How to Prepare for Your First Therapy Session — [A Complete Guide]
“Who looks outside, dreams; who looks inside, awakes” — Carl Jung, Psychiatrist.
Psychotherapy or counselling, or therapy is the first step in a long journey of learning, unlearning, self-discovery, recovery and more. Taking the first step toward healing and self-awareness is always hard. If you’ve reached this page, that indicates you’re on the right path. And, if you have already booked your first therapy session, you must feel a range of emotions — nervousness, fear, and even excitement. And I want you to know it is entirely normal.
Whether you’re 15 or 55, the first therapy session is always daunting. I’m here to help you prepare for your first counselling session. In this blog, I’ll cover the different stages of therapy, your first session, questions, what to say, aftercare, and more.
What are the four stages of therapy?
Psychotherapy or counselling isn’t a typical clinical procedure. Everyone has a different recovery journey. It cannot be quantified using the number of sessions one needs, and so on. But, therapists and psychiatrists have categorised the process of counselling or therapy into four distinct phases.
Before we delve into the stages or phases of therapy, please understand that it is a fluid process. Each of these stages is a gradual process, not a single event. And your journey will not be linear — mine sure wasn’t.
Commitment
The first stage of psychotherapy is commitment. By booking your appointment and starting therapy, you commit to yourself. A commitment to get better, address your issues, and discover yourself. In this phase, you and your counsellor create specific and achievable goals for your therapy.
I was only 13 years old when I started therapy. And I had significant issues with any authority figure. My therapist successfully created a safe space for me by tackling all my cross-questioning and remarks. Gradually, I opened up to them.
I understand opening up to a stranger right from the beginning is difficult. So, you will hold back, and that is completely fine! Your therapist should provide you with a safe space to feel comfortable and make you feel empowered and like an equal. Little by little, as your sessions progress, you start opening up.
Process or Identification
The second stage is often considered the most complex stage in the process of psychotherapy. The second phase is the body of treatment; the therapist may ask you why you want to start therapy. It is a very telling question that reveals the patterns in your experience, triggers, and behavioural cycles.
During one of my first therapy sessions for anxiety, I vividly remember my therapist asking me, “Do the patterns in your behaviour stem from a sense of abandonment?”
The most important aspect of this stage is psychic movement, rather than the nature of the same. The counsellor wants you to become more self-aware in this stage. Thus, you gradually start identifying the patterns and cycles in your own behaviour, leading to repetitive experiences.
Change
The first two stages prepare you for this stage. After rapport building and assessment, you may engage in activities, homework and experiments outside your therapy sessions.
The purpose of these exercises and activities is to help you reframe the painful experiences. You learn to take back the power and control over your own life; through confrontation, rather than avoidance. This stage is a sign of successful treatment. You learn to manage your emotions and behaviours through self-care.
To cope with the fear and anxiety resulting from the bullying I was given a simple homework. Don’t talk in a passive voice. For example, rather than saying, “I was bullied”, I had to say, “They bullied me”.
Termination
Termination is essentially the stage where you graduate from therapy. It indicates that the therapist has helped you to manage your emotions. And now you have the necessary tools to cope with life. Although this phase is not the end of your therapy journey, you can always return to therapy if you need to.
One of the most important steps in this stage is developing a mechanism to identify triggers and warning signs. These help you, in the long run, to assess whether you need therapy again. If you see yourself falling back into your old behavioural patterns, you can choose to go back for counselling.
Why is the first therapy session hard?
“Avoidance is the best short-term strategy to escape conflict, and the best long-term strategy to ensure suffering” — Brendon Burchard.
Therapy takes us into the unknown. Sitting alone with your thoughts and emotions, picking them apart and getting to their roots requires considerable bravery and strength. And the lack of awareness and stigma around counselling doesn’t help the process either.
I have been fortunate enough to find the necessary mental health support at a young age. I like to believe that because I started therapy so early, I didn’t have the time to understand and internalise the stigma around it.
However, many of my friends, partners, cousins and family members haven’t been so lucky. Many of them have internalised the stigma that going to therapy would make them certified crazy people.
Counselling or psychotherapy needs you to let your guard down. It means confronting uncomfortable emotions and thoughts. Oftentimes, your mind will keep painful incidents, trauma and feelings hidden from your conscious self to protect you. The therapist is responsible for creating a safe space to confront such feelings and become aware of who you are underneath it all.
How to prepare before your first therapy session?
Before starting your first therapy session, you need to prepare yourself. The first and foremost step of preparation is letting your guard down. Being vulnerable and open is difficult for a lot of us, but it’s the only way to emerge victorious on the other side.
If you have already booked your first session, here are a few steps that you can take to prepare.
● Be honest about your experiences and emotions. Your therapist isn’t a mind reader. They cannot understand your true feelings about a situation unless you tell them.
