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What to expect during your first psychotherapy session?

Psychotherapy looks quite daunting at first. Here’s the time – you’ve decided to schedule an appointment, you picked the right therapist, your first therapy session is arranged, and the only thing left for you to do is to show up. This is the hardest step to take. So many clients have shared their difficulty in doing so, that I thought it is time to address the issue.

We often call the first psychotherapy session an “evaluation session”. What we evaluate is not the type of person you are, but your general level of functioning. Take anxiety, for instance. If you are a student, you probably experience some degree of exam anxiety which bothers you, but it does not interrupt your day-to-day life much. Frequent panic attacks, on the other hand, can dangerously interfere with the things you need to get done. Therefore, we need to evaluate the extent to which your complaint negatively affects your life so that we can plan your treatment accordingly.

Among the most common questions we ask in order to achieve that goal are the following:

What issue or issues brought you to therapy?

Many times people seek treatment because they have felt bad for a certain amount of time. Try to describe this bad feeling as specifically as possible. If you don’t remember when exactly you felt like this for the first time, take a moment to think about it. I will definitely ask you why you are here today – what is it that you conceive as a problem? When did it begin? And a lot more questions to narrow it down.

What symptoms are you currently experiencing?

The downside of today’s information abundance, besides its questionable origin and quality, is that many people are tempted to self-diagnose. I’ve heard it many times – “My name is Mary and I have a bipolar disorder.” or “My name is John and I have an antisocial personality.” When you come in with statements like this, you expect me to take your word for it. I won’t. Not because I don’t believe you are suffering, but because my training as a clinician has proven that you may be wrong. Thus I would like to know why you think you have such and such disorder instead. What are the symptoms you are experiencing? Mental health is way too complicated to be counted by checkboxes listed online.

What does your life look like now?

If we are to work together, I need to know what your current situation is like. Who you live with, the job you have, your legal and medical status, your hobbies and interests, the friends you hang out with, the typical day you go through. When we plan activities for you outside the session, we must make sure they won’t interfere with your other obligations. The information will also give me cues on how your problem is likely to persist.

What are some important events in your life history?

To be able to help you, I need a general picture of your life. Not a detailed biography, but some useful facts. Those include the place you grew up in, your relationship with your parents and siblings, your experience in school, the jobs you’ve changed, and the partners you’ve had. Often the problems we face are rooted in some of our past experiences, so I will need that information about you when we start looking into the things you want to change.

This is why I like to say that the first session feels like an interview. You talk a lot about yourself and you fill in some questionnaires. Some people feel awkward to do that. So I always stress the fact that whenever you find something uncomfortable, you are free to say so and not talk about it – I don’t mind at all. It’s not an interrogation, it is a discussion in which we are equals. The degree to which you share your personal views is up to you. You won’t be judged or criticized, that’s for sure.

I hope that all of the above will slightly alleviate your going-to-therapy anxiety and be of use to prepare you for your session. I wish you a pleasant and productive journey!

You can see more about me and the cognitive-behavioral approach.

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