First Therapy Session: What To Expect

*Disclaimer: the information in this post is for educational use only and are not substitute for professional or medical help. Please seek professional advice if you require help in your local area. The information mentioned here are meant as a general guide and might not apply to everyone.


This is the first post in a new series of posts about mental health and well-being. Today, I interview Dr Motaz Sunbul, MRCPsych, to discuss what to expect in the first therapy session and how to make the most out of it. Dr Sunbul is a psychiatry registrar in the UK.

-Dr Sunbul, thanks for joining us today.


=Thank you, glad to be here.


-So, let's dive into it. A lot of people wonder what to talk about in therapy in general but today I wanted to focus on the first session and what to expect from it.

=well, the aim of the first therapy session (or few sessions) is for the therapist to perform a comprehensive assessment (usually called intake session) with a few goals: to understand your problems, to know more about you and to see what type of therapy would be suitable for you and when would you be in a position to start. Because the therapist needs to collect a lot of information, the first session would be highly structured with the psychologist/counselor asking you about things like why you are in therapy, explain to you the type of therapy they can provide and also ask questions about your life. They would also agree some rules with you, like, how long the sessions are going to be and how frequently. So, honestly, you don't even need to worry about what to bring to the first session.

-I understand questions about current issues and so on, what might they ask to get to know me?
=So usually they would ask you about how it was like growing up where you lived, your experience of school and education, jobs and relationships. They will also explore things like family history, any medical or psychiatric conditions you have and any medications. They would also explore your expectations and goals you want from therapy. They will also discuss practicalities like payment (in case of private therapy), confidentiality and some paperwork.

First Therapy Session: concerns about difficult topics

-Umm, what if I can't really think of specific goals? What if you have nothing to say and just go blank?

=That's totally fine! Your therapist should be able to help you reach some goals. These are usually simple and could only be one or just a few. As I said before, the therapist needs to cover a lot of things in the first session so you wouldn't really "blank" that much. You might in future sessions feel like this, and that is also OK, therapists can deal with silence when it happens. I know some people feel very anxious about this that they come to therapy with a list of things that they would like to talk about. You may do this if you think you need to.

-Ok, now I here a lot about this so wanted to ask you: how important is it to find a therapist that you "click" with?


=This is actually crucial to the success of therapy, however, I would say give yourself and the therapist a chance! Attend a few sessions and see how you feel. You want a therapist that you can feel safe & comfortable with, and it can take a while to feel comfortable with a stranger and start sharing sensitive and personal information with them. If after a few sessions you find that therapist makes you very uncomfortable or you just outright hate them, then consider changing the therapist. 


-What about crying? Does everyone cry in therapy?


=Not really! Some people cry every sessions, others might not cry at all. There are no rules when it comes to crying, other than it IS OK to cry.

-Fascinating stuff! I think a lot of people go to therapy expecting that they will cry which probably would make me more anxious. Now, how quickly would people usually get better with therapy?


=Good question! Unfortunately the answer is: it depends. Therapy takes time and the more chronic and severe the problem is, the more time it could take to get better. Don't expect miracles, and expect ups and downs during the journey. The therapist's job isn't to give you answers or "sort you out" but rather guide you and help you find ways to deal with your problems. So, while there are no easy answers or many big "aha!" moments, there is hopefully a gradual shift in the way you deal with stress and the way you see yourself and others. On average, a therapy Cognitive Behavior Therapy (CBT) for depression or anxiety are between 10-20 sessions. Some others, like psychodynamic psychotherapy might go on for roughly a year.


More On: Things To Talk About In Therapy

-What else should I ask about in the first therapy interview?


=If the therapist doesn't already mention these, it is a good idea to ask about what modality of therapy are they going to use? How long are the sessions and how many sessions might be needed? What do you do if you need to cancel a session? 

-Thanks, that's useful. What if people can't fully open up in the session or you want to say something but you just feel you can't?


=Well, it is important to be as open as possible during therapy...No one said it is easy but hopefully you will feel safe and comfortable enough to share. If you feel you can't cope or talk about something, tell your therapist you don't want to approach this subject, or maybe suggest that you could try later. Sometimes the therapist might even suggest you change the subject, if they think it is too premature to discuss something or too overwhelming for you.


-And generally speaking, am I expected to do most of the talking from the first session?


=Actually, the therapist usually talks a bit more than usual in the first session as they would need to explain to you how the therapy works and introduce the specific modality or school of thought of therapy and practicalities. In later sessions, the patient (client) would be doing most of the talking.


-Some people say this about their therapists: that they don't say much and just listen and sympathize. Is this normal?


=It really depends on the type of therapy. In CBT, or, counseling, for example, therapists do explain some concepts, suggest homework and sometimes ask a lot of follow up question. In a more psychodynamic or analytic approach, the patient is usually encouraged to talk about whatever they want, for example any events from the last week, etc with the therapist doing minimal redirecting or asking questions.


-Ok, any final tips or advice before going to the first session?


=Sure, in addition to the things we already discussed, there a few things to consider:

  • It is normal to feel anxious before the session. You can discuss this with the therapist if there is anything you would like them to do to make things easier.

  • Try to be as open as possible, but don't feel pressured to do so. If you would rather avoid a topic, discuss this with them.

  • If there is anything specific you would like to discuss, bring it to their attention in the first few minutes of the session so you know whether she/he will discuss it in this session or if they think it is better discussed later on.

  • Please, please try to do any "homework" you agree with the therapist. Therapy isn't just the 50 minutes you spend with another person every week or two. This is very important when it comes to CBT for anxiety, or OCD for example. Sometimes this will be a mood or anxiety diary, exposure exercises, etc.

  • Finally, keep an open mind: expect a conversation with a professional and try not act based on quick first impressions and give it a couple of sessions to see if you think you can do this or not.

-Great. I found this really useful and I hope the readers also find it useful. Thank you for talking to me.


=Thank you for having me. I wish you and the readers the best.

 I hope you find this helpful and sending you good thoughts and prayers and wishing you good luck finding peace and good therapy. Please let me know in the comments if you have any questions or well-being topics you would like me to discuss.


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