A first therapy session can be very intimidating for both therapist and client. But first sessions seem to be more intimidating to clients because they are unfamiliar with the process, do not know what to expect, aren’t sure if they will like the therapist or office, are anxious about the conversation, and are sometimes fearful of the therapist “psychoanalyzing” them. That first therapy session could also be the very first time you have ever seen a therapist. Whatever the case, the first session can be so stressful that you forget the most important questions to ask. This article will discuss questions you should be asking during the very first session.
Pursuing therapy can be one of the most intimidating things you may ever do. Pursuing therapy says that you need help navigating certain aspects of your life and this can be intimidating, humiliating, and scary. It’s important that you frequently remind yourself that no one can go at this life all alone. We all need help sometimes. It’s even possible that your own therapist is also in therapy. Life is tough. Whether you receive “therapy” from a family member, trusted friend, or professional, therapy is often needed to survive. Once you get over your initial feelings of uncertainty, you will need to know what questions you should be asking before you step into a relationship with a therapist.
After working with multiple families who all have had various questions to ask during the 1st session, I have compiled a list of 9 questions that are often the most important to ask during the first session:
- What will individual or family therapy be like? In many cases, clients feel around in the dark when seeking a therapist. They are uninformed about the various types of therapists that there are and the various types of training that certain therapists engage in. The type of training a therapist has often influences the type of therapy you will receive. It may be difficult to determine what is called a therapist’s theoretical orientation (background, worldview, work experience, therapeutic tools, and training that influences a therapists way he or she engages with a client) during the first session unless you ask the right questions. Asking a therapist what type of therapy he or she would offer you is a great first step. You will have to listen closely as some therapists struggle with making their approach to therapy easy to understand for clients. You will have to ask what “school of thought” (or theoretical orientation) the therapist uses. For example, I use a trauma-informed, CBT and existential approach with my young clients. Some parents believe just because I work with kids and teens that I subscribe to play therapy. It’s my job to explain my approach (and your job) to ask the right questions. You don’t want to buy the service and regret it later.
- What is your policy on social media and communicating with you there? Some therapists, like me, have social media sites that have a specific purpose that may be unrelated to therapy itself. For example, I have this blog but I also have a website, twitter page, Pinterest, and a host of other social media sites to reach various audiences. Although I have a social media policy, I do not, however, allow my clients to interact with me there and ask personal questions. Some therapists prefer their client not to explore their social media sites at all. You want to be sure you understand what your therapist prefers because if you cross a boundary line, you can possibly destroy the therapeutic relationship.
- How long are sessions and can I see you more than once a week? Some individuals are unaware of how therapy goes. Therapy has rules – some spoken and some unspoken. It’s appropriate to ask your therapist how often you can see them and in what ways can you contact them throughout the week. I offer parents the opportunity of calling me throughout the week if they need something or have a concern. I have a 24hr-72hr return call policy. Some therapists, however, prefer clients to contact them throughout the week via email or write concerns/questions down and discuss them during the next session. Every therapist is different. You want to learn who your therapist is by asking this question. Not knowing how to contact your therapist or when can certainly destroy the relationship. You wouldn’t want to just show up to the office to ask a question or discuss a concern unannounced!
- How do you view human suffering? Some therapists are overly positive, some are overly pessimistic, and others are balanced in their view of life. It’s perfectly okay to ask your therapist how he or she views human suffering and life in general. For the most part, our life perspectives are what drive our therapy approaches, attitudes, and perceptions. A therapist’s theoretical orientation will also affect their view of human suffering. Because I integrate both CBT and existential principles, I see human suffering as an inevitable part of life that can be coped with using the appropriate tools (prayer/spirituality, community, and self-care, changing your thoughts, challenging your perceptions, journaling, and persevering). Other therapists believe that you have the power to control every aspect of your life if you just try hard enough. Still other therapists believe things that perhaps you would totally disagree with.
- Do I pay for sessions before or after? Some therapists will have this information written in your policy or contract, but other therapists simply don’t make this clear enough. It’s okay to ask if you are to pay for therapy before or after the session and in what ways can you pay. Some technologically astute therapists use PayPal or a counseling platform such as Wise-Counsel to assist clients in paying for sessions. But other therapists prefer check or money order or credit card using a credit card slider. Everyone is different.
- Will you make contact with my previous treatment providers? I find it very useful to obtain consent from my client’s family and contact previous treatment teams – psychiatrists, therapists, behavioral specialists, holistic doctors, etc. This process can provide a great deal of information to a therapist. It’s often very helpful to obtain historical information that can inform treatment. You also, however, have the right to ask that your previous treatment providers not be contacted. If this occurs and you have not provided consent, this is a breach of confidentiality.
- What is your experience with culture and ethnicity? Some clients, primarily the African American and Native American cultures find it very difficult to trust the therapeutic process for obvious reasons. Some not so obvious reasons include the fact that the majority of mental health professionals in today’s society are Caucasian and these two ethnic cultures have experienced a long history of violated trust and oppression. It’s difficult for this population to trust. A skilled therapist with experience working with ethnic minorities is extremely valuable and very much needed with this population. It is okay to ask how much experience your therapist has with this population. An inner-city youth is not going to open up to a middle class white male or female about his father’s incarceration, his mother’s substance abuse, and his truancy. It will be a challenge. The child is likely to feel that his Caucasian therapist will not be able to relate or utilize the appropriate tools.
- What happens if my insurance runs out or insurance stops paying for therapy? If you use insurance for your therapy, you are probably well aware of the fact that sometimes insurance does not see a purpose for why you need therapy and will stop paying. Most therapists who accept medical assistance (government-based insurance) or private insurance have to do what are known as Continued Stay Reviews which includes the therapist calling the insurance company and providing various reasons for why a client should remain in therapy and why insurance should continue to pay. If insurance does not believe the reasons for continued treatment are not strong, insurance will stop paying which means your therapist does not get paid for services rendered. You will either have to enter a payment agreement which says that you will pay your therapist “out-of-pocket” or you will have to stop therapy. It is useful to ask your therapist how he or she will handle this process.
- Who can I contact for emergencies or crisis situations when you are out of the office? Because the majority of my career has included me working in agencies and hospitals, I have always had someone, during my vacation time, to fill in for me. For those who work in private practice, there is often no one to fill in for the therapist. Even in some agencies, there aren’t too many people who will be able to help you while your therapist is out. It’s a great idea to ask your therapist who you can contact when they are not reachable.
As you can see, there are multiple questions that need to be asked during your first session. Some therapists do not allow their client’s to ask questions due to time constraints or an inability to connect with clients. You will have to be assertive with these therapists. Other therapists do a great job of scheduling a free consultation before your session so that you can have all your questions answered.
I encourage you to ask lots of questions so that you can be armed with the appropriate knowledge and can plan ahead. But I also encourage you to be kind, patient, and polite in asking questions. You certainly don’t want to come across as rude or aggressive. This can destroy a potentially equal and healthy relationship. You want to start off on the right foot but also be aware of your needs.
As always, I wish you well