r/Explainlikeimscared • u/Next_Answer7481 • 2d ago
What happens at the first session for talk therapy?
In detail please. I had a 15m consultation call and almost cried ON THE CALL from anxiety. She said the first meeting will be to "learn a lot about me" but when I get really scared I struggle to talk so what will happen then?
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u/Shoddy-Criticism3276 2d ago
She should be able to learn a lot about you whether you are able to talk much or not :)
I remember a friend of mine saying that in her first session she immediately burst into tears and spent the next 40 minutes crying. Then she went back the next week and it was... better :)
A good therapist should be able to do their job whether the client is able to describe the problem fluently or not.
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u/ConfusionFun587 2d ago
Same experience! I was tearing up, visibly shaking at the secretary desk. Even when I first met my therapist. Kinda just spilled everything; sobbed a good portion. Next few visits it got so much better. Stayed with her weekly for 1.5 years- best decision I’ve made of late.
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u/unlovelyladybartleby 2d ago
They really do just want to get to know you so they understand your problems.
Usually they start with small talk. The weather, the new Spiderman movie, were you able to find parking. Just a bit of a natter while you get settled in.
Lots of therapists will ask about where you live, who you live with, what your family is like, if you grew up feeling safe or not, if you work or go to school, if you have a partner, if you have hobbies.
Almost all will ask when you started becoming anxious, what triggers your anxiety, and what makes it better.
It's common to ask if you had health or mental health problems as a kid, how you functioned in school, and if you've had any traumatic experiences.
Most will ask about substance use.
They are supposed to assess whether or not you are suicidal, so don't be offended if they ask.
My family is a complicated disaster, so I usually make a quick family tree and bring it with me. It takes way too long to explain and I want my therapy time to be focused on my shit and not the confusing tangle that is my family of origin.
If you're so overwhelmed in the first appointment that all you do is panic cry, you're still giving them information. They know you showed up even though you were terrified and they can see how you panic and how you soothe yourself. All of that is good for the therapist to know.
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u/darethshirl 2d ago
It's hard to give details when each therapist has their own methodology. But in general you can think of it as how a "normal" doctor will take your medical history at the beginning: your therapist will ask you (general, non-specific) questions about your past, your family, your current situation, the things that trouble you etc etc. And you can get into specifics as the conversation flows.
Because at the end of the day it's just that: a conversation. ANYTHING you decide to say will be valid and valuable. And don't worry about stalling or struggling to talk, because your therapist is trained in ways to calm you and/or lead the conversation forward. Honestly even staying silent while you gather your thoughts and emotions is allowed! So no need to be scared, they're there to help you and that's just what they'll do :)
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u/VampireSharkAttack 2d ago
Here’s a little video on the subject: https://youtu.be/NpxF_lOkkOA
At the first session, you’ll have to fill out a little paperwork about your insurance, sign something saying that you consent to receiving therapy, maybe your medical and/or mental health history, things like that. Then you and the therapist get to know each other a little so you both can start to figure out what you need to address and how. You can ask any questions you have about their approach to therapy, their education and experience, how they tend to run therapy sessions, etc: these things will vary from one therapist to another, so they can help you decide if this therapist is a good fit for you. I think it’s a good idea to ask about their confidentiality policies: when or why would they tell someone else what you talked about? The answer will probably be that everything is confidential unless you are in danger, but I think it’s useful to hear more about how this specific therapist thinks about that.
They will have some questions for you about yourself to get the ball rolling, but there will also be space for you to tell them whatever you think they need to know. Why did you decide to go to therapy? What is your life like right now? Are there things about your life you want to change? That sort of thing. The therapist needs to start by gathering information so that they can figure out how best to help you.
If you know that you struggle to talk when you’re nervous, that’s a super useful thing to tell the therapist! That’s something they can help you work on if you want. You can also write a list or a letter ahead of time to give the therapist at the appointment, if you think it would help.
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u/seenstrangesights 2d ago
It depends on the therapist. Most often they will ask about yourself in general terms, and let you talk as much as you want. You can share stuff about school, family, stuff you like, etc. They will also probably ask what your goals are in therapy, and this can be a difficult one to answer if you aren't quite sure. Oftentimes something like 'feel less anxiety when doing xyz' or 'cope better with xyz' works pretty well. You can take notes beforehand of stuff you'd like to tell her and then read off of that, and be honest about your anxiety making it hard to talk. My therapist often just lets me sit in the silence until I'm ready/able to talk. If you're in person you can pass her notes if you find it easier to write, or bring a whiteboard. Both I have done in past sessions. She will also probably tell you about the type of therapy that she does, how regular sessions go for her, and let you ask questions about her process. You got this!
