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  • Writer's picturecoswaycbt

Starting Therapy? Here's What to Expect.

Updated: Mar 5

Two people in a therapy session

Following on from previous posts which busted common myths about therapy and discussed finding the right therapist for you, I thought it might be helpful to write about what to expect in your first therapy session.

Your First Therapy Session

Starting therapy might feel like an intimidating experience, especially if it's your first time.

You might feel nervous about meeting someone new, not really knowing what to expect from the session, or perhaps feel scared to discuss your personal issues with a stranger.

A therapist holding her glassess whilst listening to a client

Lots of us don’t like uncertainty and that can lead to us feeling anxious about what to expect – we might worry that we’re not going to be able to express ourselves clearly, or we might worry about how the therapist is going to respond to our problems. I have had clients who have worried that I wouldn’t take their problems seriously because of thoughts like 'there are far worse off people in the world than me', or at the other end of the spectrum some have worried that I will discover that they are crazy and I’d have them locked up!

Please rest assured that from my perspective 'no problem is too small' and I certainly don’t have the power to lock people up!

So, whatever stories your mind might be telling you about taking that first step in therapy, try to remember that you are taking a brave and positive step towards improving your mental health and well-being by doing this!

There are lots of different reasons why people seek therapy.

It can be for things such as managing mental health issues like depression or anxiety, processing past traumas or grief, or improving relationships; it can also be for simply gaining personal insight, growth and development.

Two people in a therapy session. The client is slouched on a sofa and the therapist is listening intently

By going to therapy you get a confidential and non-judgmental space for exploring your innermost thoughts and emotions, and while that can be a scary thought, the fact that you are doing it with a trained professional means that you will be gently guided towards achieving the goals that you set yourself whilst in a safe and supportive environment.

Your therapist is there to walk alongside you and support you for every step along the way of this new journey you are on.

Therapy can be a really powerful tool for personal growth and improvement.

With a little preparation and an open mind, you can approach your first session with confidence and optimism.

Preparing for Your First Therapy Session: Setting Goals and Expectations

You will get much more out of your first therapy session if you do some preparation beforehand, so to prepare yourself mentally beforehand try to think about what you hope to achieve by going to therapy and what the issues are that you'd like to address.

Therapy is designed to be a collaborative process, so try to approach your first session with an open mind and a willingness to engage fully by sharing as openly as you can your personal thoughts and feelings.

This may feel daunting at first, but your therapist is trained to provide a safe space for you to feel comfortable and supported whilst doing this.

A woman making notes during her online therapy session

When you prepare beforehand and bring a list of concerns with you to your sessions it can help you to stay focused and also remember to talk about everything that you want to discuss - I have had clients message me afterwards telling me that they had wanted to talk about something but it completely slipped their mind in the moment.

Having a notebook with you to take notes is also really helpful as it's common for people to forget some of the details that have been discussed in their therapy sessions in the hours and days afterwards.

There has been research that shows that our retention of information from therapy sessions can vary greatly, not only from individual to individual, but also for the same indidual from session to session.

The amount we retain will be affected by things like the level of emotional arousal we experienced during the session, the length of time since the session occurred and the complexity of the information that was discussed.

So What Actually Happens in Your First Therapy Session?

The first therapy session is an opportunity for you to share your concerns and begin building a connection with your therapist.

During this first session, your therapist will likely ask you some questions about your mental health history, your reasons for seeking therapy, and your goals for treatment.

They will probably also ask about any previous treatments or therapies you have tried, so that they can get a sense of what has and hasn’t been helpful for you in the past.

Two people in a therapy session. The client is slouched on the sofa whilst talking to the therapist, who is making notes.

Your therapist may ask about your current support system and any coping strategies you use to manage stress or difficult emotions, and ask you to identify what the current stressors or challenges are in your life.

It's not unusual to come away from the first session feeling like you haven't 'got started' yet, but this initial discussion is really important to have with your therapist so that they can properly assess your needs and develop and effective treatment plan that is going to be individually tailored to you and your individual goals.

You should, however, have a better sense of what to expect from therapy and, most importantly, whether or not your therapist is a good fit for you.

