Counseling - Your First Session

There are several expectations that all therapists should meet. For instance, you can expect to be warmly greeted in a respectful manner at the arranged time of your appointment. You would also be encouraged to address your reason for coming.

All therapists will explain other important matters. For instance, in the first counseling session you should be advised about issues related to confidentiality, office policies (e.g. what happens if you "late cancel" or "no show"), fees and/or sliding scale options (if it hasn't been discussed over the phone before), and the treatment that the therapist uses. You may also be informed of the considerations and risks related to specific treatments.

No one therapist can meet the needs of all clients. If you or the therapist feels that the particular approach is not suited to your needs, the therapist must direct you to alternative resources. If, as your counseling proceeds, you feel her approach is not working for you, you should bring this to her attention—although she may or may not be able to accommodate you.

You may have heard counseling called "talk therapy" but these days there is more than talking involved in many approaches. For instance, I often teach clients an easy grounding technique to help them feel more comfortable in their first session.

Nevertheless, your first counseling session will involve discussion on what you hope to achieve, so a plan of action can be formulated. Depending on their approach, some therapists will want to know more details than others. The therapist may prefer to get the "big picture" of your life so they have a context in which to consider your goals. Others may want to focus on a very specific problem area. It depends on why you came to counseling.

Counseling Tip

The reason you are going to counseling is likely emotionally charged, so it is best not to go into all the details in the first session. A general description of your problem will be sufficient until you and your therapist know each other and are addressing specific issues.

As you will learn on this site, our understanding of the nervous system suggests that change occurs through modifications in the right brain , the seat of our emotions. In speaking of an event in a way that is disconnected from your feelings you are still using your left brain (i.e. your thinking brain) and are thus at arm's length from where relevant change occurs.

Until the relationship with your therapist is established you may find it difficult to feel deeper emotions in relation to the reason you came. This is a common human trait. We feel vulnerable until we come to trust the other person. This self-protection is a good thing.

Like any relationship the therapeutic alliance takes time to develop. As you begin to feel comfortable with your therapist you will naturally find yourself sharing more details as your work continues.

My Personal Musings

For those whose emotions are often overwhelming, it is important to establish a secure, safe connection with the therapist (i.e. it helps to contain the emotions that surface). While we may feel relieved after an explosive discharge of emotion, it is not an effective way for your nervous system to learn to self regulate your emotions.

You have the right to ask any question about what happens in counseling, including questions about the kind of treatment you're getting. You can also ask about your therapist's training, their experience, their continuing education, and their ongoing supervision.

And of course, a few will be tempted to pose the not always rhetorical question…“how much more do I have to pay before I'm better”?

Recovery time is actually very difficult to predict. Read more about this subject in Paying for Counseling .

"It's pretty hard to tell in the first counseling session, but the most important thing is to trust your intuition. If the connection feels good, you're halfway there.

A power differential is usually implied whenever we refer to someone as "Ms", "Mr" or Dr., while they refer to us using our first names.

There are some doctoral level therapists who refer to themselves as "Dr. So and So" and for some clients this is what they want and expect. They may need to feel that the therapist knows more than they and that he or she is in charge; using this form of address gives them that assurance.

Also consider that a therapist referring to herself or himself as “Dr.” does not guarantee professional competence. You will have to judge this for yourself.

Some therapists try to eliminate the power differential by always using their first name. Feminist therapists, for example, have always been sensitive of this; for them, diffusing the power differential is part of the treatment.

Speaking as a Therapist

In my practice I usually return a new client phone inquiry with “Dr. LaCombe speaking”, since they often won't recognize my name otherwise. However I soon make it clear that "Suzanne" is completely acceptable too; this gives clients the option.

Yet I don't object if they want to refer to me as "Dr. LaCombe". However, if they continue their counseling there usually comes a time when they no longer feel the need for this formality.

Keep in mind that some therapists believe using a formal title is part of maintaining a secure frame…and no, it's not about them being "stuffy".

It depends to a large degree on which country you live in and how psychotherapists are related to the medical profession. In Canada we usually use the term "client" when talking about private practice but would be likely to say "patient" if working in a hospital or medical clinic.

In the USA, where many of the services of a psychotherapist are delivered through HMO's, the usual term is "patients" In this case, counseling is more associated with the medical model.

My Personal Musings

When it comes down to it, it's only semantics. That is, whether you are called a "patient" or a "client" your nervous system responds the same way. Emotional ill health and illness are inextricably tied together. This site was created in part to highlight the neuroscience research that confirms this relationship.

Unless I feel the client can benefit from more frequent counseling sessions (i.e. two or three times a week), I usually recommend once a week for the first five or six weeks, and then reconsider the question at that time. This should give you sufficient time to establish a working relationship with your therapist.

Every practice will vary, but most of my clients come once a week and the rest twice a week. As clients approach the conclusion of their work I'll see them less frequently.

Family and couples therapy are often less frequent than once a week, although don't be surprised if the therapist recommends counseling on at least a weekly basis at the beginning.

My Personal Musings

If you want to resolve an enduring emotional problem or a lifelong pattern I personally think that seeing your therapist less than weekly is stretching the limits of what counseling can do. You could still benefit from less frequent sessions but don't be surprised or blame "counseling" (or yourself) if progress is slow.

As well, if your life tends to be tumultuous (i.e. you are frequently embroiled in a crisis), counseling sessions once every two weeks will be less likely to progress quickly. You'd find that your counseling would be so focused on 'catching up' that it would be difficult to deal with the underlying patterns.

Not at all! In fact there are several therapeutic approaches (e.g. Gestalt Therapy, AEDP) that focus on emotional states as they are experienced in the present. I use a form of body psychotherapy called, Self-Regulation Therapy and the work entails feeling the past only as it is experienced in the present.

There's no need to "relive" everything from the past because the past is always with us. Our deepest attitudes and prejudices about others and ourselves were formed very early in life and we carry them still. Patterns of feeling and action were encoded by our neuropathways into an emotional template. This template was then modified and hardened by all our experiences since then.

That is, our reactions to today's events are a function of what has been laid down in that template over the years. It unconsciously determines our emotional behavior and will continue to do so until we somehow induce changes in it. The brain's plasticity makes changes possible in counseling.

So when issues that we have encountered in the past surface in the present, we'll tend to react the same way now as we did then, especially when intense activation is triggered.

Personal relationships are a good example of this phenomenon. We need only examine how we feel and behave with people today to glimpse the underlying features of the emotional template that underlies our conscious life.

Speaking as a Therapist

As your counseling proceeds, it is not unusual for snippets of past events to surface. As a rule I trust the wisdom of the moment. I believe that whatever arises in the moment between the client and myself, whether related to past experiences or not, is potentially an opportunity for a therapeutic shift.

Ultimately it's not what your past has been but what your future will be that excites me as a therapist.

The short answer is "for as long as you are making changes". Keep in mind that some changes are small but important nonetheless e.g. "I'm a little more comfortable in talking about myself to a complete stranger" or "I no longer worry what I'm supposed to say when I think of my next session".

It's ultimately your choice--it depends on what results you want to achieve and how deep-seated your problems are. Personally speaking, I don't intend to stop my ongoing counseling any time soon.

Research suggests that on average, the longer you go to counseling the more satisfied you'll be with it. (Engler & Goleman, 1992)

By the way, unless your problem is very specific, a single counseling session isn't going to do much. Although there is a treatment known as "brief therapy", there is no such thing as "instant therapy"!