_edited.png)
Embarking into therapy can be daunting and exciting, especially if it's your first time. For many, it's a step towards healing, alignment, and self-discovery, and it's normal to feel a mix of emotions ranging from anticipation to nervousness. But, no matter what happens, please trust that taking that first step towards counselling is courageous and promising. Here are some tips on what you can expect from your initial session:
Safe & Supportive Environment
Whether you are seeing a counsellor virtually or in person, you should find the set up for the appointment feels more safe and supportive than anything. Your counsellor will greet you warmly, offering a comfortable atmosphere where you can express your thoughts, feelings, and goals openly. This is conducive to honest self-reflection and growth as well as establishing a good therapeutic relationship.
If you are seeing a counsellor in person, you'll find a space designed to make you feel welcome and comfortable - don't hesitate to ask to adjust lighting, seating, temperature, and so on. It might seem bothersome, but your therapist would rather you let them know if something feels either good or bad to you than have you uncomfortable when something could be easily adjusted.
If you are seeing your counsellor virtually, make sure you have a private and comfortable space (many people see their counsellors from their cars or behind a locked door in their home while wearing headphone, for example), tissues on hand, something to sip on (ie. tea or water), and a good wifi connection. Sometimes, if there are glitches with the video system, the counsellor may suggest a phone call instead - don't worry; whatever tech issues come up, there are ways to work through.
Confidentiality: The Foundation of Trust & Ethical Service
Protecting your privacy deeply underscores the counseling relationship and is an ethical obligation for most therapeutic professionals. Understanding this boundary fosters trust and enables you to open up freely as well as is part of you providing informed consent to therapy. This means it is crucial to explore as a first step with therapy, even before you begin to share.
In the first session, your counsellor should explain the limits of confidentiality, assuring you that what you share in sessions remains private except where there is a legal requirement to break confidentiality or if you otherwise provide consent. The legal exceptions are: if there's a risk of harm to yourself or others, a concern about abuse or neglect of a vulnerable person or a child (even if historical in nature), there is a court order of subpoena to release your file or testify, you authorize your records to be released (ie. to WSBC, ICBC, a disability claim management agency, your lawyer, anyone else you name, etc.). This is also outlined in the Consent to Services agreement that you will have completed prior to the first session. Your counsellor cannot provide legal advice on any of this, and must simply comply with the legal requirements as listed, so if you have concerns about the release of your information at any time, it is important to seek legal advice from a lawyer.
One thing to keep in mind if you are a private person or worried about confidentiality is that you can decline to answer any questions that are asked, or you can ask for clarification about what the purpose of the question is, or you can ask how the counsellor is going to document your response. If there is a legal reason to breach confidentiality, you can ask to be part of the process; you can ask your counsellor to call MCFD with you to report a child protection concern, for example. In fact, if at any point you have any questions about anything happening in therapy, asking about it is strongly encouraged.
It is important to know there are legal implications for breaching confidentiality, especially regarding sensitive information shared by the client, and you have the right to report a therapist to their governing body if you believe your confidentiality has been violated, as follows: Report a Registered Clinical Counsellor with the BC Association of Clinical Counsellors, an Occupational Therapist with the College of Occupational Therapists of BC, or a Registered (Clinical) Social Worker (RSW/ RCSW) with the BC College of Social Workers (if your counsellor has a different designation, it is a good idea to check what their college or association considers ethical around privacy).c
Comprehensive History Taking: Understanding Your Story
Once confidentiality and any other key policies have been addressed, it will be time to dive into understanding you. The first session begins a comprehensive history-taking process - parts of this might feel like a casual conversation, parts might feel quite activating, and parts might feel very comforting.
Over this session and perhaps into subsequent sessions, your counsellor will ask things like:
What are your goals for therapy? What is your chief concern? Why now?
Where did these issues start in life? What do they look like in your day to day?
Explore protective and risk factors: What are some skills you already have? Who are the important people in your life? What do you have in your life that fosters connection, enjoyment, and health? What is your diet, sleep, hydration, and physical movement like? What are current or recent stressors in life? Do you drink, use any substances/ medications, engage in self harm, have a history or current risk with suicide, have a history of mental health concerns, have a family history of mental health, etc. What is your history with trauma and resiliency?
Review any screeners you may have completed in intake and explain what they mean.
Understand any history you may have of therapy - what worked or what didn't.
Explore family of origin and current family dynamics, feelings about work/ occupation, and spiritual or religious beliefs.