Building Trust: Establishing a Strong Therapist-Client Relationship

This new relationship that you are forming is a cruical aspect of the therapy because your therapist plays a crucial role in providing a comfortable and non-judgemental space where you can feel safe to share your thoughts and feelings freely.

As a therapist I help my clients to understand their feelings and behaviours better, to help them set achieveable therapy goals with the appropriare support and guidance to achieve them, whilst all the while taking into account the unique preferences and needs of the individual in front of me.

I am aiming to help my client develop coping mechanisms and tools to given them agency in managing their own mental health, so that they feel supported and empowered to work towards improving their wellbeing.

Two people in a therapy session. The client is out of focus but his distress is still visible. The therapist listens compassionately.

If you don't feel that your therapist is the right person to support you in this way, then don't feel embarassed or scared to say so.

My only interest is in helping people get better and I realise that I am not going to be the right person for everyone in that respect, so I never take offence if someone decides I'm not a good fit, and I offer to find an alternative therapist that I think will be a better fit for them if such a scenario arises.

I am sure that my colleagues in the field feel the same way; we just want you to get better!

It's also important to understand that as the client you also have a vital role in your own healing journey - your therapist isn't going to make you better, it's a team effort.

Think of your therapist as being like a sat nav directing you; at the end of the day you are the one who decides where to go, not them.

Just as you don't have to follow the directions that your sat nav is telling you, you don't have to follow any of the suggestions your therapist makes, but by being open and honest you can both work together in developing personlised coping strategies and tools for managing your mental health and well-being.

When you feel comfortable with your therapist, you are more likely to develop the willingness to explore your thoughts, feelings and behaviours because you will have a safe and suportive environment in which to do this.

Working through your challenges in therapy can be very scary, afterall you are making yourself vulnerable and addressing some really difficult emotions or experiences, but by being brave and building a strong relationship with your therapist you can work towards making positive changes that will benefit you in the long term.

Taking an active role in your treatment by engaging in between session tasks to practise the skills that you are learning in the sessions is not only empowering but also allows you to give valuable feedback to your therapist in the next session so that they can hone the therapy plan to make sure the treatement is meeting your unique needs and goals.

A therapist and client sit alongside each other on a sofa. The therapist listens intently as the client explains something.

Hopefully, what you're realising from my description of the process is that the relationship between the therapist and the client is a partnership; both the therapist and the client work together towards the common goal that has been collaboratively agreed between the two - ie improving mental health and well-being but in a personalised and individual way to meet the needs of that particular client.

The key elements for building a positive therapeutic relationship are effective communication, honesty, and openess (in both directions).

Setting Therapy Goals

As I mentioned above, therapy goals are an essential part of the therapeutic process as they help set expectations and can be an incredibly helpful part of the process of helping you achieve a better understanding of your mental health needs - it's important to understand what exactly the problem is before you try to solve it...and that may not actually be what it first seems when you start to scratch the surface.

A client having an online therapy session; his therapist is visible on the screen of his laptop.

Working collaboratively with your therapist to have some idea of what it is that you want to get out of doing the therapit can help you be more focused and motivated.

When there aren't clear goals it can be possible to drift or jump around in an unfocused way over the course of multiple sessions, so having a clear direction of travel can provide a sense of purpose for the therapy journey because you can track progress and celebrate small wins as you go, which will not only be rewarding and affirming but will help you feel more in control and empowered in your therapy journey.

The Role of Confidentiality in Therapy Sessions

Confidentiality in therapy is paramount to being able to build a strong trust between the therapist and client, and helps the client to feel safe and secure.

If your therapist hasn't discussed confidentiality with you then ask them about it, because it is essential that you can be sure that your personal information will be kept private.

All therapists have professional and ethical obligations to maintain confidentiality to protect their clients' privacy and they must be transparent with their clients about their policies and procedures - you should feel assured that your privacy will be respected and that anything you share in therapy will be kept confidential.

Often these matters will be set out in a therapy agreement between you and your therapist, and it should explain what their retention policy is for any records that they are keeping.

Therapists are bound by confidentiality not to disclose any information about their clients without the express permission of the client.

There are some exceptions to this, such as when the therapist is legally required to disclose specific information for a court case (but this has to be ordered by a judge) or when a client's safety is at risk.

