I've been thinking recently about the process of counseling- specifically, what it takes for someone to take the first step and get started. Scheduling an intake session and then meeting with a therapist for the first time takes courage- it's not unusual to have some nerves around these things. I decided to come up with a list of a few things that, I think, could help ease some of the first session nerves.
My hope is that at least one of these will resonate with you and help you to feel more comfortable about coming into therapy for the first time. Without any further ado, here are my top 13 things to know before starting counseling.
1. Your story is unique and deserves to be heard
I've heard a lot of things in my time as a counselor. Before starting in private practice, I worked as a mental health case manager for young adults with severe and persistent mental illness (SPMI). Before that, I interned at a local university's counseling services office and worked with undergraduate students. Currently I maintain a caseload of primarily young adults with anxiety and depression. Even though I've heard a lot in my time as a counselor, I want you to know that your story is unique. I don't know what it's like for you to have a panic attack. Yes, I know a lot about anxiety and depression, but I don't know how it impacts you and your life specifically. I'm a big believer in the individuality of all humans- and so our work together will be tailored specifically to your needs and preferences. Although I'm a big advocate for incorporating yoga, deep breathing, and mindfulness into our work, if that doesn't jibe with you, we won't do it. Counseling is not a one-size-fits-all situation.
2. You are not weird
I think you are unique, just like the rest of us :-) One of the greatest parts of counseling is getting to know you on a true, deep level. There is no need for pretense. It's an honor to hear all the unique parts of you and your life. Many of these things are private and not shared with others outside the counseling room- and so it makes sense that you could think you are alone in your idiosyncrasies. In fact, the more time I spend as a counselor, the more I realize how alike we all are, and how much we keep to ourselves. I'm not saying we should all go out and talk openly to anyone about the things we discuss in therapy- in fact, I'm pretty sure that would be a terrible idea. Rather, I'm advocating for us to accept ourselves just as we are- knowing there is nothing weird or strange about these things, but just that there is something unique and lovely instead.
3. I think you are brave
Counseling is an exercise in vulnerability. You come into a new office, fill out a bunch of paperwork, talk about your history, your family, your life, your struggles. All of this is shared with someone you don't yet know well. And once we start meeting regularly, you'll be sharing more about your experiences, emotions, relationships, thoughts... and that is amazing. Often new clients will say things like, "you must think I'm crazy" or "this is so weird of me, but ____"- the truth is no, I don't think you're crazy, and no, you're not weird! So many people go through life without addressing problematic relationships, mindsets, habits- the fact that you come in and want to work on these things says a LOT about you.
4. Some sessions will be harder than others
Every session will not be mind-blowing. In the same way, every session will not be light and easy. In general terms, there is an ebb and flow to the counseling process. One session you may be processing a difficult situation, and the next week you may not want to discuss it at all. That's okay. Sometimes you might walk out of my office and feel a sense of relief, peace, or direction. Other times you might leave feeling anxious or tired. That's okay too. The important thing is to keep coming back and lean into the work. After particularly emotional sessions, I might suggest spending some time with intentional self-care afterward. It's important to tend to all parts of your whole self- and so, if you've just spent 50 minutes in my office talking about your thoughts and emotions, I may suggest that you go for a walk or sign up for a yoga class that evening. This is especially helpful for the women I tend to work with- women who have a natural bent toward overthinking and feeling things deeply.
5. It's okay if we sit in silence
Sometimes you won't know what to say. Sometimes I'll hold off on responding for one reason or another. It's okay for there to be silence. Oftentimes we are made to believe that silence is awkward or uncomfortable- undesirable. But I believe there is deep value in silence. Your brain thrives on silence. With all the noise in the world, sometimes you just need a minute (or two) to sit in the quiet. Oftentimes my response will be silence- sometimes it's an invitation for you to continue processing (internally or externally) and sometimes it's a response to a direct question you've asked me. Don't feel like you need to fill the silence. If it feels uncomfortable, we can talk about what might be going on to make it feel that way. My office is a place for you to just be- you do not need to please, perfect, or perform.
6. You will laugh more than you think
People tend to be surprised at this. I've had friends ask if being a counselor is emotionally draining and even depressing. But you would be surprised at how much laughter happens in the counseling room. First of all, humor is a common defense mechanism and so it's often present. Second, looking at your life and situation through the lens of humor can be a great way to cope with heavy emotions. Third, I intentionally use humor to help new clients feel comfortable, and to set the tone. I'm a pretty laid back counselor (and human in general), and so being uptight and serious is not really authentic to me. And because the counselor-client relationship is so important, we both need to be our true selves in session.
7. I'll probably give you some homework
Most clients I work with come in for sessions weekly, or every other week. In the scheme of your month, that's between 2-5 hours of your time. I believe strongly in the power of counseling (good thing, or else I'd be out a job!) but also know that a lot can happen in between sessions. Research shows that what happens outside of counseling has a huge impact on the success of treatment. And so, I regularly assign homework to my clients. It is tailored to you and your needs, and is never a gigantic time commitment. A couple examples might be: watching a TED talk to discuss in our next session, reading a relevant article, practicing your deep breathing, exercising 3x/week, tracking your mood with an app, or making an appointment with your primary care doctor for a holistic approach.
8. Having consistent sessions is important for making progress
Counseling is not a one-and-done treatment. Oftentimes people experience a dip in their mood after starting counseling- this is because we're starting to address some of the more difficult things in your life and that can be emotionally and relationally disrupting. It's super important to have consistency in counseling appointments. We can decide together how often is appropriate for you to be coming in. Dropping in once every couple months is usually not a great way to see lasting change in your life- and coming in too often when things are going well for you also isn't helpful.
9. I see you as the expert of your own life
I have a master's degree in counseling psychology and a bachelor's degree in psychology, and have been working in private practice for a few years. However. None of this gives me insight into how YOU are experiencing things like anxiety, perfectionism, self-doubt, or depression. You are the expert in your own life. I am not here to give advice. I am here to support you, listen, provide feedback, give perspective and new insights, provide new ways of thinking and behaving, and teach you coping skills too. All of these things work in conjunction with your inner wisdom about what's going on for you internally and relationally.
10. I don't know how long it will take
Length of time spent in therapy varies so much. Each person comes into counseling with a unique perspective, history, and experience. You might come in for a specific reason, and end up processing something different as time goes on- which is totally okay! You may also be in counseling for a season, and then come back a few months or years later. This is another reason it's so important to have a good relationship with your counselor- you want to feel really great about going back to see your counselor, and know that this person will be able to support you in whatever season you are in. Exceptions apply, of course, if you happen to be seeking counseling for a specific issue that your counselor is not equipped to address- for instance, while I do premarital counseling, I don't work with couples who are already married and are experiencing issues. That's one area where I would give you a few great referrals for a qualified marriage counselor.
11. Each session won't be tied up with a pretty bow ;-)
I do a lot of work around perfectionism, and so this is often something that is addressed. People can find themselves getting frustrated with their perceived lack of progress after a couple sessions. The truth is, it's going to take more than a couple sessions to really make some headway. The first few sessions often include psychoeducation on anxiety or whatever concerns you're bringing into counseling- and we'll also work on coping skills to help you find some relief. But the deeper work will take longer, and it will take a certain amount of effort. If you walk out of a counseling session feeling like everything's not fixed, it could be a sign you're right on track.
12. You get to decide how we spend our time- but I provide direction as needed
These are your sessions, and you are in charge of where we go in them. As an outside observer, I'll oftentimes be able to see situations in a new light or provide new insights on what's going on. I can also gently suggest spending time focusing on specific issues that I'm noticing in session- but you always have the ability to decline or choose to delay those conversations. It's helpful to come into session with an idea of what you'd like to focus on that day, but it's not necessary. I review my notes before sessions so that I'm better able to focus on what needs to be addressed.
13. The first session is unique and unlike a regular counseling session
Whereas a regular counseling session doesn't follow a set structure, the first session, called the intake session, will do that. Different therapists handle the intake in their own way, but here's how it will go if you come to my office: You'll sit in the waiting room until your appointment time, where you are welcome to make yourself some coffee/tea/cocoa or grab a water bottle. I'll come to get you and we'll head back to my office. There will be some initial paperwork for you to fill out, and we'll go over the informed consent- this is a document that lays out all the nuts and bolts of entering into a therapeutic relationship. Next we'll dive into an interview- it's less formal than it sounds, I promise! Essentially I'll be asking you a variety of questions about you, your history, your family and friends, community supports (church, work, communities, etc.) and what you hope to work on in counseling. The last thing on the agenda is to create your treatment plan- your goals. Oftentimes this happens in the second session if we run out of time during the intake. We close the first session by addressing payment and insurance questions, and scheduling your next session.