What to expect from your first therapy appointment.
Welcome! I am guessing you found yourself to this blog entry as you may have been considering starting therapy, but you also may be wondering – what is going to happen during your first appointment, or even, how do you even prepare? Well, I have you covered! Here are some topics and some things that your therapist may go over with you during your first appointment:
HIPPA and Privacy Policies and Practices
This tends to be the first topic of discussion during an intake appointment. You probably received your intake paperwork prior to your session, and like maybe most people, you skimmed your intake paperwork and signed where you needed to sign. However, it is super important to fully understand what you are signing and what is all involved in the protection and privacy of your mental health information. When you start therapy, all of your information is protected – both written and verbal – unless you sign a release of information to allow your therapist to communicate information outside of the therapy space. If you are a teenager, you information is also protected with the exception of your parents have the legal access to your mental health information. However, most parents want their teen to get the most that they can from your therapy appointments, and therefore understand that privacy is essential to therapy working. Therefore, usually information that is shared with parents are things that both the teen and the therapist are comfortable in sharing, and that is approached in a collaborative way between all three parties.
There are exceptions to this privacy practice and policy, and that is in regards to safety. If a therapist is concerned about the wellbeing and welfare of their client, they do have the ethical obligation to report this information to your emergency contact, 911, the local county, and/or a hospital care system. If you ever have any questions about your privacy while in therapy, it is important that you discuss this further with your therapist during that first appointment, and at any time afterwards if concerns arise. As a therapist, the first and foremost part of our job is making sure our clients are safe.
History – both for yourself and for your family
Generally, most therapists follow an intake form, which involves specific questions they can ask to get to know you more. These questions include topics that involve yourself, your presenting symptoms and concerns, your family and personal relationships, and medications/medical history. Your therapist may ask you about your spirituality, sexuality, cultural information, gender identity, racial identity, and any other aspects of what makes you, you, that would be helpful for the therapist to know. I always tell my clients, therapy is 90% a relationship, and 10% everything else – so it is very valuable to myself to know more about you, so that I can better understand you, hold space for you and your experiences, and support you to the very best of my ability. At any time during the intake session, if you therapist asks you something that you aren’t ready to talk about or would prefer to not share, it is always okay to say “pass” or state that you are not comfortable discussing that. The point is not to have to share everything right away if that isn’t safe for you, but instead to start to create a rapport together so that you can get to know your therapist and that your therapist can get to know you.
Insurance and Payments
Your therapist will want to talk to you about insurance and billing, and if you are private pay, discussion around payments. As a client, it is very beneficial for you to understand how your appointments are being billed, how payments will be handled, and how statements will be sent to you. I know how frustrating at times insurance can be to navigate, and I aim to have full transparency with my clients as far as billing goes. If you have questions about this, it may be helpful to bring those questions to your first appointment so that your therapist can help answer them.
Scheduling
Usually during your intake appointment, your therapist will want to talk with you about scheduling moving forward. This may be questions around if you have preferences of how often you’d like to attend therapy, what availability you have in your schedule for therapy, and if you have preferences with in person or virtual sessions.
Questions for your therapist
This is also a great time to bring questions you may have for your therapist. This appointment is all about assessing goodness of fit, not only for the therapist to you, but also from you to your therapist. Again, therapy is all about a relationship, and most therapists welcome any questions you may have to help start to build that relationship and rapport together. Need some ideas of what maybe to ask? Here are some suggestions:
- Where did you go to school? What is your degree in?
- What sorts of therapy interventions or modalities do you use?
- What are your views on change or how you help clients work towards change?
- What are some things you like to do for fun, or how do you practice self-care?
- How do you handle parent-therapist relationship when you are meeting with a teenager?
- How long have you been practicing?
- What sorts of clients do you like to work with? Are there ages or diagnoses that you don’t work with?
A lot of this may have already been covered in your consultation phone call or video meeting, if you had one of those already. Or you may have read all about this in your therapist’s bio online. However, if you haven’t done this, or don’t know this information and would find it valuable to know, I encourage you to ask.
Diagnoses
One of the things that your therapist may be able to cover with you at the end of your first session – or may not discuss until your second appointment if they are still gathering information – would be your diagnosis. Being in therapy, especially if you are using insurance, means that your therapist is required to give a diagnosis for your mental health care. It is also sometimes informative to client’s so that they have a name or a description for what they may be experiencing or going through. I approach therapy, most of the time, from a non-pathologizing lens (which I will talk more about on a later blog post). Briefly what that means is that symptoms or things you may be going through or that you experience may or may not be always “tied to” a diagnosis. However, they very well may connect with a diagnosis. I approach diagnosing as a collaborative experience, and I invite clients into that discussion. It is helpful to know what you may be thinking, as sometimes you may be going into therapy already having an idea of what you may be experiencing, while others don’t know. If you ever have concerns or questions about your diagnosis, I encourage you to discuss that more with your therapist.
Assessments
Before your first appointment, your therapist may send you assessments to complete to help gather further information about your current experience and past symptoms. Going over these assessments during your intake may be something your therapist chooses to do, and can create more insight and understanding, and provide helpful data to support a diagnosis that you may discuss. These assessments may also be used to create goals for therapy, and may be used to monitor your progress over the course of therapy.
Treatment Plan and Goals
Lastly, if there is time, your therapist may start to ask you about your goals and/or intentions for therapy moving forward. There isn’t always time for this during your first appointment, so your therapist may wait to talk to you about this at your second appointment. As I always tell my clients, you cannot fail therapy, so these goals are not a pass/fail type thing. Goals are more to help monitor, guide, inform, and support you during your therapy experience. Goals give a sense of direction, and that can be beneficial for the progress in therapy. Goals also hold your therapist accountable, so that they can stay focused on what is most important to you. Again, goals are a collaborative experience, and your therapist wants to know what things you would like to see improve and change through your journey in therapy.
You may be thinking – whoa, that’s a lot.
And it definitely can be! A lot is covered during an intake appointment, but that is why completing your intake paperwork prior is super helpful – as some of these things are covered in that, and can be briefly covered again if you have questions. Most therapist also send out a brief questionnaire for new clients to complete, which has some history questions involved, which also helps with lowering the amount of questions asked during that first session.
I typically explain to clients that the first session tends to be the most structured and the most logistical. After that, sessions tend to be a lot more fluid. So if you are leaving your first therapy session going “is it always going to be like that?” the answer is, luckily, no! (: Remember, the point of an intake appointment is to gather information and to get to know each other a bit better. If you leave your session feeling like your therapist got to know you a bit, and you got to know your therapist, then that first session was a success.
