Psychotherapy 101: What to Expect in Your First Session

Written by: Mary Vuksanovic- Registered Psychotherapist, Qualifying

First, I was to commend you for being brave in taking this first huge step towards improving your mental health and well being. You are probably feeling nervous about what to expect in your first therapy session and this is completely normal! I often hear the question “how can I prepare for therapy?” The answer is very simple, just be yourself! There is no right way to do therapy other than being your genuine and authentic self. Remember that in order to help the therapist best understand your experience from your perspective we recommend trying to be as open and as honest as possible. I know this can feel scary but don’t worry, our therapists are highly skilled psychotherapists, and it is their job as a professional and expert in mental health to create a safe and nonjudgmental space for you to share.

What do our sessions look like?

Firstly, we strive to make the process as collaborative as possible, including you in all the therapeutic steps along the way like goal setting, treatment planning, progress checks, choosing homework to work on between sessions and deciding when treatment is coming to an end.

Your first few sessions will be focused on sharing your experience and building a relationship with the therapist, to promote open and honest communication as therapy progresses. Creating and maintaining a strong therapeutic relationship is our priority! Remember you are the expert on your life, so it is important to help the therapist gain a thorough understanding of your thoughts, feelings and experiences.

During the first few sessions your therapist will complete an extensive biopsychosocial assessment which will include gathering information about your background, childhood, current life, habits, interests, social life, cultural experiences and psychological functioning. We use this comprehensive approach to gain a holistic picture of what you are experiencing, to find the root of your concerns and create a specialized treatment plan to help reduce your distress. Once they have enough information your therapist will help you process your past experiences, understand and work through your emotions, work on creating healthier thinking patterns, and help you develop effective and practical coping skills that promote healing and improve your mental health.

What you can expect during your first session:

1. Obtaining your consent and discussing confidentiality: Your therapist will go over the risks and benefits of therapy and inform you that therapy is private and confidential, obtaining your written and verbal consent to continue. This process will be on going, your therapist will consistently check in to make sure that you are on board with everything you are doing in your sessions and that you agree to each step in your treatment, making the process as collaborative as possible.
2. Background gathering: The therapist will ask you questions about yourself and your reasons for seeking therapy. They may ask about your current situation, past experiences, childhood, important relationships, habits, hobbies, current coping skills, symptoms, thought patterns and behaviors. This is to get a sense of what you’re struggling with and to better understand the root cause or other factors that may be impacting your mental health.
3. Discussion of therapy approach: The therapist may describe the therapeutic approach they believe will be best suited to help you overcome your challenges while also allowing you to provide your own input on treatment planning. This is a good opportunity to ask questions and share about your experiences with past therapeutic approaches that have been helpful or not helpful. At Vital Minds Psychotherapy, our therapists are trained to use a person centred holistic and integrative approach creating a treatment plan that is specific to your needs and incorporated various therapeutic approaches such as CBT, ACT, DBT, IFS, Somatic therapy and more, to find the right skills and tools that are best suited to you.
4. Goal Setting: During the first few sessions the therapists will help you set therapy goals based on the information you’ve shared. Together you will create a plan for achieving them and discuss your preferred outcomes. How will you know when you are better? What will that look like? During this stage our therapist use a solution focused approach to stimulate your creative thinking processes while helping you maintain a realistic outlook on your future. Therapy goals are then broken down into manageable chunks reducing the feelings of being intimidated, discouraged or overwhelmed by goals that feel unobtainable or out of reach. Setting small attainable goals will help you stay motivated, increase positive reinforcement, reducing feelings of failure, and keep you focused on your healing process.
5. Assessing severity of symptoms. Your therapist may ask you to answer some questions about your experience in the past few weeks using formal assessment instruments. A score will be generated based on your responses which will help determine the severity of your experience providing both you and your therapist a better idea of where you are at today, establishing a set point to help measure your current level of distress. Your initial score can be used as a comparison down the road in treatment when your therapist reassesses your symptoms during progress checks.
6. Asking for feedback: At the end of each session your therapists will ask you for feedback to help determine your take aways from the session. We regularly check in to see if the session was helpful for you and if any changes need to be made. Honesty is the best policy as this is truly your therapeutic journey! We will never claim to know what is best for you.
7. Wrapping things up: Your therapist will summarize your session in an overview, collaborate with you on homework or provide you some practical tools to work on between sessions. Payment will be taken at the end of the session using a payment method of your choosing (we do not bill directly at this time). Your therapist will book you in for your next few sessions to limit any scheduling conflicts. We recommend booking 4-5 sessions in advance for consistency and to ensure your slot is available.

How to prepare for your first session:

1. Arrive early: Arrive a few minutes early, check in with reception and make yourself comfortable in the waiting room. Please help yourself to a drink (coffee, tea, water!) Our washroom code is 2041. If you are attending therapy from the comfort of your own home, a link will be sent to your email from our online clinic platform called Janean hour before your scheduled session time.
2. Take notes: To help you get the most out of your first session, it may be helpful to write down important topics you want to cover! We also recommend you take notes during your sessions! It can be hard to remember everything.
3. Don’t be afraid to ask questions! If you are not comfortable or sure about something the therapist says or does, please ask for clarification. Therapy is a collaborative process, and it’s important that you feel comfortable, understood and provide ongoing consent throughout the entire process.
4. Aftercare plan: Therapy can bring up painful emotions and leave you feeling tired and drained.  Make a self care plan to take care of yourself after your session. Practice self care, whether it’s curling up on the couch, going for a walk, taking a warm bath, calling a friend, replenishing your resources or doing whatever comforts you. Feeling tired or emotional after a session is absolutely normal!

Overall, your first therapy appointment can come with a bag of mixed emotions such as excitement, or anxiety. But just remember, you are taking a big step toward improving your mental health and well being! Sharing your feelings can feel uncomfortable and awkward but with time and the right therapist, you can finally feel safe being vulnerable, express your emotions, process your past traumas, and develop skills and tools to tackle life’s most difficult challenges. Our goal is to leave you feeling empowered, confident, or just lighter at the end of each session. If you haven’t already, book your first therapy session with one of our experienced therapists. We offer in person therapy in Hamilton or online therapy across Ontario. Don’t forget to ask about our Affordable Therapy Program.