Many therapy client’s may wonder, what does a therapist think about before they see a new client for the first time? What sort of expectations do therapists set for themselves when clients come into the office?
I try to prepare as best I can before a client comes in for the first time. Sometimes I have background information from doctors or referral sources, which helps me to prepare. As I schedule my own appointments, I have usually spoken to the client before they come in so I have at least a basic understanding of why they are coming to see me.
For me, first sessions are never long enough. There is paperwork to handle, then we discuss ethical boundaries, confidentiality and the therapy process in general. We usually talk about my approach, CBT and DBT and administrative things like “how long are appointments” and how often will me meet”? Once we have “set the stage” so to speak, there is some basic information that must be gathered and then finally… we get to the part we have both been waiting for.
“Why are you here and what do you hope to gain from therapy?”
In a first session there is never enough time to cover this. But there is usually enough time to gain a basic understanding of the concerns that brought the individual in and hopefully enough time to provide some support and most of all some hope. My goal for the first session is to provide hope and to let the client know that they are not alone in their struggle or situation.
As I begin to take in the client’s story and listen for the unspoken messages, I am usually thinking:
I am the right therapist for this person? Do I have the expertise to handle their particular concerns, do I understand their culture or religion? Will we be able to connect on a professional level?
Are there any red flags, barriers to treatment? Did the individual come to therapy to please someone, or because they were required to? Are they open to change? Do they want to work on their identified goals?
How can I best help this person and do no harm?
What is this person looking for? Is it support, a safe place to talk, guidance, solutions or maybe they don’t even know what they are looking for, they just know that they are lost or looking for something?
These are just a few of the questions that go through my mind during a first session and these questions are repeated internally throughout our work together. It is important to keep asking these questions throughout the therapeutic relationship. The nature of the therapeutic process involves unexpected issues, outcomes and people. No matter how many books I read, or how many workshops I attend, I can never be prepared for everything that is presented to me. My hope is that when someone is willing to trust me enough to share the most private and painful aspects of their life, that I am able help them feel at least some relief and most importantly not hurt them.
Preparation is not simply a matter of knowledge, or emotional availability, or good intention. Therapy is more than a “toolkit” of techniques, questions, and homework. It is important to have knowledge of the techniques and interventions that can be used in session, but most important is the courage of just “being” with clients.
My goal is to connect with the individual as that is where the process begins and that begins at the first appointment.