Some people are nervous to start therapy. That makes sense. Most people are unsure of what to expect from the psychotherapeutic process and not knowing what it's like often holds folks back from ever reaching out to a provider.
Read on to learn what occurs before the first session, during the first session, and then during the first few months of therapy. Don't forget to click the links embedded for more info and articles!
If we let everything we're unsure about hold us back from trying new things, well, you know, we'd all just be STUCK doing the same thing the same way for all of time. BORING! Let's lean in to those fears and anxieties about starting your healing journey with the guide of a professionally trained psychotherapist. The potential for transformation is huge! If we're willing to step into new, into discomfort, into change.
Okay, you've found a therapist (tip: try asking friends/colleagues for a recommendation, check out psychologytoday.com, or call the member services number on the back of your insurance card and ask about mental health providers in your network for a list of options) you are willing to reach out to and attempt to schedule an initial appointment. Maybe you've called and left a voicemail or emailed the provider or filled out a contact form on a website--great! What's Next?
Before Your First Session
The office manager, admin assistant, or therapist themselves (this usually occurs with small practices) will respond to your inquiry and ask a few follow up questions. Basic questions I ask of new intake requests are 1) What are your reasons for seeking psychotherapy at this time? (what is the "problem?") 2) If you have ever been in therapy before, if so, for what issue or "problem" 3) Insurance you hope to use, or otherwise how you want to address cost/payment for services 4) If someone referred you to me, I like to know who (so I can thank whoever sent you my way!). Any provider will likely ask a few questions to screen initially for fit (Is the issue or concern you have something we can help you with, within our scope and expertise for practice?), this is normal, as therapists are required to be ethically responsible and refer a client out to another provider if the issue is beyond their training or expertise. If this happens to you, don't be discouraged! The therapist you reached out to will recommend a few other therapists that might be a better fit. If your initial contact is a good fit, and after you provide initial info, appointment dates and times can be offered.
Your therapist (or their admin team) will often provide information about your scheduled intake session and then often send you info/link for signing up for a client portal (these portals are password protected and are a part of your therapist's Electronic Health Records-EHR- system). Then be prepared to complete quite a bit of intake paperwork. It may seem like all the forms are invasive, however, they are very important for mental health practice/treatment. Your new therapist wants you to be well-informed about their policies and practices, as well as, about your rights to confidentiality. So don't huff and puff about it, the potentially excessive number of forms you have to review and sign shows that your therapist is doing their due diligence to protect you from harm.
Extra Tip: If you join one of those "talk to your therapist any time, or text even!" sites and you do not receive information and or are not required to fill out/sign an enormous amount of forms, something ain't right. These forms/policies protect you as the patient/client, ensure you are able to provide informed consent for treatment, as well as, provide information on how things will go with your provider and their practice (expectations). They are necessary to begin treatment.
In this new age of telehealth accessibility to treatment, some extras are now required. Photocopies of your ID and insurance card are to be kept in your EHR and your therapist will need to verify your location EVERY SINGLE SESSION.
The First Session (Intake Assessment)
The first session is full of lots of questions. Your new therapist will be asking about your history, background, family of origin, medical history, symptoms of mental health disorders, past & present trauma, and your current issue, concern, or struggle that is bringing you to therapy for the first time. Sometimes this is completed all on session #1, sometimes this spills over into session #2.
Your therapist will also review intake forms, review policies and procedures (such as late cancellation and no show to appointment policies, and additional fees not covered by insurance), rights to confidentiality, when confidentiality can (and is required) to be breached by your therapist, verify your identity and location (for telehealth appointments), and give you an opportunity to ask questions.
At whatever point (first session or second) your therapist finishes with personal history questions, they likely will discuss goals for treatment, things you want to work on or change, coping strategies you need or want to learn, what you hope to accomplish in your healing journey. I always like to remind my clients that the goals are flexible, not rigid, and we can adjust goals for treatment at any time, they are not set in stone.