This history taking, although it may feel too comprehensive at times, helps the therapist understand your unique experiences and challenges, laying the groundwork for a personalized treatment plan as well as any recommendations for other services or follow up. It is arguably the most important step in getting you to where you want to go with therapy.
Sometimes, if someone is in crisis/ distress in the first session(s), the time will be more dedicated to understanding the specific situation and engaging in safety and action planning. Your safety must always come first.
Also, if you are especially activated at any time in any session, a therapist could engage in some grounding strategies with you. Counsellors work within what is called the "Window of Tolerance" which means it's crucial to continually reset so that people can stay in a tolerable level of activation. If you are someone who is particularly activated in general, let your counsellor know that right away, and feel free to tell them, "I need to stop," at any time so that they can properly support you. If you can't find the words to say that, you can even just put up a hand, and a good therapist will know that means you need a break and maybe some extra support. You might also experience a therapist telling you, "Let's take a break here for a moment and get a bit more grounded," or similar. This is not the therapist shutting you down or trying to stop you from going where you want to go in therapy; it is them using their clinical expertise to take care of you and keep you in a good emotional range. You might also have a therapist interrupt you or redirect what you are talking about; again, please know this is them taking good care of you. Especially with trauma, we know that although there can often be a compulsion to share all the details of what happened; it is likely that a therapist will do some things in the first session to contain that a bit to take care of you. For example, they might ask you to tell them your trauma history only by giving the year/ time in your life something happened and a label for it, like, "4 years old - car accident," and then moving on. Overall, this all comes down to developing, right from the start, a feedback rich relationship; you and your counsellor will need to trust each other to be honest about what is coming up and where that means things need to go.
Identifying Goals and Expectations
Throughout the first session and all subsequent sessions, you can expect to explore what you hope to come away with. Whether it's managing burnout, alleviating anxiety, desensitizing and reprocessing trauma, just having a safe space to process, or improving overall well-being, clarifying your goals sets and maintains the direction for your counselling journey. Your counsellor will work collaboratively with you to establish realistic expectations and a roadmap for progress.
For the first session, there's no need to prepare anything; the therapist will take you through the process and you just need to show up. If the history taking and relationship building continues as the main focus for several sessions, you can expect the same; just come.
If you and your therapist are looking to treat a condition, and you have completed history taking in one session, your therapist should be able to let you know by the end of the first session what to expect in terms of the different therapeutic approaches they believe will be of benefit, and a general sense of how many sessions your might expect (planning for 12 sessions weekly - biweekly sessions is a good general rule of thumb). Please keep in mind these are estimates only and vary greatly depending on how therapy (and homework) progresses for you. If you are seeking more of a supportive or maintenance therapy where the focus is not as much about treatment, you can generally plan for biweekly or monthly sessions. Whether you are in a treatment phase or in a supportive phase, in future sessions, you might wish to write down before sessions what you would like to get into or get out of the session, or you may wish to just show up and see what unfolds.
Psychoeducation & Homework: Insights into Mental Health
In your first session, your counsellor will likely interweave educational aspects. This is meant to help you start to gain valuable insights into mental health and coping strategies. Your counsellor may educate you about common symptoms of burnout, stress, anxiety, trauma, depression, etc., or common patterns in thoughts and behaviors that link into your concerns, for example. This psychoeducation empowers you to become more self-aware and equipped with tools to manage your challenges effectively.
Additionally, though it is not always the case, some counsellors will provide homework, even from the very first session. This is meant to enhance your knowledge and awareness and elevate the aspects you are working on in therapy. Whether the counsellor assigns homework or not in the first session, if you have strong views on the idea of homework, it is good to let them know if you would like the option of working on material between sessions. Most research does suggest it is helpful to work between sessions as well, and some therapists consider it mandatory while others consider it optional or even unnecessary. This can vary based on the therapists background and training.
Summary: Embrace the Apprehension & Begin A Path to Emotional Well-being
As you step into your first counselling session, remember that it's okay to feel apprehensive. Embrace the opportunity to explore your emotions, gain new perspectives, and embark on a journey of self-discovery. With the guidance of a skilled therapist and your willingness to engage in the process in a collaborative and feedback-rich manner, you're on the path towards greater resilience and emotional well-being. And, if the first session, or even the first 3-5 sessions feel especially awkward, know that this is normal; therapy is not generally like any other relationship or process you have anywhere else in your life, and it might take some getting used to. But, if you feel after about 5 sessions that things just aren't coming together for you, that can be a sign that it's worth trying a different therapist.
Ready to try therapy? Please consider booking a free consult with one of our wonderful clinicians here, or email us at connect@kaydahealth.ca with any questions you may have.