What Happens During the First Counseling Session?

A lot! The first session covers quite a bit of content and sets the foundation for the counseling relationship.

You reviewed and signed a lot of paperwork before that session. However, like almost all Terms of Service agreements, most people don't read it! Clinicians spend time in that first session going over specific information, providing examples, and highlighting important aspects for you to be aware in order to work together. To make an informed, intentional decision about engaging in counseling means you need information about what the process looks like, confidentiality, how your information is used, stored, and transmitted, policies, etc. Ask any questions you have and for clarification about any of the information discussed.

The bulk of the session is discussing the issues that brought you to counseling as well as other information from your life. Your clinician may ask that you complete symptoms screeners and questionnaires before the first appointment to make this step more efficient. The clinician will ask various questions to gather information about your symptoms, challenges, strengths, childhood experiences, relationships, work, etc. There may be times where you wonder, "Why are they asking about_______? That doesn't have anything to do with what I came in for." Clinicians use the information from the first session to create a biopsychosocial conceptualization of you, your symptoms, and experiences that includes current and historical data. Even if something isn't directly related to what brought you in, it might be assessing and ruling out something else. For example, if you mention attention, focus, and concentration problems, it would be important for the clinician to understand the history of those symptoms. They might ask about school and what type of student you were, what it looks like at work, are there times it gets better, was there a time you didn't struggle with these concerns, etc.? The clinician is trying to understand who you are and what these symptoms/issues look like across various domains in your life. A lot of things can impact attention and concentration issues and it's important to account for those. If you are using your insurance to pay for services, your clinician will also be using that information to create a diagnosis and treatment plan that should be shared with you in a future session. That treatment plan is a blueprint for how to treat your symptoms.

The other thing that happens in the first session is that you and your clinician are developing the counseling relationship. You are getting to know each other, what it's like to work together, and developing first impressions. The quality of the counseling relationship is one, if not the most, important aspect of counseling. You need to feel safe, heard, and understood by your clinician before they can assist you with treatment. Treated by a competent clinician using the best techniques would be sabotaged if the counseling relationship was poor. The trust you develop with your clinician impacts every interaction.

It's really hard to summarize your entire life and provide extensive details about challenges and symptoms in 60 minutes, while you are getting to know a stranger and discuss the logistics of their policies and procedures. If there is anything important that isn't covered in a first session, you and your clinician can each make note of that so you can discuss it in the next session.

If you are interested in counseling, you can use your free 20-minute consultation to start the process of sharing information and getting to know your new clinician. Complete our Contact Us form to get that consultation scheduled.