What happens in the first counselling session?

The prospect of your first therapy session can be a very daunting. In addition to the reasons for coming to therapy in the first place, there could be additional worry and anxiety around what the first session will be like and what will be expected of you. 20% of people drop out of therapy prematurely, due to unrealistic expectations (Swift and Greenberg, 2012). Therefore, here are some things to expect in your first session, to help you feel prepared.

Therapy Contract

Most therapists will spend the first session going through the contract. This lays out what therapy is all about, a therapist's professional boundaries, confidentiality, how your information is stored, and the ethical code of the governing body. Each therapist will have their own contract, which means there may be nuances in their contracts to fit their values; so even if you have been in therapy before, it is important you read the contract. My own contract is very thorough (arguably, too thorough), so in the session, I will pick out the most important points that you need to know and discuss them with you. You might read and sign the contract then and there, or take a week to read through it until your next session.

Outcome Measures

A therapist might ask you some questions about how you have been feeling over the last two weeks to get an understanding of your emotional, mental and physical state. Typical outcome measures used are PHQ-9, GAD-7 or CORE-34. In my sessions, I might offer something creative to 'check in' your feelings in the first session, or I might use the CORE-10 (A shorter version of the CORE-34). These are used to get an understanding of how you have been feeling recently, and to measure if there has been an improvement at the end of therapy.

Agreeing an End Date

I remember my first ever counselling session, this was a massive question mark for me - will I be in therapy for three months or three years? The thought of my problems taking a long time to work through felt very worrying to me. Luckily, I was assured by my therapist that I could explore my problems at my own pace, and the average number of sessions for clients was about 12-16 sessions. This felt like a huge relief. Therefore, if it feels important that you have an end time in mind, please share it and your therapist can work towards that. You can always change it as you get deeper into sessions.

Rapport Building

This is an integral part of the first session. Your therapist will want to get to know you and what's brought you to counselling. You might say a bit about what you want help with, so it is always good to have it in mind before you come to your first session. In turn, therapists might seek to understand things from your perspective and ask you open questions to help you to expand on your answers. A therapist's aim is to gain your trust, so that you feel comfortable to open up about the things that are bothering you later on. Don't worry if this does not happen in the first session - we do not expect rapport building to happen immediately. Every encounter between a therapist and their client is different, so it might take one session, or six sessions!

Goal / Intention setting

Sometimes, goals can carry a weight of expectation, and not achieving goals can create disappointment. Therefore, I prefer to refer to them as 'intentions' rather than goals, as intentions infer a greater sense of openness. The co-creation of intentions tend to be an a part of my private practice. Intentions such as 'I would like to get rid of my anxiety' might be unrealistic. However, saying something like 'I would like to understand or process my reasons for anxiety' might invite a more open and in-depth discussion around this feeling. This slight change in language ensures that you have something to work towards, but also allowing these intentions to be open enough to shift and evolve.

Whilst it might seem like there is a lot crammed into those fifty minutes, the bottom line of your first session is that you feel comfortable with your therapist. You should be able to feel warmth and empathy from your therapist in the first session. Like any relationship, building trust and opening up to them might take time. Therefore, allow yourself to trust in the process of therapy.

Hope this helps!

V x