Taking that First Step; a Pre-Therapy Primer
“I made it to my first workout class!” This was a text my friend sent to me early one Tuesday morning. To understand how exciting this really is, you need to understand my friend Brian had been solo attempting different home workout videos for more than a year. He knew he wanted to attend a class to benefit from professional instruction and needed camaraderie to stay motivated, but nearly every morning he could find a new and better excuse to stay home. The text meant Brian finally decided to leave his living room, and excuses, behind and give class a try. Guess what, he loved it! Purchased a quarterly package and sent the follow up text, “Don’t know what kept me from giving class a try.”
Haven’t we all been there? Wanting to try something new, but fear or nervousness or made-up scenarios holds us back. Similar to Brian’s first workout class, beginning therapy can be quite daunting. Probably more so, because as Hollywood has taught us, therapy is the place where you bare your soul and reveal your deepest, darkest secrets. Instead of trusting Hollywood, here are some important things to consider to help you get comfortable with the idea of therapy - and maybe even encourage you to pick-up the phone or send an email to make your first appointment.
Sometimes you are just in active crisis and know you need help. Many clients start therapy because they are experiencing life not working and they simply need someone with whom to process heartbreak. Loss of a loved one, addiction ravaging a family, or a significant other not being faithful are examples of common issues addressed during a first session. While this list is helpful for anyone seeking a therapist, it was created for someone pondering a first step into therapy rather than someone in the middle of life breaking down. If something in your life seems broken, and the hurt or loneliness seems unbearable, I highly recommend making a commitment to weekly therapy (also, feel free to skip step 2, and ignore step 7).
Have a goal in mind. Any therapist will tell you, a client who knows what they want from therapy is the client who is likely to get the most out of therapy. Think about what you want to be different in your life, and how you would know change has taken place. My primary goal as a therapist is to help you attain your goal, so what you want out of therapy is nearly always the best place to start. And if you don’t know exactly what needs to change, but just know something needs to be different, easy enough … your first goal in therapy can simply be to create one or two clear goals each with a realistic and measurable outcome. My hope is that, no matter who’s your therapist, you will not only achieve your goal, but leave therapy with new skills to overcome the future challenges life will deal you.
You need to believe your therapist is a good fit for you! Cannot. Stress. How. Important. CLIENT-THERAPIST FIT. Is. Enough.Would you believe that of all the things researched in the world of therapy, the client’s belief their therapist can help (read ‘believe their therapist is a good fit’) is nearly always the No. 1 predictor of a successful outcome in therapy? ‘Fit’ can be determined a lot of different ways, but let me offer two possible scenarios so you can hit the ground running. First, and I believe most importantly, trust your instincts. Say you check out the therapist’s bio online and something inside says, ‘Yeah, something in me connects with that!’ Bingo, that is an example of fit. Or, if during the first appointment you experience a comfortable feeling, say you believe the therapist is listening and responsive, this is another great sign of fit. And of course, if you think the therapist will help you get what you want out of therapy, this is a great sign of fit. Second, is the therapist someone you want to spend time with? During the initial conversation on the phone to set-up the first appointment, or during the first session, are you left thinking a) “That was time and/or money well spent” or b) “I could see myself spending regular time with that individual.” If not, I would question the initial fit you are experiencing with the therapist.
Feel free to ask questions. I don’t hide the fact that I have participated in a lot of therapy. I have actually run the gamut, and done extensive work in marital therapy, group therapy, and now mostly individual therapy. Here are two questions I almost always ask my therapist during the first session. First question, do you work with people who have my issue? Personally, I try to avoid working with therapists who are not competent to assist me. Second question, do you yourself see a therapist? I wouldn’t go to a medical doctor who told me going to see a doctor was for crazy people. I believe every therapist needs a therapist, so if yours doesn’t have one, consider seeing someone else. (Quick note: both of the questions above are relevant to your therapy, but don’t be surprised if your therapist chooses not to answer personal questions such as where they live, information about their family, or their religious beliefs.)
Therapy takes time. If you believe me on No. 2 (client-therapist fit), a client determining whether the therapist is the right fit for them can take between three-to-five 50 minute sessions. You need to begin to trust your therapist, and your therapist needs to get to know you, before you can expect any change from the therapeutic relationship. It will take time for your therapist to begin to learn about your family dynamics, coping mechanisms, and ways you are resistant to change. Typically, clients begin talking about the ‘real’ reason they decided to start therapy somewhere around session 15 or 20! Don’t worry, your therapist knows this, so give yourself and your therapist time to get to know one another and enough time for change to take place.
Therapy takes time. (I think this one is important enough to do twice.) Therapy is not as easy as A-B-C-Done! Getting to the place you’re in didn’t happen overnight. Likewise, healing or accomplishing your goal will not happen in two or three sessions. Assume you are 30 years old, and think of the time equation; ‘I have lived 263K hours and during that time I’ve developed a pattern/tendency that I want to change, but I’d like this change to happen in 3 hours or less!’ Therapy/life doesn’t typically work that way. Therapy takes time, but if you are ready to commit, the results are almost always worth the investment (at least that is what years of therapy has taught me).
What you put in is what you get out. Therapy is not a passive endeavor. Simply making and showing up to appointments is not enough. The client is the agent who drives change. You need to actively participate to accomplish progress. That said, you are not in it alone. You and your therapist will work together to find the healing/change you are hoping for. Just know, successful therapy is a collaborative endeavor.
Confidentiality is important. Basically, a therapist lives by ‘Fight Club’ rules; what happens in therapy, stays in therapy (just to be clear, only rules 1 and 2 from the movie). Licensed professional therapists are ethically bound to maintain your confidentiality, not only information communicated during sessions, but also your status as a client. Confidentiality includes bumping into a client in public. For example, I wouldn’t acknowledge you unless you acknowledged me first. It is also important that your therapist share with you that various state and federal laws have mandated limits to confidentiality and that a therapist is mandated to report; information about the abuse or suspected abuse of a child, information about the abuse or suspected abuse of an elderly or disabled person, an imminent threat of harm to an identifiable third person, and an imminent threat of harm to self.
Trying something new is almost always a little scary. Being apprehensive is perfectly understandable and completely normal. Just think of my friend Brian. Once he eschewed electronic interaction for face-to-face, he found that his real workout journey had only begun. So far, besides strengthening his muscles and improving his cardio, Brian has started to see that the courage to take that first step is now beginning to show up in other areas of his life, and he really enjoys his workout class. If you are considering therapy, the risk of scheduling a first session might be worth a try.
Jeff Grossman offers individual and group therapy in Nashville & Brentwood, Tennessee.