The “What If” Questions Before Starting Therapy - Answered by a Therapist

Author: Alysha Ackley

The session is on the calendar. You put it there yesterday or last week or last month, and the moment you hit confirm, you started having little spikes of dread about it. What if you cry? What if you can't think of anything to say? What if you say too much? What if it's not the right fit. What if you sit on a couch and they say "tell me about your mother" and you just start sobbing about something from second grade you forgot you remembered.

Here is what I want you to know before you walk in: nothing about the first session is what you're picturing. You will not be lying on a couch. You will not be expected to perform. The first session is not the work. It's the orientation to the work.

Most practices, including AGP, can demystify the first session by offering 15 minute complimentary consultation calls. During these calls, I often get asked ‘what can I expect?’ Even if you have been in therapy before, the approach may be slightly different from therapist to therapist. With May being Mental Health Awareness Month I wanted to take the time to break down some questions that come up to help understand and prepare with less ‘what ifs’ in your mind.

What if I am not ready in session 1 to ‘go deep’?

You will not be expected to have a polished narrative. The throughline of the intake session is gathering information. Yours about the therapist, theirs about you, both of you about whether this might be a good fit. You can ‘go deep’ if you want to, and many people naturally end up touching on certain topics because it's relevant to whatever brought them in. But you are not required to. We start where you are. If what's most pressing is that your relationship is on the rocks, we talk about your relationship. If what's most pressing is work anxiety or grief or a recent loss, we start there.

There is also no such thing as the ‘right pace’. Some clients are ready to dive right in and want to. Others are very clearly not ready, and the therapist should be able to track and respect it. Either is fine.

What if I don't know what to say?

A trained therapist has many ways into a conversation when a client does not know where to start. Common openers include: "What made you decide to reach out now?" or  "Tell me about your week." If you arrive and your mind goes blank, you can say exactly that. "I don't know where to start". I hear this many times and it can be a great place to start, it is vulnerable and real. Some clients have a list of things they want to cover. Others do not and we let the conversation unfold.

It's also okay to bring notes. I have clients who type things on their phone during the week and read from them from the first session. The fear of not knowing what to say is usually the fear of being judged for not having a clean story. You do not need to be ‘good’ at therapy, there is no such thing.

What if I cry in the first session?

You might. Many people do. Crying in session usually means something the body has been holding has finally found a place where it's safe enough to come out. A trained therapist will not be uncomfortable, will not rush you through it, and will not need you to explain. If you cry and need a moment, we take a moment. If you cry and want to stop talking about whatever surfaced it and shift topics, we shift topics.

The reverse is also true: not crying in session doesn't mean nothing's happening or that you're "not in touch" with your feelings. Some of the deepest sessions I've sat in have been quiet and dry-eyed. The body does what it does, and the work works either way.

What if I don’t know if the therapist is a good fit?

The therapeutic relationship is one of the strongest predictors of whether therapy works. So fit matters, and you get to be choosy. After your first session, useful questions to sit with include: did I feel basically safe in that room? Did I feel listened to or did I feel like I was performing? Did anything they said make me feel curious? Did I feel respected — culturally, racially, in terms of identity, in terms of how I described my own experience? Was the pace of the session right for me? You don't need to feel "great" after a first session. Many first sessions feel awkward and exposing. What you're looking for is a sense that this person could become someone you trust. Sometimes it can take another session or two to recognize what you feel about the therapist fit. If the second or third session also feels off, it's okay to look elsewhere. You are not abandoning a therapist by deciding they're not the right fit; you're respecting your needs and that is also part of the process!

I tell clients at the end of first sessions to take a few days and see how they feel and I will check in at our next session to take the pressure off of them to have the conversation. I also normalize that if something didn't sit right, please tell me. We can either adjust or talk about who else could be a better match. I want to make sure you are getting what you need.

To Conclude:

If you've already booked your first session, I want to reiterate there's no version of you that is "too messy" or "not in enough crisis" or "not articulate enough" for the therapy room. The right therapist will meet you where you are. The first session is the first step.

If you haven't booked a session and want to inquire more you can book a free 15-minute consultation with an AGP therapist. 

This blog post is for informational purposes only and does not constitute therapy or a therapeutic relationship.