The Beginning of Therapy: What To Expect

By Farid Alsabeh, LLP

Farid is a Limited Licensed Psychologist in Michigan

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As a new therapy client, you’ll no doubt have many questions about the beginning of therapy. What will you be expected to talk about, and what kinds of questions will you be asked? What techniques will your therapist use, and have they worked with clients with problems like yours before?

Although every therapy process is different, there are a couple of topics that almost every therapist will cover during the beginning of therapy. These will involve not only straightforward details about your symptoms and personal history, but more complex topics related to your expectations about therapy and your ability to participate fully in it.

In this article, we’ll explore what your first few therapy sessions will look like, and what kinds of topics you can expect to be covered during them.

The Beginning of Therapy:

What are your symptoms?

Your symptoms will help to inform your diagnosis, and this is a complicated topic in psychotherapy. Although diagnoses can inform the therapeutic process, there are both benefits and downsides associated with it. Therapists want to avoid reducing you solely to a diagnosis, as this approach risks overlooking your unique individuality and life experiences.

Nonetheless, diagnosing is often useful from a clinical perspective. Your diagnosis leads to a case formulation — simply put, the way that a therapist understands you — and in turn, this informs the most effective treatment.

Take, for example, the subtle difference between depression with anxious features, or anxiety with depressive features. In the first case, the treatment may be centered around improving mood and increasing level of activity, while in the second, it may be centered around relaxation and coping mechanisms. As we can see, the diagnosis will have direct impacts on how the psychotherapy work will proceed.

For that reason, one of the first things that a therapist will want to know about you is which diagnosis best encapsulates your problems, and they’ll do this by learning about your symptoms. They’ll get this information by listening to you describe your concerns and your personal history, as well as asking you about specific symptoms directly. From there, the therapist will select the best evidence-based treatment for that particular diagnosis.

What are your goals?

Therapy is a collaborative process — you know where you want to go, and your therapist will help you get there. Your therapist is a professional, but their expertise is only about the process of therapy. You are the expert on yourself: your past experiences, your current feelings, and your vision for the future.

For that reason, your therapist will want to learn what your goals are. If you aren’t sure, that’s okay — your therapist can help you identify them. Knowing this information will help them to structure the sessions in a helpful way, and include information that will be useful to you. In addition, knowing your vision for yourself will help your therapist to include you as an active participant in the process.

Some topics that relate to your goals in therapy may be the following:

• What kinds of relationships are you seeking in your life?
• Are you seeking relief from specific symptoms?
• What kinds of skills do you want to learn?

Whatever your goals are, your therapist will help you to achieve them by tailoring the therapy process to you personally, and by taking your feedback into consideration every step of the way.

What brought you in now?

Just as important as your symptoms are the reasons why they’ve brought you to therapy. Did they appear all of a sudden? Have they been around for a while, and recently gotten worse? Or have they remained constant, but your ability to manage them has declined? Related to these questions is the following: What has prompted you to seek help now, and what other kinds of help have you tried in the past?

On a similar note, your therapist will want to understand any triggers associated with your symptoms. Has there been a certain event or circumstance that has led to you seeking treatment? For example, people undergoing significant life transitions such as starting a new job or getting married may benefit from support in processing their experience.

Knowing about these circumstances helps your therapist plan their next steps. For example, if your symptoms are new, then the initial focus may be educational in nature. By contrast, if the symptoms are long-standing, then the initial focus may be about developing new coping strategies, and understanding why the old ones aren’t working anymore.

Finally, your therapist will also want to know about any past experiences you’ve had with therapy. How long ago were they, and what prompted them? Did you find it helpful? What did you appreciate about your past therapist, and what do you wish they did differently? These questions will help your therapist to understand any expectations or beliefs you may have about therapy which will be helpful for the therapeutic process.

What ideas do you already have about therapy?

Fortunately, public awareness of therapy has been growing along with a decline in the stigma associated with it. Because of this, many clients already know many details about therapy, whether by word of mouth, popular media like movies or podcasts, or even their own past experiences.

Getting some idea of what you already believe about therapy is beneficial for many reasons. First, it allows the therapist to understand what expectations you may have about the process, and affirm, change, or challenge them as necessary. Second, it allows the therapist to tailor the treatment so that it can be as helpful to you as possible.

To assess this, your therapist may ask questions like the following:

• What’s your understanding of what goes on in therapy?
• How would you know that therapy is working for you?
• Do you have any concerns about starting therapy?

Overall, understanding how you already think about therapy will help your therapist to ensure that you benefit the most from it, and find it to be as fulfilling an experience as possible.

Are you ready to put in the work?

Unlike other kinds of healthcare services, psychotherapy isn’t something that’s simply administered to a passive subject. By contrast, as a client, you’ll be an active participant in your own treatment. This applies not only during the sessions themselves, but in between them, as you and your therapist set conscious intentions throughout the week.

For that reason, another topic that your therapist will want to know about you is your ability to stay consistent and do the work associated with therapy. This involves several factors:

• Understanding that it takes time. Some problems are relatively straightforward to treat, and can be addressed in a matter of weeks or months. But other problems will take  longer to address, and clients who don’t recognize that may be disappointed. Although the first few weeks may bring some gains in coping mechanisms or insights, deep and lasting change may take longer..
• Seeking the source, not symptoms. When we treat a single symptom, it can sometimes just be replaced by another. For example, if a client’s anxieties stem from their relationship with a family member, they may learn how to deal with that particular person. But similar problems may arise in the future, as the same relational dynamics appear with a new person. By doing more depth-oriented work, you and your therapist will work to treat the underlying cause, not just the surface-level result.
• Being open to discomfort. Psychotherapy is meant to be a safe process, but that doesn’t mean that it’s always a comfortable one. Clients who are willing to face difficult feelings during the work will be much more likely to benefit and grow from it.
• Being transparent. Honesty is the best policy when it comes to psychotherapy. This doesn’t just involve honesty about past events and feelings, but also your perception of the therapist and the ongoing therapy process. The more that you’re willing to be transparent, the more likely that the work will be fulfilling.

These are some of the topics that therapists will be looking to know more about as they assess your willingness to do the work in psychotherapy.

Beginning the therapeutic journey on the right note

A successful first couple of therapy sessions will set the tone for an engaged, constructive, and collaborative therapy process. The topics covered during these sessions will involve not only information about your symptoms and past experiences but also topics like your ability to commit to therapy and benefit as fully as possible from it.

A well-conducted first couple of sessions lays the foundation for successful psychotherapy work: one founded in compassion and mutual respect that helps you develop your self-understanding, achieve peace of mind, and commit to a life that better reflects your innermost values.