In last months blog, part 1 of 3, I talked about the process of deciding to have counselling and how to find a therapist. This month, I will be talking about what to expect in the first sessions.
Oh, and just to clarify, the terms counselling and therapy mean the same thing, just as the terms counsellor and therapist are the same, so I will use them interchangeably.
Consider the end at the start
Ok, now I know this sounds odd. You may not at this point even walked through the therapist’s door but it is important you know what you want to get from therapy, otherwise, how will you know when you have achieved it? Some therapists will book you in for an agreed number of sessions and then review, some will review at the end of each session or sporadically. Your counsellor will support you in reviewing the work done in the counselling room but the decision to end will be yours, so having an idea of what you want to achieve, how things will be different when these things are achieved is important for you to know when you will be ready to end (see part 1: finding a therapist for how you can think about this). It may be that during the work you and your counsellor do, other things ‘come up’ which you also want to explore, and that is fine. But let’s not ignore the fact that therapy can be a costly commitment and takes a lot of mental and emotional energy and so breaks can be useful – remember you can always come back!
The first session
The first session in therapy is likely to involve going over some paperwork. This will definitely include a contract or counselling agreement which sets out what the therapist will offer, what is expected of you and important information such as confidentiality and exceptions, session details, contact between sessions and payment and cancellation policies. This will be discussed with you and you are invited to ask questions and get clarification wherever something is not clear – it is important you understand the details of the contract before you sign it!
There may be other paperwork to sign, depending on the counsellor, such as questionnaires or rating scales to establish where you are at the moment in terms of thoughts, feelings and behaviours, risk assessments, consent forms and goal setting. The therapist will talk you through all of this and it can be a gentle way into therapy, allowing you to understand how your counsellor works, a chance for you to ask questions and begin forming the therapeutic relationship, which is vital for you to feel safe enough to explore what you need to.
Preparing for sessions
Spend some time noting down points you may want to cover. A lot of clients come in to the first therapy session and say they have been worrying about what to say. There are no expectations and I tend to find sessions are pretty organic with what ‘needs’ to be said or come up tending to do so. However, the thought of not knowing what to say can cause worry and even a sleepless night before the first session so jotting down some key points of things you feel are important to you to say or giving the therapist a brief overview of why you have come to therapy is enough to get you started. You won’t be expected to dive in to the deep stuff straight away – it’s a process and in the first few sessions, you and your therapist are getting to know each other so its natural for you to be cautious. Your therapist will understand this. Yet, if you want to dive in straight away, that’s fine too, your therapist will work with you to keep you safe and within your ‘window of tolerance’ – that is, not too anxious that you go into panic, and not too disconnected that you ‘zone out’.
If you are attending face-to-face therapy or walking therapy, ensure you know where you are going and allow yourself sufficient time to get there. The last thing you want to is to feel anxious about starting therapy AND feel stressed due to traffic and delays! If you are delayed, just drop your therapist a text or give them a call and let them know – they will understand. If you are having therapy online, ensure you have checked your connection and the link before the session start time. Make sure you have a quiet and private space to be with no distractions or chances of being disturbed. It can be useful to have a set of headphones for your electronic device as these can keep what is said private and block out any noisy distractions.
Wherever your session is due to take place, it is a good idea to have a bottle/glass of water with you. One reason for this is that while you are talking, sips of water can stop your mouth going dry and can offer you a chance to pause and think. Also sipping cold water mindfully can be a great grounding tool. By this I mean, if you are talking about something which you find triggering – maybe an upsetting memory, or a conversation with someone which led to uncomfortable thoughts, instead of getting stuck in these and going outside your window of tolerance (which I mentioned earlier), sipping cold water and noticing how it tastes, what temperature it is, how it feels as it washed around your mouth and down your throat, can keep you focussed on the here-and-now where you are safe as opposed to you being pulled back into the discomfort of the past. If, during therapy you do find yourself feeling triggered and either going into panic or ‘zoning out’, your therapist will be monitoring this and will talk through different ways you can stay ‘grounded’ in sessions and between them.
Remember it is important you feel comfortable – you do not have to dress up or make a good impression. Your therapist will have no expectations of what you will look like or how you will be and, in accordance with ethical frameworks, you should never feel judged. So, wear something you can feel comfortable in – if you feel comfortable you will be more able to relax and be open during your session.
It’s a collaboration
Remember, although you have chosen to go to counselling because you have noticed something you are unhappy with, you are the expert on you! Your therapist is not there to tell you what to do. They will not have a magic answer for you. They will listen intently and check their understanding with you by asking some questions, they will reflect back things you have said or put what they have heard in their own words to offer a different perspective, they may offer information or strategies they feel might help but it is always up to you if you take it on board. That said, a therapist can only check, clarify, reflect and offer based on what you say and so, it may feel surprising that a lot of the work will come from you.
It is therefore important that if you have worries about something the therapist as said or how therapy is going that you mention it to your therapist. It may feel like your therapist is a mind-reader sometimes because of the way they seem to understand what you say but they aren’t. Therapists are humans too and sometimes they misunderstand and so if something worries, upsets or annoys you within the therapeutic space it is important you tell them, so they can talk it through with you and work out a way to change it or put it right. This can feel scary, but remember this is YOUR therapy so it needs to work for YOU and you are in a safe space where the therapist will not judge you or take things personally. Indeed, voicing when you don’t like something or indeed, when you are finding something particularly helpful, gives your therapist more insight into you.
Health Warning
Right, this bit is important to understand. Many people start therapy and expect to feel better instantly. It’s important for you to be prepared that therapy isn’t magic and doesn’t quite work like that, I wish it did, but it doesn’t. Quite often, people report feeling worse after the first few therapy sessions and question ‘is it worth it? What’s the point?’ and assume it ‘obviously isn’t working’. At this point they may quit – by either informing the therapist or just not turning up.
If that’s how you feel after starting therapy why bother?
Well, let me explain. Quite often, in the time before you attend counselling (BC) you have spent a long time pushing down memories, feelings and thoughts. Squeezing them into neat secure boxes, taping the lids down and pushing them into the darkest recesses of your brain. You’ve probably become pretty good at it. However, these nasties that have been pushed down have found a way to leak out through your current thoughts, feelings and behaviours – hence the decision to come to therapy. When you attend therapy, this pushed down stuff starts rising to the surface, to your conscious awareness and it feels just as crap as it did before. The difference is – now you are in therapy, a safe place to acknowledge the stuff that comes up, explore it and PROCESS it so you can put it safely away in your long-term memory filing cabinet where you hold the key and choose when it comes out or not. You have got to become aware of and feel the crap to be able to put it away and this can initially feel rough. It can be tiring, can mean experiencing nightmares, panic attacks and some pretty horrid thoughts, it feels uncomfortable and unpleasant at times. IT IS NORMAL and it will be ok. In the next session you have booked with your counsellor, tell them what it has been like between sessions and talk through ways of managing these things between sessions – strategies such as journaling, meditation and grounding techniques are all helpful. You then have a 2-pronged attack against the nasties that you have boxed up – strategies to help you feel able to manage them when they creep up on you AND therapy to help you process what they are/where they are from and what they mean to you so you can put them away for good.
Next month we will look at the final part of this series of blogs, beyond therapy. How to prepare for when therapy ends and how you can continue your growth beyond it.
Take Care
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