Your first therapy appointment is coming up and you’re nervous, “Is my therapist going to be weird? What’s she going to ask me? Am I going to find out I’m crazy?” First appointments are nerve-wrecking but they can be less so. Arm yourself with information and eliminate the majority of “the unknowns.” Here are some of the most important points to remember before meeting your new therapist.
1. Most people, even those that have had previous experience in therapy, feel nervous about coming to the first appointment with a new therapist. Whether it was your idea to come or not, it takes a lot of courage to talk to a therapist. How scary it is to sit face-to-face with a person you’ve never met before, telling him or her vulnerable details about your life! Part of the initial sessions in therapy involves exploring the question of “What does it feel like to be here, coming to therapy and seeking help?” It may feel like an ego hit to admit that you or your family is struggling and needs support. Each of us has a story to tell and that story becomes our reality; in times of struggle, we first have to recognize that something in our version of reality is not working. We grieve the reality that we have always known in order to be open to change which allows for the creation of a new reality. You may also be worried about being judged or if the information you reveal is really going to remain private and confidential. If you are 18 and older, what you say will remain confidential with the exception of the following situations: you are at risk of hurting yourself or others; someone you know is currently being hurt or is at risk for it; in some legal proceedings. If you are younger than 18, your guardians (usually your parents), have access to your records; however, good therapy is built on trust between you and your therapist, so the extent of what your therapist tells your guardians should be discussed and agreed upon as soon as possible. Parents, you can imagine that your child would be hesitant or unwilling to talk to his therapist if he knew that you would receive a play-by-play of the therapy session; thus, many therapists working with minors in individual therapy encourage the rule of not revealing the content of therapy unless the minor is at risk of hurting himself or others. For more information on privacy and confidentiality, visit http://www.apa.org/ethics/code/.
2. Being in therapy has been historically stigmatizing, but this is rapidly changing. In the past, psychology was about identifying and fixing a problem; in recent years, positive psychology has influenced therapists to consider what is working in a person’s life and find ways to maximize this success. Many therapists practice psychology by identifying a person’s strengths and work with the patient to help him/her use those strengths to overcome areas of struggle. Life is full of opportunities for beautiful experiences, but it is not always easy. We all face struggles at different points in our lives… it’s part of the human experience. Therapists can help you navigate the hardships and manage the stress. The better you are at managing your distress, the more available you are to enjoy.
3. Whether you have been to a therapist in the past or this is your first time, you are entering therapy with specific expectations and it is important to identify them. Most people who have had a previously disappointing experience with therapy did so because they expected therapy to be one way but experienced something else. Therapists’ approach to treatment is guided by their theoretical orientation. Most therapists are trained in a variety of theories that help them conceptualize what happens in therapy; most importantly, a therapist’s theoretical orientation influences how they behave in therapy and how they envision the patient should behave. A therapist who works from a cognitive behavioral therapy (CBT) approach is very directive in therapy, speaking a lot, educating, and giving homework assignments. On the other hand, a therapist specializing in psychoanalysis may listen more, resulting in the patient doing the majority of the talking, and will periodically make interpretations about what the patient is saying. A therapist who uses art therapy or psychodrama will encourage a patient to draw, create, speak to an empty chair, or act out hypothetical scenarios to work through a problematic situation. Imagine if you, as the patient, expected to do the majority of the talking with the therapist only occasionally chiming in with insightful interpretations… you may be turned off from therapy if your therapist begins assigning you homework or asking you to represent your emotions as a roller coaster in a drawing. The opposite is also true; if you expect your therapist to be very directive and hands on but you begin therapy with a therapist who mostly listens to you and occasionally makes interpretations, you may be disappointed because your expectations are not being met. Before your first appointment, think about your expectations and what you are looking for from your therapist; then, discuss your expectations with your therapist. Fortunately, most therapists are trained in many theoretical approaches and identify themselves as “eclectic,” pulling from many different theories as therapy progresses. My belief is that there is no “one size fits all” approach to therapy. Everyone is different and it is important for therapist to be flexible when working with distinct problems and diagnoses. Being able to pull from a variety of theories, each with their own interventions, allows a therapist to customize the therapy experience and honor the uniqueness of each patient. It is also important to identify your goals for therapy, keeping in mind that different participants may have different goals (i.e., young adults could have different goals from than their parents). A therapist can use an eclectic approach to address a variety of goals.
