How to Prepare for Your First Therapy Session

by John Pajarillaga, a Doxa counselor.

So you’ve found a therapist and scheduled your first therapy session.


Are you excited? Nervous? Do you know what to expect? 


For people who have never been to therapy though, it can be an intimidating experience. It can also be extremely rewarding and even life changing. 

Even though today I am a therapist, I was once a first time client. Back then, I didn’t really know what to expect. My only reference points were scenes from TV shows and movies. I didn’t know how to find a therapist. 

Once I found one, I didn’t know if there was anything I needed to do to prepare for my first session. Was I just supposed to show up? Or was like it like going to the dentist where I spent the week before my appointment preparing by being more diligent about flossing my teeth at night? 

If you’ve never been to therapy before, I wrote this guide for you. In my previous two articles, I wrote about how to find a good therapist. In this article, I’ll talk about the steps you can take to prepare yourself for your first therapy session. 

How to Prepare for Your First Session\

Plan Ahead  

Two or three days before your first session, reach out to your therapist by phone or email to confirm their office address. Some therapists see clients at more than one location so make sure you are going to the right place. If you are not familiar with the area, do yourself a favor and look up the directions on your GPS beforehand. 

Even if you can find a therapist’s office address on their website, I still recommend reaching out to them because this gives you an opportunity to ask them about any issues you should be aware of when it comes to traveling to their office. 

A good therapist should have thought ahead of time what it would be like for a new client to show up at their office for the first time. That simple phone call or email gives them a chance to warn you about quirks that are unique to their location. They can tell you if parking is hard to find because their office is in a busy shopping complex or that the building’s front door locks after 5pm so you’ll need call the therapist when you arrive so that they can buzz you in if you have an evening session.

It’s important to plan ahead because if you can’t find the office or run into some other problem 10-15 minutes before your session, your therapist may not be available to help you if they are still in a session finishing up with another client.

Even if you are doing a virtual session for therapy, it’s still important to plan ahead and think through the logistics like making sure you do therapy in a place where you’ll have privacy, a reliable Internet connection, and good lighting. 

  • Complete the Paperwork 

Your first session will feel a lot like seeing a new doctor for the first time. Before you even meet with the therapist, you will have to fill out intake paperwork. Depending on the therapist, they may ask you to fill this out electronically before you even show up at their office or they may ask you to arrive 15-30 minutes early to complete these forms in their waiting room. 

Intake paperwork usually consists of HIPAA forms that explain confidentiality, your insurance information, payment information, a therapist/client service agreement, the counseling practice’s policies, and a questionnaire the client fills out about themselves. 

These forms explain things like how much the therapist charges per session, cancellation/late fees, the therapist’s social media policy, risks and benefits of counseling, etc… The therapist may also go into more detail about what services they offer, the types of clients they serve, the issues they address, and their approach to therapy. 

As you read each form, make note of any questions you have. You can email the therapist ahead of time with your questions or you can wait until your first session to ask them. 

The intake questionnaire is an in-depth survey where you get a chance to share more details about your life. You will answer questions about your personal and family history, the symptoms & issues you are currently struggling with, past therapy experiences, current medications you may be taking, your reasons for coming to therapy, and what you hope to get out of it, etc… It is important for you to thoughtfully and honestly answer the questions because the information you share will help your therapist have a clearer and more complete picture of what’s going on with you. So, take your time filling this form out. 

  • Confidentiality

Many people who have never been to therapy before have concerns about opening up to a stranger. They also have concerns about their privacy and whether what gets shared in session with others. It’s an important enough issue that I believe it’s worth going into more detail about it.

For therapy to work, you have be able to trust your therapist. From an ethical and legal perspective, what you discuss in therapy stays between you and your therapist. That means, your therapist cannot and will not share anything that you’ve discussed in therapy with anyone else. This is known as confidentiality. A therapist won’t even confirm that you’re seeing them for therapy even if someone asks. The only way a therapist can share anything about you is if you sign a consent form and give the therapist written permission to disclose that information to specific people. 

