When you go to a physician, you probably know what to
expect: your vital signs will be taken by a nurse, you will wait on the exam
table, perhaps changing into a gown, and then the doctor will come in, ask you
questions about your health, and physically examine you. Most people have had
this experience many times since childhood and know exactly what to expect.
When they make an appointment with a psychologist or other
therapist, however, many people have no idea what to expect. They are usually
coming in at a time that is already quite difficult and can be quite
apprehensive about the initial appointment. For therapists, on the other hand,
the process is so familiar that they forget that not everyone knows it as well
as they do and don’t offer much of an explanation.
So, what should you expect?
The initial meeting, or intake session, will be an
opportunity for the therapist to learn the reason the client has chosen to come
in, which is also call the presenting problem. It is also an opportunity for
the therapist and client (or patient) to get to know each other. For human
beings, change takes place primarily in relationship with another human being
so feeling comfortable in the relationship with the therapist is key.
The initial session is sort of a mutual interview, where
both client and therapist get to know each other a little and find out if they
feel comfortable with each other, and are a “good fit” to work together. The
session may feel uncomfortable because it is difficult to talk about whatever brings
you in but the therapist will attempt to empathize with your situation and help
you to feel at ease.
After one or two initial sessions you will likely have a
good idea whether this therapist is someone with whom you feel comfortable
enough to work on the difficulties in your life that prompted you to seek
psychotherapy. If you identify discomfort with the therapist that is not
related to the distress of discussing your situation, it is perfectly fine to
look for someone else.
Before the first appointment, you may be asked to complete
some initial paperwork in which you will provide your contact information, describe
the reason you’ve come in, and any symptoms related to this issue. You may also
be asked for information about your relationships, occupation, medical care,
drug and alcohol use, and previous experience with mental health care such as
previous psychotherapy, hospitalizations, and medications prescribed. You may
also be asked to complete standardized questionnaires to provide further
indications of how you’re feeling.
During the first meeting the therapist will ask you to
describe the issues verbally and in more detail. She or he will also ask
questions to clarify the problem and to understand the wider context of your
life. The provider will also inquire about current and past drug/alcohol use,
thoughts about death or suicide, including previous attempts, and any traumatic
experiences. You may also be asked questions about unusual experiences or beliefs
related to delusion and hallucination.
These questions are asked of everyone who presents for
psychotherapy and should not be interpreted as an indication that the therapist
thinks you are more disturbed than you are. Most people who do have problems
related to these issues will not talk about them unless directly asked so these
inquiries must be made in every initial interview.
While asking these questions, the therapist will also be
making an effort not only to listen and understand your situation but to make an
emotional connection with you, communicate understanding and empathy, and to facilitate
the discussion of your concerns. At the same time, he or she will also be
looking for patterns in your presentation and symptoms to consider possible diagnoses.
Sometimes all these inquiries can be completed in one
session; often it takes 2-4 sessions to fully assess a person’s situation and concerns.
As this process continues, the client and therapist will begin to set goals for
their work together. The therapist may also make referrals to other providers,
such as the primary care physician or a psychiatrist. With these preliminaries
completed, you and the therapist will begin to work together to resolve your
problems and improve your situation.
Nancy R. Soro, Ph.D.
Licensed Clinical Psychologist
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