Neal Kaplan I'm a director of technical communications working for a data analysis startup in Redwood City. I started as a technical writer, and since then I've also been learning about information architecture, training, content strategy, and even something about customer support. I'm also passionate about cross-team collaboration and user communities.

What should a therapy session look like?

5 min read

A problem-solving session is what each session is all about. You describe your current situation, and your feelings about it, and then the therapist uses their expertise to assist you in trying to resolve that problem so you can move closer to having the life you wish to have.

How do you structure a therapy session?

In counseling there is a familiar pattern of sessions – introduction, information gathering, discussion, conclusion and homework. There is a framework for an Initial Visit, Middle Visit, and Final Visit.

What should a first therapy session cover?

The therapist will ask you questions about your past and present. Most likely, you’ll be talking about your current symptoms or struggles, as well as your interests, strengths, and goals.

How should a therapist open a session?

  • The client was welcomed to the consultation session.
  • Diagnostic evaluation is very short and focused.
  • The feedback to the client.
  • Let the client know that you can help them.

I noticed that new clients weren’t coming back for the second session when I started Private Practice. I knew I was doing something wrong in the first session when I wasn’t connecting with my clients. This includes a preview of tools I will teach them, the order of things, how we will track progress, etc., and I thank you for taking the step to come.

After I ask my questions, I will give you my thoughts and observations about what you have said to me, so you are aware of what I am thinking. I will share with you my initial thoughts and plan for how I will help you feel better. The key to not getting lost in the weeds is to identify the main clinical concerns right away and then ask a few follow-up questions to understand the severity and symptom presentation of that clinical concern.

Ask a few follow-up questions to get a broad understanding of the issue, and ask about previous therapy experiences, and what was helpful and not helpful, so you can learn how the client responds to therapy in general. Jane, I know we spoke briefly on the phone, but I would like to start with a broad question and ask what brought you in today?

It’s where I thank the client for being so open and talking about difficult things, and for providing feedback and a rough/initial diagnostic impression. When you see the doctor, you want to know what they are thinking and that they understand why you came in, so I don’t use that language with the client, but just like when you see the client, you want to know what they are thinking and that they understand why you I emphasize that I hear them, reflect their own language back to them, and that their concern is not just in my head, but it is serious enough that they came to a therapist about it, and that they deserve a professional’s help to feel better. It is clear to me that you have an above-average amount of anxiety and that it is impacting your ability to sleep and your job.

You have been dealing on your own with a clinical issue because I hear markers of an anxiety disorder. I will ask you more about your symptoms and make sure we get the right idea of what you are dealing with, but I am pretty confident that the focus of our work will be tackling this anxiety together.

Sharing that will give you a sense of how difficult or easy the client’s issue is. If there was any, incorporate what was helpful about previous therapy, so the client feels heard and understood. If you choose to work with me, I think we will start with practical tools to help you with your anxiety in the moment.

We can move past the shame by talking about it. Give the client a choice of scheduling for follow-up with you.

‘Am I weird’ and ‘Can you help me?’ are the most common questions I get. It is easy to reinforce your treatment plan during those times.

I don’t want anyone to assume that they are comfortable being my client yet, so I give them a choice between scheduling our next session right now or getting back to me after they think about it. The client that does not sign up right away will circle back to me in the future.

If that is the case, I need your permission to follow-up with you via email in a few days so we can get to know each other. If they have signed up to be a client, I look forward to working with them.

If a client didn’t schedule during the first consult, this is an opportunity to ask if they would like to meet again. I remember that you mentioned that your husband felt powerless when that happened, so I think it’s a good idea to share this article with him. We will find a time that works with your schedule if you would like to meet again.

How do you structure a first therapy session?

  • Welcoming them with warmth.
  • Asking questions and listening to them.
  • During the session, you can either face them or turn toward them.
  • It is common to let them know that they are nervous about the first session.

If you have been seeing clients for a while, you may still be interested in tips for a smooth intake session. You can find out more about their mental health struggles and emotional distress in the first session. If you haven’t been working with clients for a while, you may be a bit nervous before the first session.

You may want to spend some time getting ready as your client may be wondering how the appointment will go, and you may want to fill out any pre-session intake forms. I will be discussing confidentiality and client rights and responsibilities and giving information about my education and experience if I am clear and concise. Will Zogg, a clinical child and family therapist in Washington, says that he wants the client to be very clear about what he is asking from them. Your client will be required to sign a professional disclosure statement.

If you want to work with other mental health care providers, you may need a release of information form. Some therapists have potential clients fill out intake forms so they can talk about their answers.

Having a blank form ready will make the process easier for clients if they prefer to have them fill these out after their first session. If someone has let you know a little about what’s going on with them through their first email or phone call, or you have notes from a doctor or other therapist who referred them to you, prepare yourself with that before the first session.

If a client seems uncertain or has difficulty speaking about what is distressing them, you can say, “You wrote that you have been having a hard time with the issue lately.” If you don’t know where to start, you might ask, “Is there anything you want to make sure we talk about today?” You might want to ask if they have been thinking of suicide or self-injury. If you are a new therapist, you are more likely to feel nervous before your first session.

The person you will be seeing may be nervous and anxious about their first therapy appointment, so keep that in mind. The beginning of the first session may feel very businesslike, which can surprise or confuse people who weren’t expecting a lengthy discussion of forms and policies. Future awkward moments of having to handle payment can be prevented with this. Make sure your client is aware of your policy if you plan to take payment at the beginning or end of the session.

They may want to know more about your approach to treatment after reading your disclosure statement. You may have made a decision to become a therapist based on your feelings of compassion and empathy. It is more likely that a person will return for future sessions if you show them you care about what they have to say and are interested in helping them.

What should I talk about in my first therapy session?

  • What are your symptoms?
  • What made you want to go for therapy?
  • What do you believe is wrong in your life?
  • Questions about your history include your childhood, education, relationships, your current living situation, and your career.

You can learn more about the different types of therapy, what to expect from your first appointment, and questions to ask your therapist.

We’ve tried, tested and written unbiased reviews of the best online therapy programs, including Talkspace, Betterhelp, and Regain. The therapist’s office is similar to a doctor’s office. Don’t expect an instant solution to your problems on the first day of therapy, because it’s usually multiple visits. You and your therapist should come to an agreement about the length of your treatment, methods to be employed, and ins and outs of patient confidentiality, as well as some questions about your history.

A variety of techniques can help you better cope with mental illness, resolve personal issues, and create personal changes in your life. According to the American Psychological Association’s “Ethical Principles of Psychologists and Code of Conduct”, confidential information can be disclosed with the permission of the individual. The information must be given to a person who can take action to reduce the threat.

You can get to know your therapist better by asking more about their training, experience, approaches, and goals. It takes time for you to feel comfortable with your therapist. The National Alliance on Mental Illnesses suggests asking yourself a few questions to determine if you’re receiving the best care from your therapist.

Neal Kaplan I'm a director of technical communications working for a data analysis startup in Redwood City. I started as a technical writer, and since then I've also been learning about information architecture, training, content strategy, and even something about customer support. I'm also passionate about cross-team collaboration and user communities.

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