Friday, April 30, 2010

Finding a Good Therapist: What to Expect from the First Appointment


"Otherwise they might see with their eyes, hear with their ears, understand with their hearts, and turn and be healed."

Isaiah 6:10b

Your first appointment time has arrived. What is reasonable to expect from this interview? That is what the first appointment is: an interview. During the first 45 to 50 minutes the counselor will listen to why you are seeking help, the history of the issue(s), and your hopes and expectations of treatment. This information will determine the course and method of therapy.

The style of first appointments varies from clinician to clinician. Some therapists have a specific set of questions that they ask every first-time client. Others will start with an open-ended question and let you lead the direction of the appointment. The purpose of either method is to understand your emotional or psychological difficulties and to establish some treatment goals and objectives. By the end of the session you should have a sense that the therapist has an initial understanding of the problems and that there is a direction or a set of goals that will guide the course of treatment. How this looks again varies among therapists. I usually tell the client the initial diagnosis and together we identify the treatment goals. Not all clinical styles are this direct.

You should also have an understanding of the rules of therapy. Confidentiality, expectations about how to make and cancel appointments, the cost of each session, any financial arrangements to cover treatment, and how to contact the counselor if an emergency occurs are all terms that should be covered. Some of these points may be outlined in the initial paperwork you will have received and other terms may be discussed directly. These are very important issues. If you need further clarification or don't feel fully informed, please discuss it with your therapist. These rules help to create a sense of predictability and safety. They enable good treatment to occur.

You may feel a need to have someone accompany you to the first appointment. Can this individual join you for the first session? Again, this varies among clinicians. Unless you are seeking family or relationship treatment, you will eventually need to attend the appointments alone. Sometimes a new client is feeling so ill that an accompanying friend or family member is helpful to physically aid the client to the therapy room, and also to provide the necessary history of the problem. I often allow a close friend, a family member, or a spouse to attend the first session with the understanding that in subsequent sessions only the client will attend.

I frequently have clients who ask a family member or a friend to drive them to appointments. That is perfectly acceptable.

By the end of the first session, you should feel comfortable and safe enough to explore personal topics with this clinician. Also, the rules and terms of treatment should be very clear and understandable. If these objectives are achieved, then you have a good foundation for the beginning of therapy.

How does the first appointment look when a child or a teenager is the client? Next week, I will provide an overview of a first session with a minor.

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