So you finally picked a therapist and you decided to go ahead and book that first session. And now you're curious about what you should expect. Are there certain things that you have to do? Is crying required? What should you expect during this new kind of appointment that you scheduled for yourself?

You should feel safe in therapy

In general, your therapist should be warm, kind and confident. Some of us like to tease and joke. Some of us can be a little more serious. Some of us are somewhere between. You should expect that any therapist that you meet with feels confident with you. If you feel like they don't know what to do, or they're nervous around you, you're welcome to ask about that. You're also welcome to choose a different therapist.

You should also feel safe speaking in their space. There's always going to be sound that leaks through the walls, and few offices will be perfectly soundproof. But if you feel like you're not going to be able to have privacy or you feel like you can be overheard or seen, you're more than welcome to bring that up to your therapist. If you feel unsafe, you are always able to leave and let the therapist know that this is not the right space for you.

What does a therapist office look like?

This is one area where TV and movies usually get it right. Most therapists create a warm, comfortable environment similar to a living room, as opposed to something clinical like a doctor's office. Most of us have couches, although not everyone. And multiple chairs to choose from. Some therapists do have a specific chair for clients, but usually you can sit wherever you feel comfortable. If you're not sure, feel free to ask your therapist where you should sit. If there are blankets or pillows, feel free to use them and to get yourself comfortable. That's why they're there.

What do you do when you meet with your therapist for the first time?

Your therapist should be the guide here and will likely tell you a little of what you can expect in the first session. It's rare that a therapist is just going to look at you blankly and expect you to start talking. If you aren't sure what to do though, it's always OK to ask. You can always say "hey, this is my first time here, I'm not quite sure exactly what I should do." We are all trained to make people feel comfortable and we do this everyday, so we know that you may not necessarily know exactly what to do in this room.

What is a diagnostic evaluation?

If you're using insurance to cover the cost of therapy, you will more than likely need to do what's called a diagnostic evaluation. In a diagnostic evaluation, your therapist will interview you, asking questions that can sometimes be detailed and even quite personal. We're not doing this to get all the gossip about you or to make you feel uncomfortable. We're doing this so that we can have a better understanding of what your symptoms are to find out if you do have a medical need for therapy.

Most insurance companies won't cover therapy unless there is a medical need, so part of our job during this evaluation is to establish if there is a medical need and, if so, what needs to be done. You may be given a diagnosis by your therapist of a mental disorder that is in the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5). A diagnosis is not made to judge you or stigmatize you. It's just a set of criteria that gives us a general idea of what you're struggling with and how to help. Common diagnoses include Generalized Anxiety Disorder, Major Depressive Disorder, and Posttraumatic Stress Disorder, but there are other disorders that can be diagnosed in this evaluation.

You are always welcome to ask if you can pause or to ask if you can come back to the evaluation later. Some insurance companies do require that the diagnostic evaluation is completed in the first session, but not all of them do. If you're not comfortable, you can ask your therapist if this is something that you can finish when you feel a little bit more comfortable.

In a diagnostic evaluation, you may also be asked to complete a couple of assessments, which may be either in a secure online environment or on paper that's handed to you in the office. None of these assessments should be too long. And if you have any questions about them, you should ask your therapist. It's completely OK to ask about anything that's put in front of you.

In Colorado, a diagnostic evaluation is not required if you are paying for the service directly. Most states also have this rule, but some don't, so you will need to check with your therapist during the consultation call if you don't want to have a diagnostic evaluation. In Colorado, if you are paying for the session directly, which is sometimes referred to as cash pay or out of pocket, then you can work with your therapist to decide what the first session looks like. Keep in mind that some therapists still like to do a diagnostic evaluation. And if your therapist chooses to do so, they are within their right, just as you are within your right to state that you don't want to work with them.

What is a treatment plan?

A treatment plan is simply a plan that outlines what your goals are and how the therapist will help you meet those goals. If you are not going to have a diagnostic evaluation in the first session, then you can expect to still answer some intake questions which will involve things like why you sought therapy and what your goals are so that your therapist can write your treatment plan. In Colorado, even if we do not do a diagnostic evaluation, we are required to have a treatment plan on file to answer those questions on the treatment plan and come up with those goals. We have to know what is going on, what your symptoms are, and what your goals are so that we can create a plan for how we're going to get you to meet your goals.

Questions to ask your therapist during your first session

Ask about your diagnosis and treatment plan

Your diagnosis and your treatment plan are both part of your chart (sometimes called client file or client data). Everything in your chart technically belongs to you. You're welcome to ask about your diagnosis and why your clinician thinks that you have that diagnosis. You're also welcome to ask what your treatment plan is and what your treatment goals are and to ask questions about the different interventions in the treatment plan. It's a good thing to ask about these, because that means that you can collaborate with your therapist and both work together towards meeting your goals.

Ask what to expect in the next few sessions

Another question that you should ask your therapist is what to expect in the next few sessions. When I see clients at True Grit, often my first session is very different from what my other sessions look like. If I have to do a diagnostic evaluation that typically takes up all of our time, and so I'm left with very little time to get to know someone. If I don't have to do a diagnostic evaluation, then that means I can spend more time listening and exploring who the client is, what their hopes are, and what their goals are for treatment.

Ask about homework

Some people love having specific tasks they can do outside of session in order to build skills and reach their goals. If this is you, let your therapist know and ask what she would like you to practice outside of session. Some people feel pressured when there is a specific assignment and prefer to think about the session during the week and try different skills on their own time. If this sounds like you, let your therapist know. Some therapists will require homework, but that doesn't mean you have to do it. If you don't want to do homework, find a therapist who won't assign it.

Is it okay to...?

It's OK to do the following in the first session.

It's OK to say that you're nervous.

It's OK to laugh and joke.

It's OK to share your trauma.

It's OK to say that you don't want to share your trauma.

It's OK to cry. We don't take it personally, and we're not going to be uncomfortable.

It's OK to ask questions.

It's OK to ask your therapist a bit about themselves.

It's OK to give feedback to your therapist if they say something that you don't like or that hurt your feelings.

It's OK to tell your therapist if you're still not sure if you want to work with them or not.

It's OK to tell your therapist that you are sure that you want to work with them and to schedule your next appointment in session.

It's OK to leave if you don't want to be there.

It's OK to swear or use slang. It's OK to show memes.

Colorado does not require therapists to report drug use in adults, sexual behaviors or activities, history of miscarriage or terminated pregnancies, or any crime that has already been committed. Which means that it's OK to tell me that you used drugs. I'm not going to judge you or report it.

It's OK to ask about your therapist's religious, ethical, political, and moral beliefs and to choose to work with a therapist who aligns with your beliefs.

It's OK to have different beliefs from your therapist and to talk about them in session.

Your first session should help you to feel confident continuing your work with this therapist. If you are unsure, that's just fine. Give it another session or two and see if your feelings change. Another goal of the session is to decide what your treatment plan is going to be and what you're going to work on with your therapist. Some first sessions are amazing and you walk out feeling better and grateful that you went to therapy. Some can sometimes feel empty or clinical. Neither of these are predictors of the future. Things can continue to go well, or maybe you get a few sessions in and you decide that this isn't the person for you.

If you're in Colorado and are curious about starting therapy with True Grit, feel free to click on the contact button below and reach out to schedule your free 15 minute consultation with Stacy Andrews, LPC.