Therapy Series Part 2: Your First Therapy Appointment
In Article 1 of this series, Choosing a Therapist, we talked about how to find and choose a therapist. In this segment, I will talk about making your first therapy appointment, how to prepare, and what to expect when you get there. Finally, I will talk about the evolution and growth of the relationship between you and your therapist.
Booking Your First Appointment
Now that you have chosen a therapist, call them and book an appointment. Therapists are notoriously busy, so you will generally have to wait a week or longer for an opening. One tip for booking appointments; most therapists have evening hours. These tend to book quickly, so you may have to wait longer, but evening appointments can be nice because you have a better opportunity to relax afterwards. Also, it’s dark at night so if you are worried about being seen going to a therapist, you do have a bit of anonymity from the darkness.
I generally tried to book my appointments in the late afternoon or the evenings. I did this because I found that when I had morning appointments on work days, I had a lot of trouble going to work after my therapy appointment. You might want to experiment with different times, but for your first appointment I recommend booking one later in the day, just in case it is difficult and you need to have some time to yourself afterwards.
Preparing For Your First Appointment
Before your first appointment, write down any questions that you might have, or any issues that you want to discuss. (for example if you are having particular symptoms) Try to get an idea of what you want to say to the therapist when you first meet them. Writing things down will come in very handy in your first appointment.
On the day of the appointment, you will be anxious, but try to keep calm and relaxed. Take it easy on yourself, and focus on getting through your day, not on the upcoming therapy appointment. Dress in comfortable clothes. (one therapist of mine didn’t like me wearing business suits to therapy because she said I “hid behind them”) Above all, try to relax and keep a positive attitude about your appointment.
When the time for your appointment comes, try to avoid arriving too early. Therapists operate on a 50 minute schedule, which means that the patient before you will be leaving the office 10 minutes before your appointment begins. Take this from my experience; you don’t really want to be there when that other patient comes out. Either you will worry that it is someone you will know, or they could be coming out of a bad session and they will be visibly upset, which could make you upset. Either way, it is better to arrive 5 minutes before your session.
The Session: What to Expect
Well, you’re here. You have entered a therapist’s office. What you will probably see is a couple of comfortable chairs, some art on the walls, a smiling therapist, and a coffee table that will have a big box of kleenex on it.
After this point the conversation is in the therapist’s hands. They will generally introduce themselves, invite you to sit down, and ask if you need anything.
Then, they will ask you how they can help you.
The first question is one of the hardest parts of therapy, but you can get through it. If you have written down the reasons why you want to talk to a therapist, tell them about what you have written. If you think you have a specific condition like depression, say “I think I have depression.” Or, you can simply say “I don’t know why I am here.”
Once you are over this hurdle, then your therapist will generally start asking questions about you, your symptoms, and your feelings about why you are there.
Time Out
This is a good point to mention time outs. If you find that the session is getting very stressful, or if you just want a break, ask your therapist for a short time out. A good therapist will generally sense when you need to take a break, but even if they don’t, they will have no problem with you taking a time out. Remember that the therapist is working for you, so if you need a break, they should have no problem with giving you one.
Beginning Therapy
Depending on the length of your first session (20 or 50 minutes), after getting an idea of why you are there, your therapist will then tell you three things: 1) whether they think they can help you, 2) how they work, I.E., what kind of methods they use, and 3) how their payment structure works.
This is the “deal” part of the session. If you are comfortable with your therapist, that is, you are confident that they understand your problems, and you are comfortable continuing in a therapy relationship with them, then you can begin discussing your treatment and how you will be paying for it. If you are not comfortable with your therapist, then you can choose to either discuss with them what makes you uncomfortable, or you can thank them and be on your way. Remember that there is no obligation on you to continue with a specific therapist.
If you choose to stay with your therapist, then you can discuss your treatment plan and payment plan. Because you are early in the therapy relationship, your treatment plan might still be quite vague. Chances are, your first few sessions with your therapist will involve a lot of testing and diagnosis work. This helps your therapist get a better understanding of your overall mental health and it helps them determine which conditions you might have. However, at the end of your first session, your therapist should be able to give you their general opinion on your condition.
