What to expect at your first therapy or counseling appointment:
For many people, “going for therapy” can be a misunderstood, stigmatized process, full of the unknown. I can’t speak for other therapists, but I can tell you what coming to see me is like, and tell you about my experiences. Coming to therapy is hard, but in my opinion (and I’ll admit I’m biased) very worthwhile.
The first thing that you face is calling or contacting the therapist to set up the appointment. In private practice, I generally try to get a little information from you regarding what your situation is (without going into a huge amount of detail) so that I’ll know if my areas of expertise match up to the situation you’re calling about. If they don’t, I’ll let you know and offer to refer you to someone that might be able to address your needs better than I am able to do. However, if your need is something that I work with, then we talk about finding a time for an appointment.
In my private practice, I worked during the days on Tuesday through Thursday in my private practice. I ran a DBT Group Saturday mornings between 10 and 12, and I worked Longmont providing counseling in nursing homes on Mondays and Fridays. I made sure to tell people in advance and up front if I don’t work certain days or evenings. I also made sure to let people know that I don’t bill insurance, so you would have to pay at time of service. Once we set the appointment, I ask that clients come to that first visit about 30-45 minutes early so you can fill out my paperwork, if you haven't done it ahead of time.
My paperwork was pretty simple to understand, but may take you some time to complete. I had an office policies handout, which explained my fees and billing procedures (including what happens if you don’t show up for scheduled appointments) as well as how to contact me. I had a separate Privacy policy/HIPAA document, which detailed confidentiality and privacy concerns, as well your rights in regard to your records, and an Informed Consent/Disclosure form so that you knew my qualifications and how I work. I also asked clients to fill out a detailed history and intake form. It’s long, but it allowed me to focus most of our time in session on what brought you to me rather than have to spend all of that first session gathering information. I also had my sliding scale fee scale and a release of information form that I used.
While these procedures have changed somewhat now that I work with a clinic, much of the first session remains the same.
Once you’ve arrived, I’ll come out of my office to greet you and introduce myself if I'm able to do so. However, if I’m in a session, I won’t be able to meet you right away, but will as soon as possible. When the time arrives for your appointment, I’ll gather your paperwork and invite you into my office.
Ok – here’s where many people start feeling more nervous. One of the first things I want to say here is that I have a great amount of respect and admiration for you – it’s really hard coming to a stranger’s office and trusting me enough to tell me your secrets, problems, and fears. That, quite honestly, takes courage and “guts” and I’m not afraid to tell you that. In fact, I think you NEED to hear that because it lets you know that I respect you.
Once I bring you in my office, I give you a little “road map” of what our first session looks like. I'll tell you I’m going to give you some information first, then give you a chance to ask me any questions that you feel are important. From there, I review the office and privacy policies. The state of Idaho requires me to verbally go over privacy and disclosure policies with you, and that’s for your protection. I also want to make sure you understand your rights. It's called "informed consent" and it's critical.
I start by telling you that I have to give you some information on confidentiality – specifically when I need to break it. There are usually three conditions where I need to break confidentiality. The first is if I suspect child abuse. I am required to report that, as well as any threatened harm to another person. I also need to break confidentiality for your safety – if I feel you are in danger of harming yourself, I am required to do what I can to keep you safe. Next, we go over the office policies. We talk about things like what happens if you miss a session without calling, how much notice I need if you’re going to cancel, and who to contact if you’re not satisfied with my services. (In my private practice, when going over the financial policies, we determined what fee I would charge you for my services. Because I worked on a sliding scale, I asked people to bring proof of income if you want to use the sliding scale; if you didn’t bring documentation, I assume you could pay the full fee.) This is not possible in my current position, but I'm happy to help you gain information about finances and billing if needed.
Once I've gone over this information, I give you the chance to ask me questions. I think it’s important you be given that chance, as a matter of respect and to make sure your questions regarding policies and rights are answered. Once you’ve had the chance to ask me your questions, we go to the “intake” portion of the interview.
