How to approach an initial therapy session

Committing to psychotherapy can be daunting, but after reaching and scheduling your first session it can be really helpful to know what to expect and think about what you want to gain before you begin the psychotherapeutic journey. In this blog three of our UKCP psychotherapists offer some helpful advice on where to start. 

Written by Martin Weaver

Congratulations on considering psychotherapy. It’s a big step for most people. It’s important to say that just as clients are individuals, so are therapists, and each will have their own way of starting therapy with you. After 25 years of working as a psychotherapist here is how I suggest you can prepare for that first session.

• Clearly you need to know something about what it is that you want out of therapy. This could be a single word e.g. ‘confidence’, ‘peace’ or even ‘happiness’. It could be some skills in how to deal with arguments, relationships or decision making, or you may have a specific event in your life that is causing you distress that you want help to resolve. I ask my clients to jot down some ideas in preparation for our first session.

• Money is always important, and yet it can be the most uncomfortable issue to think about. Try this: make a list of the last four big spends that you made, more than just the every day-to-day items or events that you need. Were these just for you? What did you get from buying them? How does the cost of your therapy compare to these items? Sometimes we can spend a lot of money on other people or buy things without thinking about the price or cost. Link these thoughts to what you want to get out of therapy and measure them against this cost. Is the cost affordable for you and is the cost worth what you want out of therapy?

• Time is perhaps the most important feature of our lives. There are two measures here: how long are you prepared to devote to your therapy and how quickly will you accept change? For some people, and for some issues, change can happen quite quickly and for others it can take some time. To feel comfortable with the time issue you may need to set this alongside your thoughts about money and this will give you an idea about your measure of the value you hold of yourself.

• It is perhaps an obvious point and yet it’s worth saying that honesty about your thoughts, feelings and actions in the therapy is vital. Although clients can often give away far more details about their situation than they think, it’s incredibly helpful for the therapist when you give as much honest information as you can. This can feel embarrassing, shaming and even painful when recounting actions or thoughts and yet as therapists we are trained to accept all that you say and provide positive help and guidance for you to achieve your goals.

• All the research says that it’s the relationship that matters. Before committing to a session talk to few therapists until you find the one with whom you feel most comfortable, safe and believe you can trust. Safety is very important as you need your therapist to hold you through what could be some dark and upsetting times. 

• Finally, what kind of changes do you want to see or feel to know that the therapy is actually working for you?  So, after you have jotted down some ideas from the above, ask your therapist about the shape or structure of your sessions. It’s difficult to know exactly what will happen during therapy and yet you may prefer to know that there are planned times to stop, review and check that you are going in the right direction and at the right speed.

• I regard myself as a resource for my clients, a resource that my clients pay for, so value for money is incredibly important. Whenever we go to a specialist, we are, to some extent, in their hands and so as therapists we have ethical codes and support structures for ourselves to ensure that we provide the safest and best service possible to our clients. It is perfectly acceptable and expected that you will ask about our training, qualifications and membership, as well as what happens if things go wrong. 

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Written by Melissa Cliffe

Starting therapy for the first time can be a big step and if you have never experienced it before, it is natural to wonder what it will be like. An initial session is a great opportunity to test whether it is for you before making any firm commitments. It allows you to meet with a chosen therapist, explore what you are hoping to gain from therapy and how they might help.

• Repeated studies show that the strongest predictor for effective therapy is the quality of relationship between client and therapist. Give yourself permission to be choosy about finding someone you connect with. If something doesn’t feel right, take it seriously, and consider setting up an initial session with an alternative therapist so you can compare.

• Therapists have different styles of working and what might be right for one person might not be ideal for another. Consider what you are drawn to – are you hoping for encouragement or challenge, do you like the idea of expressing yourself using creative materials or having exercises to practice on your own?

• Share what you hope to gain from therapy. A good question to ask yourself is what you would like to change as a result of therapy? This will be the foundation of your work together.

• If you don’t know what you want, that’s ok. A therapist can help you to explore what you need.

• Share any worries or fears you may have. It is normal to have apprehensions about therapy and addressing them early on can make therapy a safer place. For instance, if you fear that therapy will bring up intolerable feelings, you can discuss ways to manage them so that you don’t become overwhelmed.

• If you have faced discrimination, oppression or alienation in your life, it is especially important that you find a therapist who is both affirming and that you feel safe with. You can use the initial session to ask about their history of working with people with similar experience.

• Go at your own pace. There is no need to share everything in the first meeting.

• Ask questions about the therapist’s approach, how they think they can help and how long you might want to meet.

After the session

• Allow time to process whatever comes up in the session before moving on to something else. It can be helpful to allow 24 hours before deciding whether to commit.

• Sometimes a therapist will decide that they are not the right professional for you. There are many reasons for this, and it does not mean there is something wrong with you. Perhaps they lack the relevant experience or there might be a personal reason that makes them unsuitable. If this happens, in most cases, they will offer alternative suggestions for support.

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Written by Lorna Evans

• Once you've decided to start therapy, think if you’d prefer to work online or in person. The pandemic has opened up many new ways to access therapy. It may be that working online fits in well with your life and work patterns. You now have more choice.

• It's helpful to take some time to think about who you'd like to be your therapist ultimately; this is somebody you'll feel comfortable and safe with.

Consider if you would prefer a female or male therapist, younger or older, with experience of working with diverse groups, for example, people of colour, LGBTQ+, trans, neurodiverse.

This process will help you find the right therapist for you. If you don't like or connect with your therapist, it won't work.

• I recommend looking on a reputable website when looking for a therapist , like UKCP’s. Punch in your postcode and see who you like the look and sound of from their profile.

Shortlist around 3 - 5 therapists, and contact them directly to check if they have availability that works for you. If so, arrange a short phone or zoom call with them; that will be free of charge, so you can decide if they are the right therapist for you.

You must keep yourself safe on these short calls. They are to decide if you would like to work with them. There is no need to go into any great detail about what brings you to therapy. This can be discussed in the actual therapy sessions.

• If you have an idea of what you would like to work on in therapy, be super clear with the therapist, either in the first contact email, phone call, or first session.

If you feel the therapist is not hearing you or connecting with what you are saying, move on to the next one. This is your therapy, and you and the therapist must agree on what the work will be and what you would like to get out of starting therapy.

• It’s beneficial to understand how payment and cancellations work. I ask my clients to pay in advance and have a 24-hour cancellation policy. Each therapist will be different; however, this helps get all of the admin out of the way to focus on the therapy.

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