Are You a Counselling Virgin? – What You Need to Know About Starting Therapy

So you’ve gone to all the hard work of finding a therapist. Now what?

Some of the most common questions I hear from people new to counselling are:

  • What can I expect?
  • How do I know what to say?
  • Am I supposed to prepare anything?

These are all great questions!  What does happen behind that closed door?

This article is aimed at looking at what we may experience early on in the counselling process as the majority of the counselling out there is short term, regardless of the therapist’s theoretical approach.

I will offer the caveat that therapists are as diverse as the people they serve, so while there are a lot of commonalities in the way counselling is practiced, there will be some differences too.  My writing on this topic reflects my experience as a therapist, and to some extent as a client.

What to Expect

Most therapists will kick-start the first session with what is known as an assessment.  This may be formal, informal, or somewhere in-between, depending on the therapist’s style.  The counsellor will likely ask:

  • What is the issue(s) that brought you to counselling and what’s happening with it currently
  • When the issue started and how it has evolved over time
  • Other factors related to and influencing the issue
  • What is currently going well for you in your life and what things would look like for you without the current difficulties
  • Background information about you to better understand you as a whole person
  • What your goals are for counselling

The assessment is important; for the client, it can represent an opportunity to release thoughts and feelings and to feel heard and acknowledged for all that you have been through.  For the therapist, it is a vital first step toward getting to know you as a person, what is you difficulty and your sources of strength. Strengths are important because they can be used to mobilize against the current difficulties.  The assessment process may take more than one session because people’s problems are often multi-layered.  Part of the wonder of therapy are the insights that develop along the way.

The middle-part of therapy is where one can see more variation; there are differences in what therapists may zero in on but I feel strongly that what you identify as the priority must be respected and explored in counselling.  If you feel that this is not happening, don’t hesitate to speak up!

Together with the counsellor, you will identify themes and patterns in your difficulties and, depending on the counsellor’s perspective, themes and patterns of personal strength.

Ideally, your goals for therapy are determined collaboratively and many therapists will then work with you to come up with a plan for how to meet these goals; again this may be structured or loose, depending on your needs and the therapist’s style.  If the approach is structured, or semi-structured, you may be given exercises, readings or homework to do outside of the session or tools that you can use to help you with specific problems.  Of course, this approach may not resonate with you, especially if you are looking for a more relaxed and informal experience.  This can be just as valid!  Again, be sure to communicate to your counsellor what your needs are.

As I mentioned above, therapy length is often short-term, whether the counsellor or client intend this at the outset or not! In fact, the research shows that the most commonly occurring number of sessions is actually one!  There can be a number of reasons for this: sometimes it’s all that’s needed and other times the fit is poor between client and therapist.  Other times, life just happens in-between.

It’s great when therapy can end on a mutually decided-upon time and wind down in a way where your progress can be reviewed and a plan in place for you to carry on independently.  Sometimes referrals are given that will help to ease the transition or tools to enrich your counselling experience long-term.

What to Say

It can be nerve-wracking to think about what to say, especially when you first sit down on the counselling couch.  Many therapists try to make this as comfortable a process as possible, asking respectful open-ended questions designed to help facilitate dialogue.  When clients are deeply immersed in this process they will make comments like, “where did the time go?” or “I feel so much better” when a session is wrapping up. The fear around knowing what to say has left but there is a sense that a meaningful and purposeful conversation has taken place.

What to Prepare

Some counsellors may ask you to complete forms before your first session, others not.  It is always a good idea to give thought to your reasons for coming for counselling, although these do not have to be memorized.  Some people find it helpful to write them down, others like to speak spontaneously.  There is not a right or wrong to this; whatever helps you feel most comfortable is what’s best.  In my mind, the willingness to be open to the value of counselling and curious about your potential is a great step forward.