13 - What Happens In The First Session?

The day is here and you have arrived for your first session with the psychotherapist. While you are waiting, take stock of the surroundings. Ideally (remember what I said about "ideally"), here is what you should find:

• The therapist has a private office with a comfortable waiting room.
• If the office is in a home or other less-than-private location, it has a private entrance and is completely shielded from any contact with people or sounds in the home.
• There is no secretary or receptionist in the waiting room. You encounter no other people either while waiting for your session, or when you leave your session.
• The waiting room and office are soundproof, and any windows have shades or blinds so that no one can see in.

By now, you no doubt can see that all these elements are ensuring your privacy and helping you to build a secure frame. If, shortly after your first session, you have dreams or find yourself telling stories about intruders, spies or the like, take a look at the therapy setting.

If you think these details don't bear mentioning, think again; a therapy office in a town where I once worked had a glass storefront on a main street, where all clients were clearly visible to passers-by. The words "drug counseling" were prominently painted on the window. It happens.

However, in our "ideal" therapy office, the therapist comes out to the waiting room, introduces him/herself, and shows you into his/her office. If it isn't immediately obvious where to sit, you can ask; the therapist's chair is usually evident, since he/she spends the majority of his/her time in it. Otherwise, sit wherever is comfortable for you.

When you are settled, it's usually up to you to start; otherwise the therapist may prompt you with a general question such as "What brings you here?" You can describe the problem you are having, or anything else that comes to mind. Don't worry about whether you can say everything with absolute precision. The therapist should be able to help you get it all out.

In this first session, you can expect to do nearly all the talking. You can expect your therapist to listen actively. He/she may not say anything at all until halfway through the hour, or may make one or two interpretive comments or ask for clarification. While you are talking, the therapist will be listening carefully, evaluating your situation and deciding on possible treatment. In order for the therapist to do this, he/she must listen to you, and not influence what you say, or the way you say it. Beware of a therapist who talks more than you do in the first session, especially about him/herself.

Toward the second half of the time, the therapist should indicate whether or not he/she can be of help to you. He/she should then propose a therapeutic structure: a schedule of appointments, a fee, and any other related details. You have the opportunity to react to this structure, and decide whether to continue. Remember that this therapeutic structure -- the schedule, fees and other details -- is not incidental, it is a very important element of therapy. This "holding" environment is an important step in establishing the secure frame. The proposed structure should be clear and unambiguous, and should reflect safety, consistency, and containment. Though you may think, consciously, that flexibility on the part of the therapist is desirable, the opposite is true. At this point, you need the therapist to be firm and consistent (like a good parent). If you are able to manipulate the therapist, you may find yourself dreaming and telling stories about seduction, infidelity, or theft.

Having agreed on the fee and on a regular day and time for your appointments, you are, hopefully, on your way to emotional healing. You say goodbye and leave. Many therapists allow extra time for a first session; this is probably an exception.

Next: Safety is in the details >>

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Home

1. Why I wrote this article
2. How to tell if a therapist is competent, or not
3. What psychotherapy isand why you need to know
4. The secret that you already know
5. How a good therapist makes you feel safe
6. The perfect therapist
7. Privacy: the essential ingredient
8. Non-judgmental acceptance: you deserve it
9. How to choose a therapist to call
10. How you find out about the therapist
11. Therapist credentials: the truth revealed
12. First contact. Watch out for these red flags!
13. Your first session: what should happen
14. Safety is in the details
15. Now what?

Copyright 1991,1996, 1999 Martha Ainsworth. All rights reserved. Please refer to reprint information before reprinting or distributing all or any part of this text.