Therapy is a collaboration — and it starts in the very first session, where you help the psychologist understand the emotional problem you are facing and the change you want.
You may know exactly what you want help with. But it is not always that simple, and sometimes it is genuinely hard to put into words. In that case it is the psychologist's job to help you find the words for what you want to work on. Either way, a little preparation makes the first sessions considerably more effective — this article shows you how.
Presenting what you want help with
The first session begins with the psychologist asking what you need help with. This matters, because it lets the psychologist structure the therapy around the actual problem.
Describing the problem can be difficult, and the psychologist will often ask follow-up questions to make it more concrete — for example by identifying the specific situations that are hard.
A general description such as "I feel uncomfortable", "sad" or "stressed" is a starting point, but it needs unpacking before it can drive focused change. Therapy is easier to aim, for instance, if you know that the discomfort only shows up when you talk to your boss.
When you present your problem, it helps to be as concrete as possible about the situations, feelings, thoughts and behaviour you experience as problematic.
Early in therapy: clarifying control
An early step in therapy is clarifying control. The more control you potentially have over the problem you are working on, the greater the chance that therapy creates real change. Conversely, working on a problem you have no control over rarely succeeds.
Time is therefore spent examining whether the problem you bring is within your control.
Two examples: "My partner is not affectionate anymore." Or: "My boss doesn't treat me well."
Faced with problems like these, the psychologist will gently turn the attention towards you: is it a problem for you to be with a partner who is no longer affectionate, or to have a boss who treats you poorly? That reframing opens up what you can actually work with — how you want to handle the relationship, and whether you want to keep it.
The emotional challenges
Once the challenge is well defined, emotional challenges usually follow — for example the uncertainty of expressing yourself differently towards your boss or partner. Step by step, the psychologist helps you build the capacity to hold and carry these emotional experiences, so they do not become a roadblock for the changes you want to make.
Sometimes the emotions themselves are what bring you to therapy. The psychologist will then look at how you currently handle them, and whether that way gives you the best chances of living the life you want. Where the emotional side is holding you back, therapy works systematically on letting it have less influence on what you do.
How to prepare — a short checklist
You can save time in therapy by preparing for the first conversation. The psychologist wants to understand your problem well enough to put together treatment that changes it. Questions worth asking yourself beforehand:
- Which thoughts or feelings would I like to change?
- Which situations are difficult for me?
- What do I want to be different when therapy is over?
- How would I be able to see that I am living life the way I want?
Examples of questions the psychologist asks
In therapy, the psychologist uses questions to understand your situation and to help you explore new ways of approaching the world around you — and the feelings inside you. Typical questions include:
- Can you give an example of when it happens?
- What does it do to you?
- How do you react to it?
- How does that work out, when you do that?
- Am I understanding correctly that if you keep doing the same, the problem is likely to continue?
- That must stir up feelings?
- Would you like to change the way you handle it?
- Can you give an example of how you could change it?
Questions like these recur across therapy — always shaped by the therapeutic approach the individual psychologist is trained in. Some psychologists are trained in several methods and can approach the problem from different angles.
Will the psychologist ask about my childhood?
It is a bit of a cliché that everything is about childhood. It is not without truth, though: early relationships shape many of our patterns of acting, feeling and thinking.
Patterns learned early are often unhelpful later in life. It is not necessary to talk about where a specific pattern was learned, but at times it can be helpful to identify — especially where there are clear, emotionally charged memories. Whether it is useful to go there is a judgement you and your psychologist make together.
Be aware that not all psychologists are trained to work with early-learned dynamics — and there is no evidence that knowing where a reaction was learned is necessary for change in your current life. Most psychologists therefore work primarily with the problems as they play out in your life now.
Summary
Before your first session, consider how you can help the psychologist understand what you are struggling with: in which situations it shows up, and what you want your life to look like when therapy ends. A few notes on paper are plenty.
You are always welcome to write to us if you have questions or want to book a first consultation with one of our psychologists.