4. Cultural considerations are part of good therapy and they are important for everyone, not just people from other countries. Culture is commonly understood to mean the beliefs, attitudes, and behaviors of a group. We frequently hear the phrase “from a different culture” and our minds typically imagine something or someone from a different country. Though this mental leap is not wrong, we must consider that “different cultures” exist in our home country. The culture in the northeast of the United States is different from that of the south. Within the south, the culture in Texas is different from that of Mississippi. The culture in Houston is different from that of Temple. In addition to geographic location, culture is influenced by socioeconomic status, religion, ethnicity, race, sexual orientation, language, disability status, marital status, age group, and education level. Corporations have a company culture, schools have their own culture, and families have their own unique culture. A therapist is trained to consider these cultural factors in therapy and how they interact with and affect the patient. “Making assumptions” and being guided by cultural stereotypes is the first mistake to good multicultural treatment. As a psychologist with a passion for multiculturalism, my training and experience has taught me that we can never know everything about a specific culture; there are too many variables. Thus, for a therapist, the best approach to multicultural therapeutic work is to embody the spirit of curiosity, ask questions, and try to understand the uniqueness of each patient. As a patient, be open to exploring culture with your therapist so he/she can get to know your individual and special story as it is told by your specific combination of cultural factors.
5. If you are a parent bringing your child for treatment, it is important to remember that family involvement is crucial for sustained progress. Your child does not live in a bubble; rather, he/she lives in a family which influences and affects him. Each member of the family has his/her own individual life that may include going to school, work, church, spending time with friends which can all interact with one another. A husband’s day at work may affect his mood and stress levels which, in turn, affect his relationships within the family, familial duties, and also the child. A good therapist will explore these interrelated connections, so be open to exploring not just the factors directly related to your child, but also seemingly distant or seemingly unrelated factors that the therapist may ask you about. More information is always better than less, which relates to previous testing/evaluations; if your child had previously been evaluated by a speech therapist, an education specialist, or a psychologist, bring a copy of the results to help your new therapist understand the progression and history of the presenting problems.
6. Receiving a diagnosis can be scary, but a diagnosis is not necessarily set in stone. Psychological diagnoses and their criteria come from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM 5). For insurance purposes, codes are given using the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD 10). It is important to notice that the DSM is on its fifth edition and the ICD is on its 10th revision. Diagnoses and their criteria change as the fields of psychology and psychiatry discover new information through research and over time. When compared to the DSM-IV, the DSM 5 eliminated some of its diagnoses, changed criteria for others, collapsed some categories, and introduced new diagnoses. The original DSM was quite different from both the fourth and fifth editions. Providers qualified to give a diagnosis may be required to diagnose after the first appointment when information about a patient is incomplete, which speaks to the flaws in our medical system. Many of the diagnoses have overlapping symptoms and it can be difficult to pinpoint the exact diagnosis, especially after the first visit with limited information due to time constraints or other factors, like trust between patient and therapist.However, as therapists gather more information over time, they can alter the diagnoses. When working with children or developing young adults, diagnoses often change as developmental changes occur within the body. In addition, new research on brain plasticity tells us that our brains can change throughout life and can reorganize themselves to form new connections between brain cells. Diagnoses can be useful in identifying a problem and giving it a name so that appropriate treatment interventions can be applied; on the other hand, diagnoses are not very useful because they are susceptible to change. In short, rather than being overly concerned about a label (diagnosis), pay more attention to the problem areas and the symptoms. After all, diagnoses and their criteria in the DSM 5 and the ICD 10 can evolve, appear, and disappear, but the lived reality of your experience remains.
As you prepare for your first appointment, consider these six points and discuss them with your therapist. Remember, therapy is an interactive process and it is important for you to be an informed and active participant on your journey to well-being and managing your life.
Eleonora Bass, PsyD.