Preparing for your first Psychotherapy Session

What to expect when starting therapy?

If this is you first introduction to psychotherapy, it may be normal to wonder what to expect. Both individuals and couples entering therapy often wonder how therapy can help. They may worry about how long the process may take, what their total investment may need to be, what should be disclosed to a therapist, or even place doubt it its effectiveness. The answer to some questions are here but many tend to unfold through the process itself. To make your journey as enriching as possible, we'll also make some recommendations along the way.

 

How can psychotherapy help?

Perhaps the biggest hurdle most individuals face is wondering whether or not therapy can help. It is quite normal to feel that we know ourselves better than anyone else. And in many ways we do. At the very least, we are the sole experts of our perceptions and how we face our own reality. We humans are constantly processing data (thoughts and emotions) and producing results (behaviors). In fact, on average it is estimated that we are engaged with approximately 6,000 thoughts per day and experience at least one emotion being present to us 90% of the time. Add a few stressors or relationships to the mix, and life can get complicated pretty fast. 

 

Just think of how challenging it may be to organize all of this onto an Excel spreadsheet if we've never known how to organize the data. Although we may firmly believe that we can tackle the task on our own, we may quickly to realize that we may need to first learn how to use the software and then create an effective strategy to address the most important data. Psychotherapy is not about what we think, but rather it's about how we think. It provides the necessary foundation to organize our thoughts and emotions. It helps us understand and question our motives, patterns, and behaviors. It essentially teaches us how to use our software efficiently and effectively. Raising our proficiency to process information in new ways allows us to manage our thoughts, engage in healthier behaviors, and improve our outcomes.  
 

What to when expect when you first meet your therapist?

One of the most daunting parts of therapy is knowing where to begin and who you are going to trust. For some individuals, a specific concern may be prominently affecting their lives. They may be desperate to solve a problem and know exactly what they want to work on. Others may be fuzzy or unclear on where to begin. In either case, you may be entering a strange therapeutic space and find yourself in front of a complete stranger. Yes, this environment will likely feel foreign at first, but in due time, this setting may become a place to deal with life's most uncomfortable dilemmas or serve as welcoming retreat.

When you first meet your therapist, their goal is to help you feel welcomed and get to know you a bit. They will introduce themselves, go over some guidelines, and perhaps introduce their therapeutic approach. This is necessary but generally relatively brief. The therapist will want to focus the session on getting to know you, or you together with your partner if you are in couples therapy. He or she may begin to ask some questions regarding your immediate concerns or what brings you to therapy. They will generally ask some specific questions to help gain an understanding on how your concerns are being experienced or felt. They may also ask about your experience with therapy, gather some personal history, and obtain some background information. Some of this will continue to come up throughout future sessions as it may become relevant to adopted defense mechanisms, pattern of behavior, and established beliefs that may be contributing to our current concerns. 

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What to disclose to my therapist?

It's important to highlight that therapy is a safe, non-judgmental, and completely confidential space to talk about our thoughts and feelings. Therapists abide by strict rules regarding confidentiality and ethics. They understand the importance of providing a neutral space that can welcome an individuals thoughts and feelings to be expressed without judgement. Therapists understand that without adhering to these strict boundaries, any exposure can hurt their reputation, their clients, and their entire industry. In addition to the therapeutic and ethical value gained from honoring a clients privacy, information is also protected under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) which is a federal law designed to protect sensitive patient health information from being disclosed without the patient's consent or knowledge. Therapists have trained for years to learn how to create and hold a safe and confidential space. Many therapists have also worked extremely hard on themselves through their own therapy and how to recognize their own biases or unconscious feelings that may be inadvertenly brought up by their clients.

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We encourage clients to talk about whatever they'd like. Most therapists have heard it all and don't hold judgements over anyone's thoughts and feelings. In therapy, all thoughts are welcomed. Therapy often provides a space to finally give our thoughts and feelings a voice which could be incredibly helpful to express. Psychologically speaking, some content is repressed or hidden from our immediate awareness, while other material may be held back and never disclosed due to fear, shame, or even anger. When we finally make our way to exploring certain events or learning how to talk about certain things, we can gain an understanding and begin to heal.

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Are my psychotherapy sessions truly confidential? 

While your therapist will maintain your sessions confidential, there are only a few reasons why that confidentially may need to be broken. As part of your Informed Consent, therapists are mandated reporters and have the legal obligation to report any of the following situations:

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• If there is direct intent to harm yourself or someone else. Therapists will need to do everything in their power to help keep people safe. 

• If there is actual or suspected physical, verbal, or sexual abuse of a minor or an older adult. Therapists want to make sure that vulnerable individuals are kept safe.

• If for legal purposes, a judge subpoenas the therapist for their notes. While notes are often general, some legal proceedings may take steps to obtain notes regarding a particular treatment or understand a particular condition.

• If there is financial exploitation of a vulnerable population such as older adults or someone who may be disabled. Therapist will need to report this if someone is being taken advantage of financially. 

• If you yourself decide that your therapist can disclose something on your behalf to other parties. This may often be used when a therapist and other physicians may need to collaborate for the purposes of treatment.

