In this article I will share with you the common practices of therapists in their first session(s) as well as give you some ideas of how to choose a therapist that could be a good fit for you.
We will explore:
Finding a therapist • Assessment • Confidentiality • Your first session • What to expect from therapy
Finding A Therapist
There are many ways to find a therapist:
- Direct referral from a physician or psychiatrist.
- Referral from a friend
- Websites that are “Therapist finders”
- Your own research
Do your research:
There are several different “Theoretical Orientations” that therapists practice from. Many therapists practice from multiple modalities, but to be an educated consumer, it is important to have an understanding of a therapist’s emphasis because it will have a HUGE effect on how you do therapy together.
There are several theoretical orientations, I will share with you three main theoretical orientations of psychotherapy.
Psychodynamic theoretical orientation primarily focuses on problems in your past experiences, what happened in your childhood primarily in you key attachment relationships (ie. parents, siblings and any prominent relationships that served as building blocks in your life), and draws a connection with your present problems or issues and emphasizes feelings. This orientation consistently asks “How does it make you feel?”
Cognitive-Behavioral theoretical orientation primarily focuses on how your thoughts affect your feelings and behaviors/actions. This orientation believes that it is not what happens to you that determines your quality of life, but it is how you think about what happens to you and how you respond to it.
Post-Modern (Narrative Therapy & Solution-Focused Therapy) theoretical orientation is one of empowerment that holds the perspective that people have strengths, abilities and resources that once we develop our gift at using them, we have the ability to resolve problems in our lives now and in the future.
The focus of therapy is on the stories people tell themselves about problems and the effects of those stories on people’s lives. A post-modern therapist emphasizes understanding the problem, but focusing your attention and growth on what you want instead of the problem.
Postmodern therapists believe that “You are NOT your problems. You are in a relationship with your problems.” For instance, “You are not depressed. You are affected by depression. You are an intelligent and capable person who happens to be affected by depression right now or is currently in a relationship with mania (mania is powerful and causes you to do all sorts of things).”
The therapist does not take the stance of “the EXPERT”, instead you are the expert of your life (you are the only one who has lived it) and the therapist uses their expertise to collaborate with you and share a process with you that may help you develop your strengths and abilities. This form of therapy is highly collaborative and transparent.
I could go on and on with post-modern therapies….
YES…I am biased. My foundation and training is as a Post-Modern therapist. However, I have integrated Cognitive therapy and Psychodynamic therapy into my practice and use anything that works for my clients.
Most therapists will want to collect a significant amount of personal information about you in order to do a thorough assessment.
It is important that we have an accurate medical history so that we can make necessary referrals to be able to rule out any medical cause for dysfunction in your life.
It is also important that we have an understanding of your current symptoms – their onset, duration, intensity and history (have you experienced them before). This is how we diagnose (make sense of a problem you are experiencing) as well as determine if it is in our scope of practice and competency to be able to help you.
We want to know about your support system both for your own safety and so we can provide resources and referrals.
We will ask you about medication history, drug history, suicide attempt history and abuse history.
Often times people are not honest about this from the get-go because it is very hard to share this history AND it makes sense to fear judgment, stigma, shame etc.
There are many therapists who will not take on new clients who have current drug use or have a history of suicide attempts or current suicidality because it is NOT in their scope of competence and requires more availability and urgent care.
In your first few appointments, your therapist will likely explore this information with you in a formal assessment.
Confidentiality & HIPPA Agreement
In California, it is the law that in your first appointment the therapist goes over with you “Confidentiality” and the ‘HIPPA Agreement”.
Everything that is shared in therapy is held CONFIDENTIAL, but there are exceptions to confidentiality that you MUST know.
- If a therapist suspects current or previous CHILD ABUSE (physical, neglect, sexual, emotional), we are legally mandated to report it to Child Protective Services.
- If a therapist suspects current or previous ELDER or DEPENDENT ADULT ABUSE (physical, neglect, sexual, emotional, financial), we are legally mandated to report it to Adult Protective Services.
- If you tell your therapist that have the intention to HARM a specific identifiable person, we are mandated by law to make reasonable efforts to warn that person and notify the police. (In California)
- If you are suicidal (you have the intention to commit suicide and a plan to carry it out AND therapeutic interventions are not working) it is our ethical responsibility to contact the psychiatric emergency team (PET team) to have you hospitalized, even if it is against your will.
In Your First Session
Now that all of the legal and ethical stuff is out of the way
It is all about the relationship
Things for you to pay attention to to determine if you have a good fit with your therapist.
- Do you feel comfortable in the therapist’s presence?
In my opinion, the therapist is NOT supposed to be intimidating. You can expect yourself to have walls up when you first meet and to feel anxiety.
A therapist’s presence should feel good, provide containment and feel safe once you build trust.
- Do you like the therapist? Do you respect the therapist?
It is important that you like your therapist’s personality and respect them. No therapist is a perfect person who lives by everything they say all of the time (or even much of the time)…nonetheless, it is important that you VALUE THE WAY THEY THINK.
- Do you feel that the therapist gets you?
I cannot express how important this is! If you share things that are very important to you and the therapist doesn’t acknowledge it and asks a question that changes the topic to what they think is important…THEY DON’T GET YOU.
I am adamant about this because there are so many people who refuse to go to therapy because they have had this experience. I was one of them.
I believe that a good therapist will check in with you and make sure that the conversation is useful for you and that you want to be having it.
- Do you believe the therapist can help you?
It is pretty common for people in their first session to “dump” out all of their feelings and experiences with the therapist.
The challenge with this is that it feels good in the moment, but the trust is not there in the relationship so it makes most people feel so vulnerable that they won’t come back to therapy.
Trust is not something you automatically give your therapist. Trust must be earned.
I recommend honoring your boundaries and taking your time in therapy. Your boundaries and walls are there to keep you safe.
I believe we should change our boundaries and walls only when we have something of more value to replace them with. In your first session, you have not created that something of value yet.
What To Expect From The Process of Therapy
- Therapy will open up wounds in order for them to better heal and it will be painful at times.
- Therapy will affect the way you think and feel about yourself and your life.
- Therapy will affect your behaviors and actions.
- Because you are growing, therapy will affect all of your significant relationships.
I hope this is useful.
To choose me as your therapist, if you reside in the state of California, please contact: