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The First Face to Face Therapy Session

By Caroline Kendal MBACP (Accred)
Before you even walk through the door and set eyes on your therapist for the first time, you will probably already have plenty of preconceptions and expectations. You’ve spoken on the phone and made certain evaluations based on the brief conversation in which the first appointment was made. She may have been brief and businesslike on the phone and you might therefore fear that she is cold and uncaring. Or you might have experienced this same manner as calm and professional. If she sounded well-spoken, you might assume she would have no understanding of your money worries. If she sounded young, you might expect she won’t relate to your fears of ageing. Either way, you will have formed an impression and it can be useful to be aware of the picture you’ve constructed before meeting. Discussing these preconceptions with your therapist is an effective way of addressing your fears and realising whether they are grounded in reality. It takes courage to be so direct by expressing your doubts, but your therapist will be trained to understand and address such concerns. Airing your qualms can also be a way of delaying disclosure of highly personal information before you’re ready. After all, why should you launch into your whole life story to a complete stranger before you’ve even made up your mind whether they are the right therapist for you.
One final factor to take into consideration before you walk through the door is the level of anxiety you are feeling. Almost every single client is nervous, although knowing this probably won’t make any difference to how anxious you are feeling. There’s no way round this one. Doing anything for the first time makes us nervous. Taking an honest look at our lives is scary. So is confiding in a stranger. The simple answer is that if we don’t push past our safety zone every now and then, we won’t develop. The long answer can be discussed with your therapist.

Common Anxieties Prior to the First Therapy Session

  • Does it mean I’m screwed up if I go to therapy?
  • What will the therapist think of me?
  • Will he/she think I’m being silly or self-pitying?
  • Will he/she think I’m mad?
  • Will I end up hating my parents?
  • Will this work or will it be a waste of money?
  • Is this confidential?
  • Will I cry?
  • Will I bore him/her?
  • Will I unearth a hideous family secret?
So, you turn up at the appointed hour and you’re shown into your therapist’s consulting room.  You may be surprised that your therapist neither engages you in conversation nor responds to your attempts at chit-chat en route to the room. She is not being rude, simply adhering to the principle that contact between you stays in the room. By limiting conversation to within the confines of the consulting room, your therapist is attempting to set the boundaries of your relationship. You are not friends and this is not a social visit. Your relationship is a private, professional and confidential arrangement that deserves to take place within a safe, secure setting. 
It can take a while to adjust to this type of relationship, particularly as it is unlike any other in our lives. It may feel as if there we know there are different rules of engagement, but we’re not quite sure what those rules are. This will almost inevitably be disconcerting. Asking someone ‘how are you?’ feels like second nature to some of us and when the other person fails to respond, it’s hard not to feel rejected or dejected. The impact of the rebuff upon you is, however, like everything else, up for discussion with your therapist. In the meantime, it may be useful to know why your therapist doesn’t respond to such a harmless, social nicety. Firstly, as mentioned earlier, although it may be the start of a very special relationship, it will never be a friendship. You won’t be going out for coffee or invited to her son’s wedding and you won’t be having long, late-night phone conversations about what you watched on television that night. In order for the relationship to be effective, as well as ethical, firm boundaries need to in place. How you respond to the limitations of the relationship will form an important part of the work you undertake in therapy. Secondly, by not responding to the question ‘How are you?’, your therapist is giving you an important message: This is not about me. This is all about you.
By now, you’re sitting opposite each other. Most therapists angle their chairs so that you are not facing directly into each other’s faces – there is an appreciation that this can feel confrontational and unnerving. Gazing into a neutral space gives you time to think and allows you to avoid feeling eye-balled. You’ve noted the box of tissues by your chair and wonder whether you’re supposed to cry. Shedding tears in the first session is not uncommon. Often, there is a build up of tension and simply offloading facts and feeling, hitherto unexpressed, can bring a sense of release as well as relief. Others find it extremely challenging to cry in front of another person.
But first, you have to start and knowing where to start can be tough. Do you start at the beginning? Launch into your family background? Offload your latest traumas? Confess you’d quite like to run for the door? Some therapists will prompt you with a question, usually along the lines of ‘What brings you here today?’ Others will wait to see what you bring. Once again, a silence at the beginning can be experienced by clients as unhelpful or even cruel. But by not immediately rescuing you from your discomfort, your therapist may be allowing you to experience a fundamental rule of therapy: you decide what to bring and you decide when to bring it. Obviously, if you’re still sitting there in silence ten minutes after you’ve sat down and although not quite breaking into a sweat, you are nonetheless gnawing your nails, it would be cruel to leave you floundering. A caring therapist will initiate discussion, perhaps by asking why you decided to come for counselling or by acknowledging your anxiety about beginning the process.
At some stage during this session the therapist will wish to introduce and agree the terms upon which you will continue to meet. This is known as The Frame and includes how often you meet and the length of sessions (50 minutes is the normal practice). The length of the work may also be discussed. Some therapists offer a fixed number of sessions, open to review, whereas others might offer open-ended therapy. Therapists will let you have an idea of when they take their holidays or breaks. Payment will be negotiated and agreed. Therapists will advise on their policy on missed sessions; most therapists ask to be paid for missed sessions, whether or not notice has been given. Confidentiality may be mentioned, but either way it is understood that it is at the heart of the process.

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