There are limits to confidentiality though. These exceptions also vary depending on what state you live in. The most common exceptions include situations when a) the client is in danger of hurting themselves or someone else; b) if the courts request a therapist’s records with a subpoena; and c) if there is suspected abuse or neglect with a minor or elderly person.

Another limit to confidentiality is if the client is a minor or if a couple sees a counselor for couples therapy. 

If a minor is engaging in risky behaviors and talks about it during therapy, a therapist will likely inform the parents or guardians about it. In a situation with the couple going through couples therapy, the therapist may occasionally have an individual sessions with each partner. If one partner discloses relevant information that their partner doesn’t know about over the course of that individual session, this can put the therapist in a potentially compromising situation. If that happens, therapists will often have a discussion with the person disclosing the secret that for therapy to work, what was shared will need to be disclosed with the other partner. For that reason, therapists often stick to a “no secrets” policy in couples therapy.

I’ve worked in mental health since 2012. In all my years of being in this field, I can count on one hand the number of times I had to break confidentiality. In each of those situations, I only did it because someone’s life was in danger or because I suspected abuse or neglect. 

Therapists take confidentiality very seriously and would never flippantly break it. When you go into therapy with a therapist, rest assured that your secrets stay with us. 

  • Reflect on Your Expectations and Assumptions

New clients often have misgivings about therapy. There is a very real stigma around mental health and going to a therapist for help and support. Some people think that seeing a counselor is a sign of weakness. Some don’t trust healthcare institutions and think that healthcare professionals only care about making money. Here are some things I’ve heard over the years from new clients:

“Growing up, my parents told me that therapy was only for crazy people.”

“No one in my family has ever been to therapy. They always said that our problems were a family matter and it wasn’t anyone’s business what was going on. If had issues, then we needed to deal with it as a family.”

“Whenever I was struggling, people would always tell me that I didn’t need a therapist. I just needed to pray more and go to God with my problems.”

“I always thought therapy was about talking about your past and blaming everything on your parents.”

For people who have never been to therapy before, I believe it is worth it to reflect on and explore your assumptions and expectations about therapy and mental health.

If you don’t know where to start, you can ask yourself questions like, “What do I think about therapy?” and “If my friends and family found out I was going to see a therapist, what would they think or say about it?” 

Once you have an idea of your assumptions and expectations, share them with your therapist at your first session. I promise you, they will not be offended if you tell them that,”I always thought only crazy people went to therapy.” It’s important to talk about these things because it gives your therapist a chance to know where you’re coming from and to meet you where you’re at. It gives them the opportunity to begin gently addressing any misconceptions you may have. 

  • Make a List of Your Questions and Concerns

For therapy to work, there has to be a foundation of trust and safety between the client and their therapist. Being honest about your questions and concerns gives your therapist a chance to begin to alleviate your fears. For this reason, I believe no questions or concerns are too small for a new client to bring up with their therapist.

Whatever fears, questions, or concerns you have about therapy, start making a list of them with the intention of talking to your therapist about it at your first session. 

You can even email the therapist your list ahead of time. Let them know that you’ve never been to therapy before and have some questions and concerns that you’d like them to answer during your first session.

If you don’t know what to ask, here are some questions you can go in with:

  1. Tell me more about your background and your approach to therapy. 
  2. What is your experience working with ______________ issues? 
  3. How long does therapy last? 
  4. How often do you want to meet? 
  5. How long will it take to work through __________ (your issue)? 
  6. How do I know therapy is working?
  7. When do I know it’s time to stop going to therapy?

I am sure you can come up with many more questions on your own if you take the time to think about it. 

Keep in mind that not all your questions may be answered at your first session. It’s okay if that’s the case. These questions are simply a starting point for you to begin to develop trust with your therapist.

Conclusion

I know I’ve given you a lot of food for thought. Going to therapy for the first time can be intimidating, but it doesn’t have to be. I hope this guide helps prepare you for your first session.  

In my next article, I’ll go into more detail about what a typical first therapy session might look like. 

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