So you just made your first therapy appointment. Maybe it’s your first session ever. Or maybe you’ve talked to someone in the past but now you’re about to meet with a new therapist. Even though you know you’re taking a positive step, you may still feel apprehensive.
“It’s OK to be nervous! You’re meeting someone for the first time who is likely going to ask you some very personal and emotionally sensitive questions and you’re expected to be very honest and forthcoming with them,” Gina Delucca, a clinical psychologist in San Francisco, told HuffPost. “It’s a very unnatural and nerve-inducing type of situation, and as therapists, we try to be sensitive to this.”
To ease your pre-appointment jitters, we asked therapists to reveal what they typically bring up with clients during the first session. Below, they share what you need to know to start (or re-start) therapy on the right foot.
Questions You’ll Probably Be Asked
Before your first session, your therapist will likely send over some intake paperwork to fill out. One of those documents will probably be a questionnaire that asks for your medical history (including any medications you’re taking), mental health services you’ve received in the past, current issues or stressors, and what you hope to get out of therapy. The therapist will review your responses and may want you to elaborate on them during your initial session together.
Here are some of the questions you may be asked and why:
1. What prompted you to seek therapy now?
The therapist wants to know if there’s something going on in your life that pushed you to make the appointment when you did. It could be anything from a messy breakup to a conflict with a family member, unmanageable levels of anxiety, a sexual assault or some big life change like becoming a parent or starting a new career.
“We are interested in knowing what event or experience preceded you deciding to get some help to help us understand the nature of the problem and what you are wanting to work on,” said Kate Stoddard, a marriage and family therapist in San Francisco.
2. How have you been coping with the problem(s) that brought you into therapy?
Delucca asks her new clients this question to learn how they handle stressful situations and difficult emotions. Do they turn to something productive like meditation or spending time outside? Or do they rely on unhealthy habits like excessive drinking or drug use?
“I find it helpful to get a sense of my client’s current coping skills and resources so that we can utilize or build upon them in treatment,” she said. “Second, this allows me to assess whether my client is engaging in any unhealthy coping mechanisms that could be exacerbating the problem and may potentially impact treatment, like avoidance, substance use or self-injury.”
3. Have you ever done therapy before?
If you’ve talked to a therapist in the past, it’s likely this person did some things you liked and others you didn’t. Your current therapist can use this information to help treat you in the most effective way, explained Los Angeles-based marriage and family therapist Danny Gibson.
“If the experience was positive, why was it positive? If not, why was it a negative experience? What would you like to do differently?” he said. “The client drives the therapy session ― I act as the useful guide.”
If you answer no to this question, “the therapist can spend more time orienting you around the structure and process of therapy and how it works,” Stoddard said.
4. What was it like growing up in your family?
Many people enter therapy to gain a better understanding of themselves and how they relate to others. Learning about a client’s childhood and their family dynamics can offer insight into the person they are today, said Zainab Delawalla, a clinical psychologist in Atlanta.
“Although it is not a given that people will repeat the same roles they adopted during childhood, often the pattern of relating that they develop is tied to how they have internalized certain role expectations in the past,” she said.
5. Have you ever thought of harming yourself or ending your life?
For those who have experienced suicidal thoughts or harmed themselves in the past, these types of questions may bring up difficult emotions. But it’s crucial for your therapist to know this information from the get-go.
“Most clinicians will want to know if you’re struggling with thoughts of self-harm from the very first session so they can be sure they are recommending the appropriate level of care,” Delawalla said.
If you answer yes, Delucca said you can expect follow-up questions like: “Are you having current thoughts of suicide?” “Do you have a suicide plan?” “Do you intend to act on these thoughts?” and “Do you have the means to carry out the plan?”
6. How connected do you feel to the people around you?
Loneliness can have serious mental and physical health implications. So your therapist wants to know if you already have a solid support system in place. If not, they can help you work on building one.
“There is lots of research that documents the importance of social support in maintaining psychological well-being,” Delawalla said. “Having a good understanding of your social network will help your therapist know how to best use your social support resources to augment treatment and whether bolstering social support should be part of your treatment goals.”
7. What do you hope to accomplish in therapy?
“It’s helpful to explore this question in more depth during the first session to hear the client’s expectations for therapy and also to help them manage their expectations about how the process of change works through therapy,” Stoddard said.
When setting your therapy goals, be as specific as possible about what these improvements in your life might look like. Instead of just saying you want to be “more self-confident,” think about what some concrete markers of that change would be.
“For example, how would you know if you were more self-confident? What would you be doing differently if you were more self-confident?” Delucca said. “By having more observable and measurable goals, we will be better able to track your progress and know whether therapy is effective.”