Emilia Pacholec

The First Therapy Appointment — What to Expect

Pictured: A young woman engages in a virtual/online therapy appointment. Photo sturti by from Getty Images Signature on Canva

So you found a therapist, you mustered up the courage to get in touch, and you scheduled your first therapy appointment. Now what?

I want to start by saying congrats on being a baddie… not only do you have the self-awareness to realize that you can use some support, you also have the courage to move beyond awareness to action and reach out. I don’t care what anyone else says, that’s badass👏.

If you haven’t reached out, you’re still a baddie because you’re trying to figure out if therapy is for you and I commend you for that.

Reaching out for help and starting therapy brings many emotions but there’s two that I can confidently predict that you’re experiencing — excitement and fear.

New things are exciting! The idea that you will have your own person who will listen, support, and challenge you without their own agenda, biases, or judgements is exciting… in theory. Until it dawns on you that in order for someone to listen, support, and challenge you, you have to talk (insert fear).

Many of us were taught not to talk about personal stuff with strangers and many of the things we go to therapy to talk about are the very things we’ve actively avoided talking about — the things we pushed to the side and said oh that? I don’t know what that is. It’s nothing. There’s nothing there. What?

Humans don’t like surprises and we don’t like fear. The only thing that helps us work around those is preparing. It’s why you searched for this information and why I thought it would be a good idea to write about it. My hope is that when you reach the end of this article you’ll have a better understanding of what to expect at the first appointment so that you feel more confident, know how you can prepare, and make the most out of your first therapy hour!

So here’s what you need to know…p.s. I’m a therapist so you’re in good hands here:

After you say your hellos and before you get to talking about you, your therapist will review important information about privacy and confidentiality and the limits to keeping your information private and confidential. You’ll also discuss clinic policies around payment, cancellations, electronic communication, communication outside of the office, complaints, emergency procedures, etc. This is to ensure that you’re making an informed decision to proceed with therapy. After asking any questions (I encourage you to ask whatever is on your mind!) You’ll sign a consent form stating that you understand and agree to these policies. This will likely take about 10 minutes.

You may also be asked to sign a consent form giving your current therapist permission to obtain your prior therapy or diagnostic records and/or to communicate with others involved in your care (eg. a psychiatrist, dietician, etc.). This is not mandatory but can offer useful information to the therapist and clients tend to find that coordination with other service providers is helpful.

The first appointment is very much about the therapist getting to know you, what brings you to therapy, and how they can support you. Most therapists, especially those who offer specialized services like trauma therapy, cognitive behaviour therapy, dialectical behaviour therapy, etc. will ask many questions to develop a strong understanding of how your problem developed and what you need to move on. Generally, you can be expect to be asked about:

What brings you to therapy — This may sound like a no brainer. Sure, most people who seek therapy have an idea of what problem they would like to work on, but how many times have they articulated it? After living it for months or years there might be a lot to unpack and it can be hard to fit all that info into an hour long session, let alone only one question during that session.

You might find it helpful to spend some time before your first appointment reflecting on what brings you to therapy — what the main problem is, what you’d like to see changed, how the problem has impacted you. No, you don’t need to come up with an elevator pitch! Just take some time to think about it and jot down any of the important information you think is most relevant for us to know. We’ll ask questions to get more details.

Medical History — Believe it or not your mental health is strongly connected to your physical health so we like to know if you’re taking any medications and if you’re experiencing any chronic or acute health problems.

Current coping — What do you do to deal with stressors as they come up? You may also be asked about substance use, self-injury, etc. at this time. We want to make sure you’ll be able to effectively cope between sessions. If you don’t have many strategies we’ll work that into your treatment plan so that you’re covered.

Suicide and suicide ideation (aka. thoughts of suicide) — Therapists truly want to see your mental health improve and that’s not possible if you complete a suicide attempt. You’ll be asked about any present or past suicide ideation and attempts to assess your level of risk and safety. If we’re concerned about your immediate safety we will work with you to create a safety plan.

Relationships — Friends, family, romantic partners. Humans are social beings and relationships (or lack there of) will be affected by, or contribute to, your mental health. Therapists like to know the extent to which this has become a problem and it’s not uncommon to work on improving relationships as part of treatment.

Prior experiences with therapy — What went well? What didn’t? What did you like? What did you hate? Don’t lie on this one. If you didn’t enjoy your last therapy because it involved weekly handouts and you HATE handouts, be honest so that you’re not disappointed when your therapist unknowingly assigns you a handout. If you really enjoyed having a summary at the end of each session because it helped you remember the important points discussed, your new therapist can implement this into your sessions. We really do want this to be a helpful process for you!

Questionnaires — Many therapists use standardized measures (questionnaires) to get some more information about what you are experiencing. For example, to understand if you meet the criteria for various disorders, to better understand your symptoms, and to determine which therapy would be most appropriate for you. Sometimes you’ll be asked to complete these throughout treatment to track your progress.

Goals — You will 100% be asked about what you would like to get out of therapy, aka your treatment goals. These will guide treatment so it’s important that you’re the one setting them — not your therapist, not your parents, not your partner. Spend some time before your first appointment considering what you would like to see happen in your life, how you would know when you’re doing better. Goals can always change but it’s important to have some as a starting point.

Importantly, the first appointment is a time for you to get to know your therapist and understand what your time with this therapist will be like. If there are any questions about anything, ask! This includes asking about the therapists experience and expertise, how they approach certain problems, etc. I love it when clients have questions because it shows that you’re trying to make a good decision for themselves and I will always support that!

You’ll also get a sense of the therapist and this will help you determine if they are a good fit for you. Most people won’t be fully comfortable with a therapist at the first appointment — it takes time to develop trust and safety to be able to discuss sensitive topics; however, after the first meeting you will typically have a sense of whether you mesh with this person, if their personality/style suits you, etc.

Sometimes the therapist isn’t a good fit and that is perfectly okay. If you do not feel it is a good fit or have any concerns you can discuss this with them and they may be able to help you find a referral — seriously! We won’t be offended.

A closing note — every therapist is different and has a different approach but these are standard questions and procedures that most of us follow. Throughout this article I mentioned a few times things that you can do to prepare. Please note that no therapist expects you to prepare before hand. If you want to and have the time, this will help you stay on track but it’s not necessary. Sometimes life and time get in the way of being able to prepare, sometimes we just have no clue what we want or it’s too overwhelming to think about it. Whatever it is, therapists are here to support you and it’s not uncommon for people to show up and say “I don’t really know what it is, something just feels off” or “I just don’t like the way things are right now”. A strong therapist will work through this with you — it’s what they’re there for.

So my ferocious lions, I hope this article has been helpful and that you’re feeling a little less stressed about your first session.

Best of luck to you and happy therapizing ❤