What to Expect During Psychotherapy: The First Session(s)
Cody Kaneshiro, M.S.
Practicum Trainee (2019-2020)
Deciding to engage in psychotherapy is often an important, yet somewhat intimidating process. Emotionally, you may be feeling anxiety, hopefulness, fear, confusion, or possibly a little bit of everything all at once—these are all very common experiences described by those starting psychotherapy, and you are not alone! While some initial nervousness is completely understandable, learning more about your first psychotherapy session can decrease the discomfort. Below you will find some information answering a few of the most common questions people have when beginning psychotherapy.
“What type of provider should I see?”
There are many different types of mental health providers that receive different forms of training, hold different forms of specialization, and possess different educational degrees. The vast array of choices between psychologists, psychiatrists, mental health counselors, social workers, and other clinicians can sometimes make finding a provider confusing and can leave many people unsure about what kinds of services they can expect from their therapist.
One major distinction between different psychotherapy providers is the difference between clinical psychologists and psychiatrists. Clinical psychologists are doctoral-level providers (i.e., have earned a Ph.D., Psy.D., or Ed.D.) who specialize in the diagnosis and treatment of psychological disorders and everyday behavioral problems primarily using psychotherapies as their treatment approach (i.e., “talk therapy”). In contrast, psychiatrists are physicians (i.e., have earned a M.D. or D.O.) who often specialize in treating psychological disorders using medications. Thus, psychiatrists can prescribe medications such as anti-depressants to their patients to treat psychological symptoms, while psychologists largely cannot prescribe medications (except in certain states and territories or within the U.S. Military) and instead rely on various forms of psychotherapy and behavioral modifications. Other providers such as licensed clinical social workers (LCSW), licensed professional counselors (LPC), and marriage and family therapists (MFT) are similar in some ways to psychologists in that they all cannot prescribe medications, but differ in their clinical training and schooling.
“What will my first session look like?”
Your first session with a new therapist will likely look very different than future sessions. The primary goal of the first session of psychotherapy is to collaboratively define the main concerns and goals of treatment. This often means providing details about why you’re seeking psychotherapy, describing your symptoms, providing certain details about your own personal history (such as your family history, relationships, and occupational history), and so forth. Your therapist should also discuss with you information regarding their clinical policies and procedures, their approach to treatment, and clearly explain patient confidentiality.
One understated aspect of the first session is that you should feel comfortable playing an active role with your therapist. You are the best and only expert of your experiences—therefore, you should feel empowered to share aspects of your life that are important to understanding your distress (even if your therapist may not ask you explicit questions about it) and to ask your therapist questions about your treatment. For example, asking your therapist about what future sessions might look like, how long you can expect to be in treatment, and their approach to psychotherapy are all great questions to prompt important conversations around your treatment.
In fact, effective psychotherapy typically involves active participation of both the therapist and the patient. This means that while psychotherapy can be a great source of validation, hope, and positive encouragement, it also requires a fair bit of work and a willingness to challenge ineffective behavioral and thought patterns on the part of the patient. Although your therapist will undoubtedly be the “expert” facilitating your care, you should expect to play a large role in practicing skills and completing psychotherapy assignments outside of sessions. Additionally, you should feel free to voice your concerns, likes, and dislikes throughout the course of psychotherapy; after all, your therapist is only human and cannot read your mind. Doing so can open communication around what approaches are most effective to help you.
“How do I know whether my therapist is a good fit for me?”
Not all therapists are the same! Therapists are human beings just like anyone else, and each therapist may possess different clinical expertise, personalities, communication styles, and so on. Given the many multiple of factors that can impact the relationship between you and your therapist, it can be difficult to make sense of what to look for in a therapist. Fortunately, there has been quite a bit of research conducted in this area; for a detailed account of the attributes of an effective psychotherapist, follow this link to an article summarizing studies conducted around effective practitioners. In essence, you might consider asking yourself the following questions outlined by the National Alliance on Mental Illness over the course of your first few psychotherapy sessions:
· Does your therapist guide you towards your goals?
· Does your therapist show acceptance and compassion?
· Does your therapist challenge you?
· Does your therapist check in with you?
· Does your therapist help you learn?
· Does your therapist practice cultural competence?
· Does your therapist treat you as an equal?
An effective psychotherapist should actively facilitate each of these considerations as part of your ongoing care. Ultimately, it is okay to seek out different psychotherapists to find a clinician that suits your needs.
References
Greenstien, L. (2018). How do I know if my therapist is effective? https://www.nami.org/Blogs/NAMI-Blog/February-2018/How-Do-I-Know-if-My-Therapist-is-Effective
Schimelpfening, N. (2019). What to expect during your first therapy session. https://www.verywellmind.com/psychotherapy-101-p2-1067403
Soeiro, L. (2017). 10 reasons why people refuse to talk to therapists. https://www.psychologytoday.com/us/blog/i-hear-you/201710/10-reasons-why-people-refuse-talk-therapists
Wampold, B. E. Qualities and actions of effective therapists. https://www.apa.org/education/ce/effective-therapists.pdf