Payment should be the last issue that you discuss with your therapist in your first session. If you are covered by insurance, you will probably make your arrangements at this point. Also, if you are unable to afford your therapist’s fees (they can be quite high) you can ask whether they bill on a sliding scale, or if they are aware of any government programs or charities who can help you pay for your therapy.
Once you have the details out of the way, you are finished your first session of therapy.
Congratulations! Make sure you take the time to go out and celebrate. You are past the first big hurdle!
The Therapy Relationship
Therapy relationships are complex, but there are a few common items that should exist in a good therapy relationship. So rather than try to play relationship doctor, I will list some of the things that I found to be the most important factors in my relationship with my therapists. I will also try to provide you with some idea of how these factors should evolve.
- Trust
Trust is the single most important factor in a therapy relationship. For therapy to work, there needs to be a very high level of trust between you and your therapist. Good therapists will begin building trust with you right from the very start, but trust is a two-way street. If you feel that you can’t trust your therapist, or that they have violated your trust in some way, you owe it to yourself to raise the issue with your therapist so the two of you can discuss it.When you achieve a high level of trust in your therapy relationship, then you will really begin to see the positive effects of therapy. Trust is worth working towards and establishing a trusting relationship should be one of your early goals in therapy.
- Openness
Openness is related to trust. The therapy relationship should be open. Your therapist should be honest about what treatments they are using, and they should be forthcoming with their opinion on your progress. Also, therapists should be willing to discuss with you how they arrived at your diagnosis. At any time, if you don’t understand your therapist’s treatment methods, ask them to explain them to you. For example, when I was treated for post-traumatic stress disorder, my therapist used a treatment called Eye Movement Desensitization and Reprocessing (EMDR). I had no idea what that was, so my therapist explained how EMDR worked, and gave me a bunch of reading material on EMDR to take home with me. - Respect
Therapy can be extremely painful. Your therapist may take you into very disturbing areas of your mind, and they will test your limits and boundaries. There may be sessions when you absolutely hate them. However, there should always be an element of respect in the relationship. A good therapist will always explain why they are doing something, and they will always try to help you recover after a traumatic episode. They will never leave you high and dry, and they will never mock or belittle you. In other words, they will show you respect. If you feel that your therapist is not being respectful, you should bring it up with them. - Compassion
This is a tricky one. For most of us, compassion means loving care. It means the same thing in therapy, however, like any medical procedure, therapy can be extremely painful. Sometimes it might not be obvious that a therapist is showing compassion, especially during the very painful stages of therapy. Compassion is very similar to respect. A compassionate therapist will always be soothing and healing after painful episodes, and they will try to manage sessions so that you will always have time to relax and recover after painful stages of your therapy.
Tomorrow in Part 3: What do Do After Each Therapy Session, I will discuss what to do after each therapy session; including relaxation techniques, homework, and when to contact your therapist.
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Christy responds:
Posted: February 28th, 2007 at 10:22 am →
I’ve had 3 therapists over the past 5 years and each one has asked about my goals in the first one or two sessions. With the first two therapists, I wasn’t prepared for that question. With the third therapist, I knew she was going to ask that question so I had given it some thought. I really like to be prepared to knowing that this question would arise made me more comfortable in that first appointment.
Scott Davis responds:
Posted: February 28th, 2007 at 8:27 pm →
That’s a very good point. I think a lot of people get blindsided by the “what are your goals with therapy” question, and some preparation before the first session would be a really good idea.
Judy responds:
Posted: July 24th, 2008 at 7:04 pm →
I wonder if I should quit therapy, but I don’t know if I’m ready. I’ve talked to my therapist about this and have been told that quiting is up to me and I will know when I’m ready. I’ve asked how I will know but I haven’t had an answer to that question. How can I tell if I’m ready?
Scott Davis responds:
Posted: July 24th, 2008 at 7:46 pm →
Hi Judy, thanks for writing.
That’s a really difficult question. Sometimes there’s no way of knowing if you are ready for therapy until you actually end your sessions.
Here are a couple of things to ask yourself, though, to see if you’re ready.
Are you comfortable with your recovery, and do you feel relatively “in control” of your life and your mental health?
Have you developed good mental health habits such as knowing when to take breaks and knowing the warning signs for your condition?
Have you considered moving your therapy appointments to a longer schedule? For example if you are going once a week, have you thought of changing that to twice a week or once a month?
Scott