An “intake” is basically an initial interview, where I talk to you about the problem that’s causing you trouble. I usually begin by asking you to “tell me your story.” I like and need to hear in your words what happened, and why you’re here. This gives me a basis for figuring out what’s going on from a psychological perspective. I ask you questions about your family, your significant other(s), friends, education, and a whole lot of other things depending on what your issue is. I like to spend as much time as possible talking with you about your situation, and completing all the paperwork ahead of time helps us spend more time doing that. I try to make this conversation as comfortable as possible and and not like a medical interview.
One thing I want to mention is that I *always* ask about certain sensitive topics. I ask these questions of everyone, because your answers affect the way I work with you and also affect who you are as an individual today. These questions include gaining information about alcohol and illicit/non-prescribed substance use, prescription medications, physical abuse, sexual abuse, and emotional abuse. I also ask about whether or not you’ve been suicidal, and if so, have you attempted to hurt/kill yourself as well as what you did during those events. I also ask about the outcome – who found you, who cared for you, how did you recover, how do these events affect you today? These are very important questions/topics and I make sure to ask everyone these questions. So, if you come to see me, expect me to ask about these. I also want to let you know that I’m not the police – if you’re using drugs or alcohol, I don’t break your privacy to report that. I'm not asking these questions to embarrass you or judge you - they help me understand what happened and how it's affected you today.
Once I’ve gathered all the information I think I need, I ask you if you think there is anything else I need to/should know. If not, then I ask again if you have any questions. Finally, I ask if you think that working with me would be a good fit for you. If so, we set another appointment to begin our work, and go from there. If not, then I again offer to refer you to another practitioner who might be better able to meet your needs.
So…that’s what happens when you visit me for the first time. I hope I was able to take out some of the mystery surrounding what happens in a therapist’s office, at least at first. If you have any other questions, please feel free to contact me!
Please Note: This article is intended for informational purposes only. If you are in crisis or danger, or are thinking about hurting yourself, please call 911 for immediate help. Please, again, realize that seeking out help really IS a sign of strength and not a sign of weakness. You don’t have to be alone in facing these things – there are people who care and who will help. Email me at: [email protected]
The first thing that you face is calling or contacting the therapist to set up the appointment. In private practice, I generally try to get a little information from you regarding what your situation is (without going into a huge amount of detail) so that I’ll know if my areas of expertise match up to the situation you’re calling about. If they don’t, I’ll let you know and offer to refer you to someone that might be able to address your needs better than I am able to do. However, if your need is something that I work with, then we talk about finding a time for an appointment.
In my private practice, I worked during the days on Tuesday through Thursday in my private practice. I ran a DBT Group Saturday mornings between 10 and 12, and I worked Longmont providing counseling in nursing homes on Mondays and Fridays. I made sure to tell people in advance and up front if I don’t work certain days or evenings. I also made sure to let people know that I don’t bill insurance, so you would have to pay at time of service. Once we set the appointment, I ask that clients come to that first visit about 30-45 minutes early so you can fill out my paperwork, if you haven't done it ahead of time.
My paperwork was pretty simple to understand, but may take you some time to complete. I had an office policies handout, which explained my fees and billing procedures (including what happens if you don’t show up for scheduled appointments) as well as how to contact me. I had a separate Privacy policy/HIPAA document, which detailed confidentiality and privacy concerns, as well your rights in regard to your records, and an Informed Consent/Disclosure form so that you knew my qualifications and how I work. I also asked clients to fill out a detailed history and intake form. It’s long, but it allowed me to focus most of our time in session on what brought you to me rather than have to spend all of that first session gathering information. I also had my sliding scale fee scale and a release of information form that I used.
While these procedures have changed somewhat now that I work with a clinic, much of the first session remains the same.
Once you’ve arrived, I’ll come out of my office to greet you and introduce myself if I'm able to do so. However, if I’m in a session, I won’t be able to meet you right away, but will as soon as possible. When the time arrives for your appointment, I’ll gather your paperwork and invite you into my office.
