Preparing for the Climb: what to expect in your first therapy session

Congratulations on scheduling your first counseling appointment! If this is your first time in therapy, you may be wondering what it’s going to be like that first appointment. Even if it’s not your first venture into counseling, it’s helpful to know what to expect with your new counselor (me). 

I like to think of undertaking therapy as similar to climbing a mountain. Just like the steps one takes to prepare for an intense climb, the therapy process starts with gathering information, taking stock of your equipment/tools, and making a plan. Using this metaphor, let’s talk about the first step in therapy: the intake appointment. 

Step 1: Meet your climbing partner 

Climbing a mountain is hard work. It helps to take a climbing partner with you – ideally someone who has climbed before and is dedicated to walking with you through the most challenging parts. The same is true with counseling. During your first session, I will introduce myself to you and go over a few important details about the counseling process. 

A little bit about your climbing partner/therapist: Right now I am a Supervised Therapist at South Tampa Therapy, which means I am counseling under the supervision and licensure of Dr. Elizabeth Mahaney while I finish up my final 18 weeks of my Masters in Counseling program Northwestern University. (Previously, I spent 12 years working in corporate America.) My current education has qualified and prepared me to counsel individuals, couples, and families experiencing a variety of life challenges, and over the past year I have accumulated 1,000 hours of experience in clinical mental health settings. I take a collaborative, integrative, and holistic approach, which means I look at the whole person and pull in evidence-based tools from various counseling theories based on what we both believe will be most helpful for you. (Approaches I often use for individuals include Acceptance and Commitment Therapy (ACT), Cognitive Behavioral Therapy (CBT) including Exposure with Response Prevention (ERP), Narrative, Internal Family Systems, and Psychodynamic; for couples, I also use Gottman and Emotion-Focused Therapy.) 

Step 2: Learn about the climb

A climber needs to be informed about the mountain they are climbing, including any risks, benefits, requirements, and special considerations. You should know the same at the outset of your counseling journey. During the first session, I will tell you what counseling is, what you can generally hope to accomplish, any risks, and what the process will entail. Counseling is a collaborative process aimed at helping clients achieve mental health and wellness. It takes work on the part of the therapist and the client. Together, we will identify goals, gain insight, work through challenges, and practice new skills. If you are here for couples counseling, we will develop insight into what is underlying any relationship problems and then work to heal wounds, resolve conflict, and improve communication. 

Now, about the risks. While counseling is successful for many people, like any endeavor, there is not 100% certainty. It might not be the right time to climb the mountain, or I might not be the best climbing partner for you – and that’s ok if we find that out! I want the best for you. Also, talking about hard things can bring up difficult emotions – similar to training your muscles for a long climb, you may experience some emotional “soreness” along the way. That is why your counselor is here to train alongside you – so you’re not facing the journey alone!

Another important aspect of the therapy process is confidentiality and its limits. Confidentiality is of utmost importance to me, and I am also bound by law and my professional ethics to uphold it. Everything we talk about in session will stay in session. I may seek supervision from my supervisor (who is also bound by confidentiality) on aspects of your case to ensure I am providing the best possible care. There are only a few instances where I would be required by law to break confidentiality: if I believe you are going to harm yourself or another person, if there is suspected abuse of a child or vulnerable adult, or if my court records were to be subpoenaed (which is highly unlikely). 

Beyond confidentiality, we will cover policies and communication expectations – things like what to do if we run into each other out of the therapy room, how to get in touch between sessions, and cancellation/rescheduling expectations. I highly encourage questions about anything – I want you to feel confident and comfortable as we begin the journey. 

Step 3: Check equipment and readiness level

Embarking on a mountain climb without checking one’s equipment (what you bring with you) and readiness levels would not likely result in a successful outcome. My goal for counseling is to help you achieve your goals. And in order to do that, I need to get to know what you’re bringing with you in your emotional backpack! That’s why this first session will be more question-heavy than other sessions we will have together (where you will be doing most of the talking). I will ask you about your health, family history, and what symptoms you’re currently experiencing. Since we’re shaped by both nature (our genetic makeup) and nurture (family, community, experiences, and global events and messages), gathering information about these topics helps us get a sense of how these factors may be impacting you. Most importantly, I’ll ask what brings you to counseling now and what you’re hoping to get out of it. I may also administer one or more assessments that we can come back to over the course of treatment to check on progress. 

Step 4: Map out the journey 

During our first session, we’ll start to hone in on goals for our time together – you might think about it like determining which mountain (or mountains) we want to climb, how frequently it makes sense to train, and a goal for how quickly we can reach the top. Each person has unique goals. For instance, a goal may be to reduce the frequency, intensity, and duration of anxious  thoughts and feelings. Perhaps it could be to find clarity on a difficult, stressful decision. Or maybe it could be to improve communication in a relationship, process through a trauma, grieve a loss, or increase self-esteem. It’s possible that the goals will start out more general and become more specific as we gain more clarity on symptomatology. As we dive deeper, they may also shift. We might even add additional goals along the way! 

Goals are important because they provide direction for our work together. They also let us know if we’re on the right track or if we need to switch approaches. Finally, if we are successful during our time together, our goals will help inform when it’s time to begin winding down our sessions. 

With our goals set, we will discuss how frequently we want to meet (I usually recommend weekly to start with) and set our next appointment time. I may also ask you if you are ok with taking part in “practice” (which I find is a more palatable word than “homework”) between the intake and the next session. This could be, for example, reading a brief article, tracking your thoughts and feelings, journaling, or trying out a new coping tool. We can both expect to leave the intake with an idea of where we’ll be headed in therapy as well as what we’ll focus on in the next session. 

What to keep in mind when beginning counseling

Embarking on the counseling journey is a big decision – akin to standing in front of a tall mountain and making the decision to climb it. And the intake session is sort of like meeting your climbing partner for the first time, taking stock of your equipment, and mapping your route before the journey. It’s ok to feel a little nervous at this stage. It makes sense – talking about hard things and putting in the work is difficult! But know that as a counselor I am there with you, creating a nonjudgmental space to feel, process, and work through the most difficult parts of your experience. It’s so much easier to climb when you know you’re not doing it alone. And the view at the top? Well, it’s pretty spectacular.

Book with author of this blog post, Kaitlin Lowey, here: https://SouthTampaTherapyBOOKAPPT.as.me/KaitlinLowey