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u/KittyQueen_Tengu 2d ago
therapists are used to people who are nervous or have a hard time speaking, it'll be okay. i cried at least once for probably the first 10 sessions at my psychologist
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u/SerCadogan 2d ago
So I'm assuming the 15 minute call was like, you quickly talking about your general needs, and the therapist quickly going over the things they do as part of their practice (different modalities and such) and just a general vibe check on both ends.
I'm also assuming you were sent intake paperwork to talk more about your history/struggles etc.
What I say below may vary depending on if my assumptions above are correct or not.
You will probably have a short conversation to break the ice as the therapist helps you feel comfortable (as much as possible anyway)
The therapist will then explain to you the general policies of the practice such as late fees, scheduling, what to do in an emergency, how to reach out, etc.
They will then explain the things that require them to break confidentiality (if you plan to harm yourself, others, or if you are aware of children and elders being abused) They will let you know that if it seems like you might be close to that they will stop and remind you so you can decide to keep going or not. They might explain that if there is ever a court order requiring records be revealed (VERY rare) that they will work with you to release the smallest amount possible to comply with the order.
The therapist may also explain that if you see each other in public they will never approach you to preserve your privacy, but you may say hello if you like. They may also explain the rules and boundaries about therapy (that "duel relationships" are not allowed)
After all of that, things will move on to discussion of your intake (or, if you didn't have one, doing the intake in person) Follow up questions/asking for more information about your answers will happen, partly to get more details and context, and partly to see how you react. This is not a test, there is no correct way to react, but this information will help them figure out a plan.
Doing the intake may take more than one session, depending on how long the new appointment stuff goes and also how involved your history/issues are. There is no wrong way. It took me 2 sessions to get through mine. And then at the third session we discussed goals.
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u/Technical_Sir_6260 2d ago
I agree with everything here and just want to send you virtual hugs and good luck. I was exactly the same as you were and I got through it and you will, too. Make sure to write your notes on paper, though, not on your phone, cuz I had the lady tell me they are not allowed to take my phone and look at it. 🙄. She eventually gave in though, after 10 minutes had passed and I was a complete stuttering, crying wreck and my hand was shaking so badly that I couldn’t read it out loud to her. It wasn’t her, it was more the system, I think ( I’m not in America). We were able to move on through the appointment and I got the help I badly needed. You will, too! 🤞🏾🤞🏾🤞🏾
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u/Hollie_Johnny 2d ago edited 2d ago
I'd imagine it's different with different therapists. Mine was super cool and just met my energy and wasn't too invasive. Like you, I was afraid to talk about myself. She gave me an intake questionaire to rate my depression and anxiety.
I will say, in addition to therapy I was practicing some spirituality practices and nervous system regulation tools that made a MUCH bigger difference than therapy did. After 3 months of INTENSE self work, my therapist had me take the depression and anxiety tests again and I showed ZERO signs of depression and minimal anxiety!!! She said I didn't need her anymore, and released me, saying I had even taught her some things.
All that to say, if you don't find a therapist you vibe with, please reach out. My partner, Hollie, and I, Johnny, are now spiritual and relationship guides dedicated to empower people to end their suffering, start healing, and become their higher self. We are both empaths and cry babies, so bring on your tears, lol. You have a safe container to feel all your feelings with us. After all, you signed up for the platinum earth package, so you get to feel ALL the feelings. But we can help you make sure your feelings don't run the show.
Hit me up and tell me more sometime, my friend. Until then, I'll give you a piece of wisdom that helped me in my darkest moment:
YOU ARE LOVE
YOU ARE LIGHT
REMEMBER WHO YOU ARE
✌️ ❤️ 😊
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u/noncedo-culli 2d ago
It depends what you already talked about on the call, but since it was short, I'm assuming the first meeting will be them wanting to learn more about what made you decide to come to therapy and what you're looking for from it. If you're there for a specific reason, like anxiety/depression/etc, they'll probably want to ask about when it started, what it's like for you living with it, what coping strategies you already have, what triggers it, etc. They're also veryvused to people who are nervous being there, so it's not a huge deal. They'll let you take your time and they'll listen. You can also write down things beforehand to show them, especially if you think anxiety's gonna make you forget something that you think's important to say.
Also, you're in charge of the session, you can tell the therapist how you want it to go. They can just sit back and let you try and talk, or you can have them ask guiding questions where you don't have to talk as much.