What to tell your therapist first time you meet them


The thought of seeing a therapist for the first time can be anxiety provoking, even if you saw other therapists before. For many people a big part of this anxiety is wondering what to tell this new therapist during the first session. While obviously this depends on what do you want from them, there are a couple of ideas below - not to use as directions, but simply as an invitation for creativity. Maybe reading what other people discuss with their therapists on first session would help you clarify what is it that YOU want (or don't want) to talk with your new therapist about.

Five things to say:

What's the problem you want help with? Surprisingly, this seems to be the most complicated thing to communicate. Let's say you want help with social anxiety, for argument's sake. Merely stating that you have social anxiety is a good start. It does help a lot more though if you talk of how it affects your functioning. I.e. "I have social anxiety, and therefore I feel uncomfortable at corporate parties and prefer BBQ with friends." vs. "I have social anxiety, and therefore I have no friends, I only hang out with immediate family, I'd like to be more social." vs. "I have social anxiety, and therefore I stay locked in the house, I'm scared to go outside because everyone on the street will laugh at me, I order my groceries online." vs. "I have social anxiety, and therefore I'm considering suicide - my life isn't worth living." These are all different things, you know. Talk of how your problem affects your life practically.

How is your overall quality of life? It's common for people (especially abuse survivors) to sense something isn't quite right, but be unable to put their finger on it. If you don't know what the problem is - talk of your daily life, what is it like. Describe your functioning, help the therapist spot possible issues. Are you eating? Sleeping? Showering? Working? Is your house clean? Taxes filed? Bills paid? When was the last time you sang in the shower? Cried into a pillow? What brings you most happiness? What causes most stress? Even if you know very well what the problem is and it doesn't involve any of the above, talking of these things helps tremendously - one common criterion for most mental health diagnoses is that your issue causes you significant impairment in functioning. Helps to know if that's the case.

What's your background like? Ever experienced child abuse? Domestic abuse? Rape? Car accident, robbery at gunpoint, 911, other life threat? History of violence? (ever been arrested for assault?) History of mental health problems? (prior diagnoses, hospitalizations, meds?) Serious physical health issues? (diabetes, thyroid problems, cancer, AIDS?) It doesn't mean you'll have to focus on this stuff for years and not touch your current problem, not at all. Just helps to know all the possible contributing factors to your current distress. These are not labels, if you share history of child abuse your therapist won't write off all of your symptoms on PTSD and refuse to work with current stressors. They would just keep in mind that it could be affecting you. Or could be not.

How are your relationships? Got friends? Partner? Kids? How do you get along with your family? Coworkers? Neighbors? Humans are social animals, and our relationships can be a big part of the problem. Or solution. Helps to know how reliable your support system is, and what are your daily stresses, joys, and responsibilities.

Got any red flags? Alcohol/drugs? Self Injury? Suicidal thoughts/feelings/actions? Risky behaviors such as reckless driving or promiscuity? Thoughts of harming others? Addictions/compulsions (don't be shy, they've heard it all)? Ongoing abuse of any sort (whether you're the victim or the perpetrator or both)? If any of these are a part of your life - you might want to mention it. It doesn't mean that fixing them will be on top of your list of therapy goals. Just helps the therapist to see the whole picture, as these issues might be affecting the problem you want help with. If you don't want to work on these just yet - say so. You're the client, it's entirely up to you, what to focus on.

Five questions to ask:

What's your new therapist's qualifications and experience? What school they graduated from? Where did they do their internship? What was their thesis on? How long ago was it? Were they in practice all these years or took a break? Was it private practice or was it a clinic? Who were the clients there? Psychotics, alcoholics, domestic violence victims? Which mental health issues did your new therapist most work with? Did they like it? Why? Which mental health issues are they more interested in working with? Why? If there's a discrepancy between what they want to do and what they end up doing - why is it? If there is none - are they not interested in hearing/learning/exploring anything new at all? Do they work with children? Why not? Or how do they like it? Have they ever worked with the issue that you have? How did it go? The reason for all these questions isn't so much to verify if they indeed are licensed - they probably have their license posted on the wall above the desk (run if they don't) - it's to get a feel for their personality, how do they like their job, and how do they approach it. I personally would not be comfortable with a therapist who never had a psychotic client because those scare her, who doesn't work with children because they are too disorganized and have a short attention span, who doesn't like addictions issues because they make her sad, and who graduated 12 years ago but took a 7 year break from practice due to personal reasons she won't disclose. I'm not a child, not psychotic, and not a drug addict, but a therapist this picky would make me wonder if I'm good enough for her or she only keeps me to pay her mortgage.

How do they handle crises/emergencies? If something happened between sessions, you're in crisis and need to talk to someone right now, - can you leave a message on their answering machine? Would they call back? How soon? Can you email them? Would they respond? What do they consider a crisis, at what point do you need to call them? When you're about to commit suicide, when you're feeling blue because your date stood you up, or somewhere in between? Or do they not want you to contact them between sessions at all, if you're in danger - go to emergency room? Doesn't mean you're planning to be in a perpetual crisis. Just crisis handling policies speak volumes about your new therapist's boundaries.

Which modality they prefer, and how long does their average therapy last? Decades, years, months, weeks, days, hours? Of course no self-respecting therapist would give you any timeframes on the first session, they can't have one first time they meet you. We're only talking of their average experience. There's a big difference between a therapist planning to "get to know each other and build trust" during the first few months and then "start exploring the problem" the following year, and a therapist planning to be done by next holiday season. Look up therapeutic modalities - it's all flexible anyway, many therapists use a more or less eclectic approach nowadays (meaning, mixing modalities, using whichever works best for you at the moment) - but a general preference says a lot about what can you expect from this therapeutic relationship. If your wife is about to divorce you due to your online gaming addiction - psychodynamic therapist might not be your best bet, you know :)

What's their confidentiality policy? All therapists take notes, always, it's a legal regulation, they have to, even in private practice. If they don't do it during the session - they do it right after you leave, before a new client comes in. So who will see those notes, when, and why? If nobody, under any circumstances - run: either they are lying to you, or they are clueless, first day in practice and didn't study in college too good. There's plenty of criminals around, many of them are in therapy, and discuss their plans/accomplishments there. The guy who did the shooting in the movie theater called his therapist a few minutes before going in. If your new therapist received such a call from a client, would they not call police? Ask them at which point do they decide to breach confidentiality and report you to authorities. Ask them if they are in supervision (it's a very good thing if they are) to discuss the roadblocks they have with their clients. Ask them if they will share their notes with your psychiatrist (if you have one or are planning to). Ask them if they would ever share anything with your family (for example, if you're a minor, or if you share the same therapist with your husband).

Finally, just ask them straight how do they feel about your situation? Do they seem interested in working with you? Confident that they can help? Keep in mind that it's not just you deciding if you want to work with this therapist - this therapist is also deciding if they want to work with you, and often they can tell much faster whether you two are a good match or not - they have more experience at judging these things. They should sound interested, excited, and confident.