The First Therapy Appointment – Therapist’s Perspective

The First Therapy Appointment – Therapist’s Perspective

First Therapy Session


Many therapy client’s may wonder, what does a therapist think about before they see a new client for the first therapy appointment? 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 (see blog on ethical questions to ask yourself). Usually I contact my client before the session. This allows me to schedule my own appointments with at least basic understanding of why they are coming to see me.

First Session

For me, first therapy 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, Cognitive Behavior Therapy (CBT) and Dialectical Behavior Therapy (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. 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 therapy appointment, there is never enough time to cover this (see tips for online practices – 5 Ways to Stay Personally and Professionally Engaged While Running an Online Therapy Practice). 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.

Client’s Story

As I begin to take in the client’s story and listen for the unspoken messages, I am usually thinking:

  • Am I 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 questions that go through my mind during a first session.  These same questions and others 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 am never fully prepared for everything that is presented to me. My hope is someone is willing to trust me enough to share private and painful aspects of their life while helping them feel at least some relief, and most importantly…not hurt them.

Therapy Session Review

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 therapy appointment.

For a related article about tips on Intake Sessions, check out Tips for Navigating Intake Sessions on GoodTherapy website.

December 13, 2016 / iTherapy Blog, Online Counseling

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