Therapy logistics made simple: what to know before your first session.
Starting therapy, or even just the thought of starting, can feel overwhelming for many of us.. especially for those who have never done it before. When talking to “first timers” I oftentimes hear the same sort of questions from them-
What does the first session look like?
What can I expect from a typical session?
How often do I need to come?
Can I use my HSA?
Am I going to be forced to talk about things that I don’t want to talk about?
Am I going to get homework?
What if I don’t have anything to say or talk about?
How do I know if it’s working?
These are all SO valid, but oftentimes we as therapists forget that these topics aren’t widely known, so they can oftentimes be overlooked in the consultation. I am going to walk you through what a first session will typically look like so that you can feel more comfortable, confident and prepared for when it’s your time.
Prior to your first session, some therapists like to offer a free 15-minute consultation call to learn more about you, what you may be struggling with, your goals for therapy, and to identify if you two would be a good fit for each other - ie. to ensure the therapist is practicing within their scope of practice. Some therapists do not offer consultations calls, though personally I like to to ensure both parties are comfortable prior to meeting in person.
Once fit is decided to be appropriate, the first session is scheduled. Expect to complete some paperwork. This is necessary to ensure we have the proper documentation needed to treat you — oftentimes this will be completed in an online form through a client portal. You’ll be expected to sign documents similar to the following —
Informed Consent for Psychotherapy
Notice of Privacy Practices
Standard Intake Questionnaire
Telehealth Treatment Consent
Good Faith Estimate
Credit Card Payment Consent and Payment Info
Give or take a few depending on practice specificities.
Once the documentation is signed and dated, we can meet!
First sessions can be nerve-racking, but I am here to tell you, if you find the right therapist that you feel comfortable with, you will feel that stress lessen rather quickly after arriving! Let’s go through those questions from above to help you feel more comfortable!
What does the first session look like?
First session will typically start with you arriving to the office (or if virtual logging on to a secure HIPAA compliant platform), checking in at the front desk (if applicable), taking a seat in the waiting room where there may be complimentary snacks and drinks (like at Emerge Counseling :)). Once your therapist is ready for you, they will come out and greet you and direct you inside the office. Therapy offices are oftentimes quite cozy, so feel free to get comfortable!
Once in the office, the therapist will take the lead. At Emerge Counseling, I first go over the paperwork you signed and explain a bit about how the first session will flow. For myself, and many other therapists, the first session is an information gathering session. I structure it to first gather information about your family unit growing up, family relationships and other important attachments you had in childhood. Next I go into asking about major events from childhood to allow for better understanding of events that have shaped you consciously or unconsciously.
Here is where I am really able to better understand your attachment style, you as a person, and make sense of your feelings and behaviors. Depending upon how much information you share/have to share this could take 1 to 3+ sessions to get through. Some people see this as the reason they are in therapy — to process through their past, while others want to discuss a more present-focused topic. This shapes the direction of therapy as a whole.
What can you expect from a typical (ie. not a first) session?
Once the history taking session(s) is completed, we get into the actual therapy. A typical session will start with me asking how you have been since our last session and then asking “what would be most beneficial for us to dive into today?”. I am at my core a very collaborative therapist. I want to make sure that the hour that we are together is as beneficial for you as possible. So I am always going to go with what you want to discuss. If you are unsure what would be more helpful, then I go back to your goals (such as “I want to understand myself better” ie. let’s talk about how your thoughts and behaviors may be conflicting against your value system. Or “I want to decrease my people pleasing” ie. let’s talk about how you may have felt emotionally responsible for your parental figures growing up.). We also must remember that some sessions will be amazing and you will uncover seemingly life-changing information about yourself, while others may be more mundane. That is to be expected! We need time to sit with and process thoughts and feelings in order for us have these more intense conversations. Give yourself the gift of time and let’s see where therapy takes you!
How often do I need to come?
Expect to come more frequently in the beginning, and as time goes by, decreasing frequency. Unlike many services, in therapy the goal is to NOT need to keep coming longterm. I typically say weekly for the first month to establish a therapeutic relationship and get through the history taking sessions. From there we will typically go down to every other week and then every three weeks, monthly and so on. Some clients achieve their therapeutic goals and no longer see the need to come frequently or at all. Other clients, even after they have achieved their goals, like to be seen monthly or even quarterly for “check-ins”. It all depends upon the individual as to how therapy evolves.
Can I use my HSA?
Yes! As long as your HSA has a credit card with a CVV code on the back, then there should be no issue using your HSA account through your work to pay for therapy.
Am I going to be forced to talk about things that I don’t want to talk about?
Nope! Will there be things that your therapist asks you that you are going to recoil from because you may not want to confront it? Sure. But if that is the case, we talk about that reaction to the question and allow that to be the topic before jumping into the uncomfortable topic.. I will never force you to discuss anything you do not want to or feel ready for. My job is to accompany you through these difficult topics, not force anything upon you.
Am I going to get homework?
Maybe! This depends on the type of therapy you are engaging in. For example, if you are doing a more structured form of therapy such as manualized CBT or DBT, expect some “homework”. Homework may look like worksheets, activities to do outside of session, or exposures. At Emerge Counseling, I typically do not give out traditional “homework” per se, but I do suggest or recommend certain activities, grounding strategies, or goals for to work on prior to the session.
What if I don’t have anything to say or talk about?
Oh, the dreaded silence. This is ok! If there is a lull in conversation, that is normal and sometimes on purpose! Silence can be a helpful tool to allow for reflection. But, if you are worried that you will have no idea what to talk about in therapy, just know that your therapist will walk you through everything. If a client does not know what to talk about that day, I will ask about things we have previously discussed in sessions, their history, or their goals. If we have covered all of these things and session after session it feels like you don’t have anything to discuss, then maybe you may be coming to the end of your current therapeutic journey!
How do I know if it’s working?
One way you can tell if therapy is working is if you are going through a difficult spot in life and you are noticing you are handling things differently.. maybe even better.. then you previously would have. Sometimes it’s really obvious if therapy is working — you’re not crying everyday, you are able to go to the grocery store without panicking, or you’re able to communicate more effectively with your partner leading in fewer arguments. Other times, the improvements may be a bit more covert — the aching pain in your back has decreased, you’re not doom scrolling as much, or you’re not as exhausted after talking to your mom.. Take note of the small changes. Small changes can make huge ripples in your life that have a lasting effect on your wellbeing. Changing your thought patterns and behaviors are not easy, and no matter how big the change, it is worth celebrating your courage and commitment to being your best version of you.
If you are starting therapy, or just thinking about starting therapy, you got this! It can be scary but you are worth it. If you know a friend who is worried about starting therapy, send them this article to help ease their minds.
If you are located in Wisconsin and want to start therapy with me, Anika Vallejo, LPC, click here to set up your 15-minute consultation call.
