New client? Expectations for Your First Therapy Session

Walking into your first therapy session can be terrifying. Baring your entire soul to a stranger? Seems like the opposite of what your anxiety may want. As a therapist I have a very routine way of starting the FIRST session. The first session is what sets the stage for the rest of the therapeutic relationship. If the client does not feel comfortable, they typically do not return.

If the paperwork was not completed virtually, show up at least 10 minutes early. You will fill out the paperwork on site. You need your insurance information if you plan on using that for payment.

My goal for the first session is to help the client feel at ease. Your therapist should make you feel as comfortable as possible. Starting therapy can be awkward, but it should not be unbearable.

Now that we have established you will most likely be a bit nervous, let’s dive into what a typical first session looks like!

A therapist must introduce themselves to you.

For myself, I always start with a 4-5 minute blurb about myself. I talk about my job, how long I’ve been doing therapy and how I conduct my sessions. Contact information, duty to report, homework, informed consent, and reviewing of cancellation/no show policies are all items covered during that time. We review how the first session is different than subsequent sessions.

In my opinion, the most important part of this discussion is letting the client know they can tell me when I am wrong. I encourage all of my clients to challenge me, if I say something that is off, please confront me. Confrontation is an important part of the therapeutic relationship. This conversation ends by asking if the client has any questions.

Informed consent: (cue the ooos and ahs)

Informed consent is the like the big scary monster in the room to many therapists. It is often glazed over and many clients have no idea what it is, because their therapist didn’t explain it! This needs to be addressed during the first therapy session and should be brought up whenever necessary.

Informed consent should be in your paperwork that you get but also, your therapist should go over it with you during your first session. (If you’re a therapist and looking at how to add this to your practice, I really like this example for wording.)

Okay, so what exactly is it? Let’s dive in. According to Society for the Advancement of Psychotherapy: “Informed consent is a process that involves the psychotherapist sharing sufficient information with the client or prospective client so the client can make an informed decision about participation in the proposed course of treatment. The client provides her or his informed consent based on being adequately informed about what they are considering participating in. With regard to how much information to share in this process, what specific information should be shared, when it should be shared, and in what format(s), the goals and potential benefits of informed consent are relevant to consider.”

Informed consent NEEDS to have the following:

• The nature and anticipated course of the proposed evaluation or treatment.
  • What will treatment look like? How long does each session run? Some therapies are time sensitive. (i.e. “We will see each other for 5, 50min sessions and will reevaluate at 4 sessions to see your progress.) This includes what you need to be doing as a client! Check out my post on What Makes a Successful Therapy Client?
• The psychotherapist’s credentials and relevant professional experience.
  • In Ohio a therapist must have their license displayed in their office. With telehealth this is not always possible, but what you can do is discuss your qualifications.
• The client’s right to refuse or withdraw without penalty, emphasizing the voluntary nature of participation.
  • This means the therapist will not seek any retaliation for you choosing to not come back to therapy.
• Reasonably available treatment options and alternatives, and their relative risks and benefits, to include no treatment at all.
  • As the client, you are allowed to choose your treatment. The therapist has to tell you if they are able to provide that treatment and what the benefits and risks of it are.
• Fees and financial arrangements to include billing, payment, and the role, if any, of insurance.
  • Most recently the No Surprises Act was enacted. This makes it so every medical provider needs to provide you with a breakdown of what a session would cost without insurance. Your therapist should go over all costs with you during the first session, it should also be in writing and given to you.
• Confidentiality and its limits to include all applicable mandatory reporting requirements.
  • Therapists are mandated reporters, I know in Ohio we are! In many states if the client has a plan to harm themself or anyone else, they will have to call the police. This typically does not mean if you tell your therapist you are having suicidal thoughts they will call the police. Their main goal should be to help you slow the thoughts and either get you to a safe place or have you voluntarily go to the hospital. However, your therapist should inform you that they are REQUIRED by law to report.

It is important to note that informed consent is an ongoing process, not a one and done type of deal. If the therapist changes their rates, or stops taking your insurance, they should give you ample notice. (Typically I have seen 3-4 months).

I am sure this seems like a tremendous amount of stuff your therapist will go over, but it is so important to be informed during your first session. Please know that informed consent is not to scare you, it is for the therapist and client to be on the same page to start the therapeutic relationship.

Post Introductions

After the introduction we move to the assessment. Every assessment is different, similar, but different. Some therapists will write your response on a piece of paper, some type while you are speaking with them, they need to be documenting the conversation in some way. The therapist will ask you some questions that may sound like this:

• Can you tell me a little about yourself?
• What brings you to therapy?
• Would you mind sharing with me some family history of mental health?
• How would you describe the feelings/symptoms you are having?
• Could you tell me a little bit about a time that has made you feel anxious?
• You mentioned (insert thing you mentioned here), would you mind sharing a little bit more about that and how it has affected your mental health?

This is the time to be as open as possible. Remember, the therapist is not there to judge you.

Following the assessment, in some sessions you complete the treatment plan, for some therapists this is completed in the second session. The treatment plan are items that you will work on in therapy. It does not mean other topics cannot be discussed, but these are the most important items to concentrate on during the session. This plan is a living and breathing document, meaning you can ask for it to be changed, and your therapist should review it with you as often as you would like or as their policy states.

Before ending the session the therapist should ask if there is anything else you would like them to know. If you, the client say no, then they may schedule with you or if they have someone who schedules for them they will direct you on how to do that.

Citations:

Barnett, J. E. (2015, March). Informed consent in clinical practice: The basics and beyond. [Web article].Retrieved from http://www.societyforpsychotherapy.org/informed-consent-in-clinical-practice-the-basics-and-beyond