes in personal relationships, and emotional changes due to personal growth revealing past scars.

Goals (If There is Time)

Your therapist may also have time to begin to clarify your goals for therapy and begin to co-create a treatment plan with you. If this does not take place in the first session, it will in the second. Remember, the first session is a meet and greet, a chance to see if there is potential for a working relationship as well as an assessment that involves many questions and background information to create an informed treatment plan and assess risk. This is all part of the process. In other words, in the first session, although it may feel as if ‘the work’ has yet to begin, this is part of ‘the work.’

That First Step

The first step is booking the session. The second is getting your foot through the door (or entering the virtual room on a screen). Peer-reviewed studies suggest in person and virtual therapy provide similar levels of efficacy with the therapeutic relationship being the factor that is most important in a person’s outcomes. The courage you demonstrate when you begin that first session is everything and it is enough. Getting yourself there is enough. Booking the session and showing up is enough. Do not feel like you need to show up to any therapy session with a list of notes on what to talk about. Although it can be helpful to keep notes in between sessions, oftentimes the most organic sessions arise when the person is truly in the moment. With my clients, I recommend a bit of both: come as you are (always) and keep notes in between sessions to help make productive use of our time together (which is to help you reach your goals).

If you are considering therapy, reach out to a friend who is already doing it. Ask them what they like and do not like about the process, about their therapist, and what they would recommend. Just by reading this article, you are already on your path to healing.