Something I personally do as a therapist at the end of the intake, is explain my philosophy for therapy and invite my clients to collaborate with me to reach their ideal self. We work together, not just me and not just you. You = pilot. Me (therapist) = co-pilot.
After the Intake Assessment
So you've 1) found suitable therapist 2) mustered up the courage to reach out to schedule 3) completed and returned all necessary forms 4) showed up for the first session and answered questions 5) provided input for goals and 6) scheduled a few follow-up sessions...what comes next?
Well, you show up for your scheduled sessions. You just start talking about "the problem" (the reason you've come to therapy-- relationship trouble, feeling anxious at work or school, recognizing trauma in your past or present, struggling with misuse of a substance, feeling dissatisfied with life or circumstances etc.) and your therapist will actively listen, ask more questions, listen some more, ask some more questions. Although it may seem by the end of the first session your therapist has boatloads of information about you and your "problem," it actually takes much longer to develop rapport with your therapist and for your therapist to really understand you and how things intersect in your life. I like to remind clients that therapy, and effective therapeutic work/transformation, is built on a relationship (working relationship with clear professional boundaries, of course, but relationship nonetheless) between you and your therapist. This takes time. Sometimes a long time.
It can be scary and overwhelming to just start talking to this stranger about very personal details of your life, and I get it, all therapists get it (most, if not all, therapists have been to or are currently in therapy themselves, we've also had to step into an office or video platform with some unknown provider, divulged all of our personal info in the hopes of healing and transformation), so I say we get it to really empathize with how uncomfortable this can feel if you've never been to therapy before.
I encourage my clients to hang in there, I validate how uncomfortable the process is, and I try to ease their concerns about judgment. It's important to note here, your therapist is trained, and held by ethical standards of practice, to provide a non-judgmental, safe space for all clients to share vulnerable and sensitive information about themselves in efforts to address symptoms, unhealthy thought or behavior patterns, and, ultimately, achieve transformational change. Your therapist is not judging you and is not disclosing the personal information you share elsewhere. We take your confidentiality seriously, we take your vulnerable disclosure seriously, we take your current struggle and dysfunction in your life seriously, and we do not want to jeopardize your progress or any way make you feel unsafe.
I encourage clients to give their new therapist at least 6 months of regular session attendance to determine fit. Developing rapport takes time and becoming comfortable with your therapist will not happen overnight.
Are You Ready To Get Started?
1) Search for suitable therapist on site such as therapist.com, psychologytoday.com, or connect.psychhub.com Or you can ask a friend, medical provider, or your insurance for some options.
2) Send email or give them a call. Be sure to leave identifying information and call back number on a voicemail if you want a therapist or practice to get back to you.
3) Complete all the necessary forms.
4) Show up for your first appointment, on time, and ready to discuss your full history.
5) Attend sessions regularly and give it some time. Developing rapport and relationship with your therapist will not happen overnight.
My hope for whoever is reading this feels more comfortable with the idea of therapy, and spilling your personal secrets to a new therapist. It can feel like cumbersome process to get connected with a provider, complete all the forms, and even to show up at the intake and answer the questions, but I assure you, all the pieces and parts that are required by your provider are necessary steps to get you the best care, in the best way (safely and privately), by the best possible provider for you (at least that's our goal!)
Want to Work with Me?
Sarah is not only a psychotherapist, she is also a trauma-informed life coach and consultant. You can schedule a free discovery call to determine fit for working together: Sarah's Calendar
Sarah also offers Compassionate Self Tool Kits. You can learn more about each by clicking below:
*Bonus Content! Self Care, Self Love, & Self Growth Workbook
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Other Articles By Sarah
*Bonus Content* For a little more information about what therapy is really about, check out my colleague's video explaining some facts vs. myths about therapy. You can find the video here: https://www.youtube.com/watch?v=n9ng3tLSEOA
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