Nonetheless, in the noraml course of events, therapists strive to maintain privacy to ensure that their client feels safe and supported throughout their therapy journey.

A therapist listening intently to her client as she explains her challenges

Therapists have a duty of care to their clients which means that they have a responsibility to provide competent and ethical support whilst simultaneously respecting their clients' autonomy.

This means that they should avoid doing anything that could hurt their clients in some way and they should follow professional ethical guideliines to ensure that their clients are receiving the highest quality of care possible - this is why it is important to check out the qualifications of your therapist and choose someone who is registered or accredited with a professional body.

I discuss this in my previous post about how to find the right therapist.

Common Questions and Concerns about a First Therapy Session

Some common questions and concerns that people have about their first therapy session include:

1. What should I expect?

Many people are unsure about what to expect during their first therapy session, and can get very anxious or nervous about it.

They might be wondering what kinds of questions the therapist is going to ask them, or how long the session will last, and what they should do or say.

Hopefully I have addressed these sorts of concerns with what I have told you so far.

2. Will I feel comfortable?

It's normal to feel a bit uncomfortable or awkward during your first therapy session, and even in some of the subsequent ones.

This is because you are sharing personal information with someone you don't know and it's going to take time to build trust with them.

Some people do worry that they won't feel comfortable with their therapist or that they won't be able to build a trusting relationship with them, which is perfectly normal as you are meeting this person for the first time.

3. Will therapy really help me?

Some people may have doubts or reservations about whether therapy can really help them, wondering if their problems are too big or too complex to be resolved through.

Others may worry that therapy could just be a waste of time and money.

It is important to share these concerns with your therapist so that they can allay your fears and reassure you.

4. What if I don't like my therapist?

As I've said above, it's important to find a therapist who is a good fit for you, but sometimes it might take a few sessions for you to work out if you and your therapist really are a good match, and that's really not a problem.

If you feel uncomfortable with your therapist or if you don't feel like you're making progress, it's important to discuss your concerns with them and explore other options.

Remember, they have your best interests at heart (they wouldn’t be doing this job if that wasn’t the case) so they won’t take offence and they will be understanding if you feel that they’re not a good fit, even if that's after you've been meeting for a few sessions.

After Your First Session

Once you've had your first therapy session it can be a good idea to take of bit of time to reflect on how it went and how you're feeling about everything.

It's really not unusual to experience mixed emotions after the session and often people can feel quite drained because they have expended a lot of emotional energy in discussing all of their challenges.

A person about to write in a journal whilst enjoying a cup of tea

Remember to be gentle and kind with yourself, allowing yourself the time and space to process your emotions at your own pace, perhaps giving yourself the opportunity for a brief walk around the block or a quiet cuppa before throwing yourself back into the thick of things.

If you are doing Cognitive Behavioural Therapy (CBT) then it is highly likely that your therapist will give you some recommendations for between sessions tasks (homework) as this is an integral part of the process, and even if they don't, then you can still develop your own helpful between session tasks by making notes on what you have done or by keeping a therapy journal.

A woman comfortably seated on her bed, writing in a journal, whilst drinking a cup of coffee

It's important to remember that this is a process and you are learning new skills.

If you'd just spent the last hour with a piano teacher you wouldn't be a concert pianist already, and the same is true of this process.

It may take time for you to see progress and results; often it is when other people start telling you that they have noticed a difference that you realise just how far you have come.

Be patient with yourself and trust the process, but if you have any concerns or questions about your therapy sessions don't hesitate to discuss them with your therapist so that you can work together to address them.


A therapist listens intently as her client explains something

A first therapy session can feel daunting and even a bit scary, but it's an essential step towards getting the help you need to support your mental health and well-being when you're facing challenges that you can't resolve on your own.

Finding a therapist who resonates with you and who helps you create realistic and achievable expectaions and goals, whilst approaching the process with an open mind can help make it a positive and productive experience.

Remember that therapy is a collaborative process and your therapist is there to help, support and guide you through the difficulties you're facing - a bit like your own person life satnav.

With commitment and perseverance you can work towards being the best version of you living the best version of your life.

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