● Don’t be hesitant to ask any questions. Before starting a journey of self-discovery, it is only natural to have questions for your guide. So, write them down and ask away.
● Think about why you’re starting therapy. It is one of the first questions your therapist is going to ask you. If it helps, you can write them down.
● Try to be as flexible as possible. Do not show up with any hard and fast ideas about how your session should go.
First therapy session questions for your therapist
Psychotherapy is a two-way street. You need to be as committed to the process as your counsellor. And to do that, you should ask a few questions to establish a clear goal and start a rapport. I suggest asking the following questions -
● How will you ensure the confidentiality of our agreement?
● In what situations can confidentiality be breached?
● How long have you been a therapist?
● Do you have experience with specific mental health challenges like mine? (Although, if you’re visiting a specialist like a PTSD specialist, family therapist, couple’s counsellors etc., this question is redundant)
● Will you prescribe any medication to me?
● Do I have to do some type of homework or activities in between our sessions? If so, can you give me a few examples?
● Do I need a referral to visit a psychiatrist?
What to expect in your first therapy session?
First of all, congratulations! You’ve put in the time and effort to find a therapist and attend your appointment. It takes great courage to take that first step. Now let me guide you through your first therapy session.
Things to remember: your therapist is just another human being. It is only natural to feel shy in the beginning. And your therapy session is like a doctor’s appointment. However, therapy appointments are typically longer than general physician appointments. Commonly, most psychotherapy session lasts from 40 mins to an hour.
How does the first therapy session go?
A popular myth about psychotherapy — the therapist will manipulate me to reveal my innermost secrets.
It’s wrong. Psychotherapy is a collaborative process between you and the therapist. The therapist will guide you, but you’re ultimately in control. If you are uncomfortable with an approach, you can tell your therapist, and they will work with you to find a different approach. It is important to remember that you are the expert on your own experience, and the therapist is there to help you achieve your goals.
I had to switch therapists as I grew up. And at my first session with the new therapist, they explained the confidentiality clause to me. As an adult, the material of the sessions is confidential. However, given my history of self-harm, they needed an emergency contact in case I was deemed harmful to myself or others.
In the first therapy session, expect to be asked many questions. These questions are designed to help you start the process of recovery and discovery. Your counsellor will also write down factors that they believe are important, so don’t be alarmed.
Questions your counsellor may ask you in your first counselling session
It was 2017. I was running late for my first appointment with my new therapist. After giving them the necessary information, I remember asking, “So, how do we start? What do I say?”
And that’s when they started asking me a string of questions. I realised these questions helped me to open up to them and be vulnerable. So, don’t worry if you have no idea what to say and how to talk about your painful experiences. A good therapist will help you do just that.
Here are a few questions you can expect in your first therapy session:
● Why do you want to start therapy?
● Are there any mental health issues in your family history?
● Do you have a history of mental illness, self-harm and suicidal tendencies?
● Do you have experience with psychotherapy or psychiatry before this?
● How would you describe your home life?
● Do you feel like you have a strong support system?
● What do you hope to achieve in our sessions?
What to do after your first therapy session?
Psychotherapy and counselling are not the end of the journey; they are the beginning. That’s why therapy aftercare is essential. You should reflect on your session to figure out whether it is the right fit for you.
Is your therapist right for you?
The therapeutic relationship is essential to the success of therapy. If you’re uncomfortable with your therapist, you should speak up or find someone else. And to figure out if your therapist is right for you, ask yourself the following questions.
● Were they compassionate with you?
● Have they created a safe space for you?
● Do you see yourself working with them in the future?
● Did you feel empowered and in control of the session?
● Did they check in with you to figure out if you’re comfortable?
● Do they help you look at your experiences from a fresh perspective?
● Were you able to be honest with them about your feelings and experiences?
If you answer “no” to any of these questions, it may be time to consider finding a new therapist. If you are not ready to change therapists right away, you can bring up your concerns in your next session. Your therapist may be able to address your concerns or offer you resources to help you find a new therapist. Talking to your therapist about how you felt during the session can help you find a middle ground.
How many counselling sessions do you need?
The number of sessions required can differ for every patient. Instead of focusing on the number of sessions, you can ask your therapist how often you should come back. It can help you to focus on the process of therapy, rather than the end goal.
Parting words from one survivor to another
You will find a lot of advice online for your first therapy session. One piece of advice is to know what you want from counselling and therapy. However, from my experience, it’s okay if you don’t.
When I started therapy as an adult, my goal was short-term: to be in control of my feelings. Seven years into therapy, I broke patterns that I didn’t even know I had.
The first therapy session is mainly about getting to know each other and answering questions. It will help your therapist understand your needs and create a plan to improve your mental and emotional well-being. Be patient. Therapy needs time and effort. Do your research and start your journey of healing and self-discovery.
