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What to expect in your first therapy session.

It is understandable if you feel nervous before your first therapy session. You might not know what to expect. This article will give you an idea of what might happen when we meet for the first time. So you can feel calmer.

What happens before our first appointment?

I will offer you a free fifteen minute consultation, which we can have over the telephone or online (using zoom). This consultation helps me check I have the right training and experience for your needs. Equally it also gives you the chance to see whether I feel like a good ‘fit’: do I feel like the sort of person you can begin to feel comfortable with? If so, we will go on to book in an initial ‘assessment’ session.

At this point I will email you a welcome pack. This will include:

  • Terms and Conditions for our work together, so you know about things such as confidentiality and cancellations (a bit dry perhaps, but necessary!)
  • An Intake Form to complete, so I have your personal details, emergency contact etc.
  • If we are meeting for therapy online I will send you an information sheet about how this works
  • If we are meeting in-person, I’ll send you a map!

What will we talk about?

Broadly speaking the assessment enables me to understand more about you and what brings you to therapy….

  • I always start by explaining confidentiality, and its limits
  • I will ask you to tell me more about your reasons for seeking therapy: current problem/s, symptoms etc.
  • I’d like to know about your life generally, such as who is important to you, hobbies, work.
  • I’ll also ask you to tell me a bit about your early life – for example, who was around, the quality of your relationships, good and bad experiences.
  • I have a duty of care to check you are feeling safe – that you are not having thoughts about harming yourself, or at risk of harm from others
  • One of the most important things we will explore are your hopes for therapy. If our work together helped you what would you notice?
  • I will probably ask if I can give you some short questionnaires. This helps my understanding of you and the problems you are bringing. We can also repeat these in a few weeks to track change.
  • You’ll probably have questions for me, which is always completely fine

I’ve been told I have a relaxed style and put people at ease, so I hope it feels just like a conversation!

What is a formulation?

During the assessment session I will be beginning to draw together the things we discuss into a ‘psychological formulation’. A formulation is a bit like a personal road map. It is summary of your difficulties. It makes sense of all the factors which are contributing to your feelings. It may include past difficulties and experiences if these are relevant to the present. It also acknowledges your strengths and resources. Crucially it helps me understand what needs to be done in order for you to feel better.

What if you can’t help me?

Occasionally I might feel you need help from someone with different skills to me. I would usually spot this during our initial 15-minute consultation but sometimes new information emerges in an assessment, or you may feel I’m not the right fit for you. Either way, I will do my best to help you find a therapist better suited to you.

What if I don’t want to talk about some things?

That is fine. There is no pressure to tell me everything. You are in control. In fact, when there is trauma I will usually ask you to just give me headlines or labels to difficult events. This is because I want to keep you feeling safe until we have worked on some skills (and you feel safe with me).

I would just add, however, that it is very unlikely you would tell me something I had not heard from other people before. I’ve been doing this work for a long time. Experience has taught me people almost always feel better after sharing something they have been upset about. But everything is at your own pace.

What happens at the end of an assessment?

An assessment can take more than one session, but I’ve usually got a good enough idea after our first meeting so we can begin to make a plan.

I will share my initial thoughts about your needs. We will discuss how many sessions you might benefit from, and what type of approach will be helpful. We decide this by thinking about your formulation, what we know works for certain problems (based on research), alongside your personal preferences.

Usually I suggest having a certain number of appointments (often eight or ten), and then a short review to check progress, before booking in some more if we need. Typically we arrange these on the same day/time each week as consistency is important in therapy.

Some things to add

I hope this article gives you and idea of what a typical assessment session might look like with me. There are a few caveats….

  • Assessment sessions with other therapists generally have a similar structure but there may be differences depending on their style or theoretical approach
  • You are an individual and it’s important that I am flexible in response to what you need, therefore the above is just a guide
  • On occasion an assessment may take two or perhaps three sessions, depending on what you are looking for help with
  • Babies-in-arms are always welcome to our session, if this makes it easier for you. Older babies are very welcome in online sessions, but I cannot safely accommodate them in my consulting room for in-person appointments.

Finally… Want to learn more?

Contact me to learn more about how I might help you. Don’t forget to subscribe to my newsletter to be the first to find out about future articles and to receive curated newsletter with tips, resources and support.

Dr Miriam Inder – helping you have Better Beginnings