The First Face to Face Therapy Session
By Caroline Kendal MBACP (Accred)
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
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- 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?
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.
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.
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.
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
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