Every therapist approaches their first session in their own unique way. I recommend that you ask your prospective therapist what their approach is. Sometimes therapists delineate a first session as an Intake Session or a Consultation Session. Other times therapists jump into therapy work in the first session.
Prior to even a first session, therapists gather information from a prospective client (typically through a phone call) about the issues they are facing and their goals for therapy. Some sample goals I hear are:
Reducing anxiety or depression symptoms
Improving communication in a key relationship (such as romantic, family member, workplace, or friendship)
Reaching a decision (often related to career, relationships, or faith)
Reducing conflict in a key relationship
These goals are guides for the therapy work. Sometimes they are worked on explicitly, and other times serve as a backdrop for conversations and tools.
When I begin with a client in the first session, I normally ask the client how they would like to start. I often get an “I don’t know…” response, so I try to offer two suggestions as potential options:
#1: Give a broad overview of your life, covering the high and low points, general history, key relationships, and decision making. This is often a chronological story. The purpose is to get the therapist up-to-date on where the client is today and how they go there.
Aside: sometimes if a client has seen a therapist in the past it can feel daunting to spend time retelling their story. One thing I have personally found helpful is to have a client type up this information. Not only does it save in-session time, but it can be helpful to the client as they put words to their experiences. For me personally, I include this in the work for no extra charge. Other therapists may have a fee for this, since we bill for our time.
#2: Start with something specific and go into details, where we’ll fill in the gaps as we go along. This can be a pressing issue or specific symptoms the client is experiencing. Likely there will be discussion about the past, but the scope is narrowed on one specific topic.
My personal approach as a therapist is non-directive. Thus, I don’t subscribe to one therapy model (like CBT, DBT, psychodynamic, etc.) or to a treatment plan where each session has specific elements.
While I want to include three specific components in each therapy session – compassionate listening, psychoeducation and tools, and empowerment (listening to your voice and planning how to confidently express it) – I don’t have an approach or plan for achieving these, they naturally occur in the course of the session.
To that end, I start most therapy sessions with the question to the client: “What do you most want to talk about today?” Because I see the client as an expert in their lives, I want to follow their lead and be a partner with them on their life journey. While I am an active participant in sessions – asking questions, making observations, noting patterns, offering tools or psychological information – I don’t set the agenda for the topics because I believe it’s the client who knows what’s most important and pressing at this point in time. It gives them a chance to take stock of their lives and decide how to use the therapy. I might wonder about things – or even challenge clients – but I have complete confidence in them to direct their life and reach a place of joyful thriving.
In conclusion, as I’ve noted above with my personal approach, each therapist has their own format for therapy sessions and you’ll want to ask any potential therapist what their approach to a first session is. Here are other good questions to ask a potential therapist too. We’re used to getting all of these and will comfortably be able to share all of our answers with you!
(To note, a Consultation Session is a way for the therapist and the client to explore working together in a therapeutic capacity without committing to a long-term relationship. My practice offers this option and we do so in that it allows clients to see what we’re like in a therapy session (after we have a 15-minute phone call to connect and discuss general areas of therapeutic expertise such as anxiety, depression, grief, interpersonal relationships, faith, etc.), and it also allows for us the clinician to ensure that we will be a good fit for the client. Most often the introductory phone call gives us a good sense; however, the Consultation Session allows us to really see. If either the client or the clinician does not think it’s a good fit, then we discuss next steps. Clients often seek out another therapist, and if it’s me the therapist who deems it unfit I offer the client referrals to other clinicians who will fit them better.)
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