Ok – here’s where many people start feeling more nervous. One of the first things I want to say here is that I have a great amount of respect and admiration for you – it’s really hard coming to a stranger’s office and trusting me enough to tell me your secrets, problems, and fears. That, quite honestly, takes courage and “guts” and I’m not afraid to tell you that. In fact, I think you NEED to hear that because it lets you know that I respect you.
Once I bring you in my office, I give you a little “road map” of what our first session looks like. I'll tell you I’m going to give you some information first, then give you a chance to ask me any questions that you feel are important. From there, I review the office and privacy policies. The state of Idaho requires me to verbally go over privacy and disclosure policies with you, and that’s for your protection. I also want to make sure you understand your rights. It's called "informed consent" and it's critical.
I start by telling you that I have to give you some information on confidentiality – specifically when I need to break it. There are usually three conditions where I need to break confidentiality. The first is if I suspect child abuse. I am required to report that, as well as any threatened harm to another person. I also need to break confidentiality for your safety – if I feel you are in danger of harming yourself, I am required to do what I can to keep you safe. Next, we go over the office policies. We talk about things like what happens if you miss a session without calling, how much notice I need if you’re going to cancel, and who to contact if you’re not satisfied with my services. (In my private practice, when going over the financial policies, we determined what fee I would charge you for my services. Because I worked on a sliding scale, I asked people to bring proof of income if you want to use the sliding scale; if you didn’t bring documentation, I assume you could pay the full fee.) This is not possible in my current position, but I'm happy to help you gain information about finances and billing if needed.
Once I've gone over this information, I give you the chance to ask me questions. I think it’s important you be given that chance, as a matter of respect and to make sure your questions regarding policies and rights are answered. Once you’ve had the chance to ask me your questions, we go to the “intake” portion of the interview.
An “intake” is basically an initial interview, where I talk to you about the problem that’s causing you trouble. I usually begin by asking you to “tell me your story.” I like and need to hear in your words what happened, and why you’re here. This gives me a basis for figuring out what’s going on from a psychological perspective. I ask you questions about your family, your significant other(s), friends, education, and a whole lot of other things depending on what your issue is. I like to spend as much time as possible talking with you about your situation, and completing all the paperwork ahead of time helps us spend more time doing that. I try to make this conversation as comfortable as possible and and not like a medical interview.
One thing I want to mention is that I *always* ask about certain sensitive topics. I ask these questions of everyone, because your answers affect the way I work with you and also affect who you are as an individual today. These questions include gaining information about alcohol and illicit/non-prescribed substance use, prescription medications, physical abuse, sexual abuse, and emotional abuse. I also ask about whether or not you’ve been suicidal, and if so, have you attempted to hurt/kill yourself as well as what you did during those events. I also ask about the outcome – who found you, who cared for you, how did you recover, how do these events affect you today? These are very important questions/topics and I make sure to ask everyone these questions. So, if you come to see me, expect me to ask about these. I also want to let you know that I’m not the police – if you’re using drugs or alcohol, I don’t break your privacy to report that. I'm not asking these questions to embarrass you or judge you - they help me understand what happened and how it's affected you today.
Once I’ve gathered all the information I think I need, I ask you if you think there is anything else I need to/should know. If not, then I ask again if you have any questions. Finally, I ask if you think that working with me would be a good fit for you. If so, we set another appointment to begin our work, and go from there. If not, then I again offer to refer you to another practitioner who might be better able to meet your needs.
So…that’s what happens when you visit me for the first time. I hope I was able to take out some of the mystery surrounding what happens in a therapist’s office, at least at first. If you have any other questions, please feel free to contact me!
Please Note: This article is intended for informational purposes only. If you are in crisis or danger, or are thinking about hurting yourself, please call 911 for immediate help. Please, again, realize that seeking out help really IS a sign of strength and not a sign of weakness. You don’t have to be alone in facing these things – there are people who care and who will help. Email me at: [email protected]