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For individuals who choose to solely rely on their insurance benefits, please note that it is not uncommon for insurance companies to request therapy notes regarding treatment. These companies work to limit the length of treatments. Since service costs can quickly surpass the amount of an individual's insurance premium, many insurances use policies and tactics designed to narrow and discontinue care.
 

How long should I expect to be in therapy?

The length of therapy can vary greatly. Factors affecting the length of therapy include affordability, availability, cost, education, and severity of concern. This also includes our understanding and beliefs and around mental health. Unfortunately, the stigma around mental health continues pathologize individuals who choose heal or create something different for themselves. 

Some individuals hope to address their concerns over a few sessions. However, one of the best analogies for mental health is physical fitness. Although we may have spent years gobbling down milkshakes and fries, once we become honest with our weight gain, come January 1st, we may decide it's time to hit the gym. Unfortunately, we may quickly face a harsh reality and see that losing the 20lbs we need to lose can't be done over two or three workouts. Although our weight is relatively simple to measure, the same can't be said for what's going on inside of us. This makes psychotherapy particularly difficult to assess since our awareness to a problem takes a significant amount of emotional pain and a whole lot of commitment to finally put an end to it.

 

For those starting off, we recommend a therapeutic process for at least 3 or 4 months. We call this a process because it can take time to begin unraveling and making sense of your world. Just like a few workouts will not help you lose those unwanted pounds, therapy works in the same fashion. It needs to involve an investment in time, effort, and commitment. Those that can commit to several months may begin to understand what it's really going to take to see noticeable changes. During this time, many individuals and couples find therapy to be helpful as it may help alleviate some pain and address their situational concerns. 

 

Once some relief is attained, therapy may continue but some individuals may choose to alter the frequency and attend every other week or so. Other individuals and couples may still desire weekly support and may prefer to remain on for months or even years. Just like working out, the longer the therapy, the more it stays with us. Therapy essentially becomes a healthy part of our daily life; a weekly routine which keeps us present to our life and relationships. The longer we attend therapy, the deeper we can also go. Similarly to pealing the layers of an onion, both therapists and clients may enjoy discovering the core of who they are. Through the process of therapy individuals may internalize a healthier symbol or mentor which can help them navigate through life challenges or assist in their growth in profoundly rewarding ways. 

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What do I do if I'm not really feeling my therapist? 

Developing a trusting therapeutic alliance takes time. Therapists are seeking to establish this from the minute they meet you. However, they also recognize that this can take time to develop. It is also not uncommon for individuals coming to therapy to feel somewhat disconnected from their therapist. Although most therapists attempt to remain neutral, they may also represent people that we've previously experienced symbolically. Perhaps an "over caring" mother, a "successful" sister, or very "direct" father. This can in many ways trigger certain emotions, which may very well relate to what brings us to therapy. While we may prefer to have someone validate what we already connect with, we may be able to just find that with a good friend - for free. Therapy often involves facing real challenges directly with a therapist who may inadvertely trigger an unresolved dynamic or strategically choose to "poke" around to help you process a pain-point or learn how to heal from one. 

We recommend you give it a few sessions to see how this dynamic plays out, but we also recommend that you bring it up during your sessions. If you are feeling in any way uncomfortable, it may be both helpful and healing to let your therapist know so that together you can process these feelings. Although they may initially be painful and uncomfortable, through the work of an expert, you may be able to process these valuable emotions. 

If you are still having difficulty connecting and are not ready to bring this up to your therapist, contact the office at 305-605-LOVE so that we can find someone that may be someone else that may be a better fit for you.

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How can I make the best of my psychotherapy journey? 

Therapy requires time, space, and a whole lot of compassion. It may be helpful to think of the process of therapy as a space to nurture and grow. Yes, we do bring in our problems and concerns, but psychotherapy is so much more. It's an investment in ourselves and our experience around others. All journeys begin with a desire for change, a strong pull to create something different. True explorers eventually learn that they will need to depart from what's familiar and enter new and unfamiliar territories. Along the way, they understand that they'll have to encounter some fierce enemies or demons along the way. Before they can wield the their true power, they realize that they will need to train hard and face numerous tests in preparation for the future challenges ahead. Once they do, they gain valuable knowledge and experience in order to face their darkest fears. In time, they gain confidence and learn how to step into their power. It's a courageous journey that will take time and training.

We recommend that individuals dive head first into the process. Prioritize your treatment and make sure that you do your work in-between sessions. Although some therapists may assign homework, not all do. However, if they don't, it does not mean that you have the entire week off. A single hour out of the 168 hours in a week is not going to make move the needle. Similarly, if you have engaging in a particular behavior for 40 years, a few hours here and there will not change anything. For therapy to be effective you really have to want the healing or growth. That means that in-between sessions, you are practicing what you are learning, you are reflecting, reading, journaling, and engaging with the material you are learning each and every day. Just like working out to shed those excess pounds, you'll need to incorporate healthy habits into your lifestyle. This is your workout(s), plus healthy eating, plus conscientious choices, plus goals, plus measurements, plus accountability, plus rewards.. it's work! The more you can incorporate psychotherapy into your life, the more rewarding the payoff.        

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