What to expect at your first session

Therapists tend to have different approaches to assessment for the first session. The session may be totally open ended, with no or only a few questions are asked, and you just talk as you wish about what is going on. Alternatively the assessment may be more prescriptive, where you’re asked a list of questions which they complete in front of you, or even ask you to complete a questionnaire before or during the session.

Unless you are there with a therapist who is skilled in diagnosis, and that is what you want, therapists won’t diagnose you.  Diagnosis can only be carried out if they are qualified to do so, typically the field of psychiatry and clinical psychologists, and would likely to be over an extended time or a number of hours or sessions. Either way, as a minimum they will want to understand why you are seeking therapy, any symptoms you are experiencing and some background. If you feel you will find it hard to express these you may wish to take some notes with you to provide, read or explore with the therapist.

Here are some questions that you are likely to need to respond or explain at the initial session:

  • Why are you seeking therapy? What issues and symptoms are you experiencing? For example, because of a bereavement, feeling low or work stress.
  • What impact does the issues cause you? For example, your problem might be causing difficulty at work, sleep issues or panicky feelings.
  • What your expectations of therapy and the therapist? For example, you may only have time for set number of sessions or want more direction from the therapist.
  • What you have already tried to help yourself? This may include past therapy?
  • Some information about your background. For example, when your problems started, pervious history of problems and even a description of your family constellation (which is to understand where you fit in your family relationships)

Of course the initial session is an opportunity to assess the therapist and ask questions.

Also If you have any concerns about the counselling contract such as confidentiality and record keeping that can be explored at the first session.

During or towards the end of the session, the therapist is likely to indicate whether or not they could work with you, if not a number of reasons may be given (one for another post). The therapist may then ask you to think about it and let them know if you wish to continue, while other therapists may ask you directly whether you wish to continue. You should not feel pressured to make up your mind immediately, you can simply ask for time to make a decision, you are free to choose.

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