What is Counseling Like?
You did your research, found someone who seemed like a good fit for you among the masses of similarly messaged websites that ooze compassion and understanding, you made the phone call or email to set your appointment, and now are just waiting to go to counseling. You may be excited, terrified, or both. It doesn’t matter how much of a social butterfly you may be, sometimes the thought of bearing your soul to a complete and total stranger is just overwhelming. That’s okay, most people don’t like that level of vulnerability even if they feel the freedom of knowing that their secrets are safe.
Your first appointment with a counselor can be a wide array of internal experiences for you. I can tell you what you can expect from most counselors, but I can’t necessarily tell you exactly how that will make you feel. Feelings that are really common in first sessions are feeling overwhelmed, anxious, scared, relieved, calm, frustrated, hopeless, hopeful, or any combination of the gambit.
When you first arrive, you’ll be in a waiting room of some sort whether it is a virtual waiting room or an actual waiting room. Occasionally, counselors will send you intake documents and informed consent forms prior to your appointment, via mail or email. If they don’t, you’ll be filling out those forms before the actual start of your first session. The main form you’ll need to sign is an informed consent form. The informed consent form and privacy practices have the legally mandated information you should be receiving upfront prior to saying a word to your counselor (such as what confidentiality is and what its limitations are).
So you sit, waiting for what might be an eternity, debating what you could do on your phone that would distract you from waiting while not being engrossed enough to require you pulling yourself out of it when the counselor comes. Finally, the counselor arrives or comes out to get you in the waiting room. There may be an awkward walk to their office if you are going in person. We are encouraged to not talk in hallways because we never know when a client might start going into something vulnerable, and we don’t want that to happen in the hallway where others could hear. If you’re virtual, the counselor will hop into the initial spiels.
What is Informed Consent?
Any counselor will verbally review informed consent prior to starting the session. We will tell you the limitations of confidentiality. We review this to ensure that you know your rights before you say a single word to us. The goal is to be as upfront as possible so people aren’t surprised (or potentially feeling betrayed) when we have to break confidentiality. Why do we go over verbally when you just signed something saying you read the limitations? Because sometimes people don’t actually read the medical forms that they sign. Also, some people are better at understanding things when they are spoken instead of written. As a person-centered profession, we strive to make sure people understand exactly what their legal protections are before we get into any iffy territory.
If you are doing virtual sessions, there may be additional components to informed consent such as making sure you are in a private place for sessions, making sure there is contact information in the event of getting disconnected, and what the potential steps are to troubleshooting if technical issues arise.
What do Counselors Ask about in Session?
Now, we get to the part where you start to run the show. Warning: yes, we will ask you about your mothers. Don’t worry though, we won’t make you sit with your back to us or lay on a couch. Every therapist opens it a little differently in terms of how they do the initial session or intake. Normally, I’ll start off with a broad review of what brought you to counseling. I try to get the big picture of the issues you are dealing with and what’s making the need to talk to someone necessary. Most people don’t come to counseling until they feel in over their heads.
After we get the broad scope of the issues, the associated symptoms, the severity, and how long you’ve been dealing with them, we start to dig into the different aspects of your life. If done well, it feels like a naturally flowing conversation where the counselor will find good openings to ask all of the questions they feel like they need to in order to have a basic understanding of who you are. I say basic understanding because there is no way a counselor can learn everything they need to know about you in the course of an hour and a half. We are normally great conversationalists which means sometimes we don’t even get to everything we want to ask. I will admit that occasionally, it will feel like an interrogation. I think it feels like this most frequently when people are feeling self-protective and guarded. Counselors want to know everything so we are making the most educated choices for your treatment. This means that our questioning can feel invasive at times because we are trying to collect a comprehensive amount of information while naturally delving into things people don’t normally talk about. Think about your most embarrassing moment, a moment that still makes you feel dread over it, and then think about sharing that moment with a stranger for the first time ever when you aren’t sure how that stranger will respond. That’s a feeling that can happen in your first session of counseling if you are normally guarded.
What will counselors specifically ask about? Your mom. Yeah, counselors will totally ask about your mom. They’ll also ask about your dad and any other parental or guardian-like figure you had in your life. Counselors ask about the adults that were in your life when you were growing up because it gives a great context on what your environment looked like and what it naturally reinforced for you as a child. Old habits die hard, and we frequently carry wounds from our childhood throughout our lives. So yes, counselors will ask you about your parents and any other prominent adult figure in your life.
Speaking of childhood, we normally will ask about development, both from a physical standpoint and a social standpoint. We do this to see if there are any aspects of your development that are different from the norms that might cue us into any neuro-atypical features. You’ll be grateful for this if you are someone who is neuro-atypical because it’ll help de-personalize some of the difficulties you may be having. Social development can also help us see if there are any patterns in your life that may be contributing to your difficulties regarding current relationships.
We will also ask about educational history. Why? Because if you struggled in school, it could mean that you have an undiagnosed learning difficulty that continues to impact you after school. It could also give us insights into your work ethic and where your priorities aligned as a kid. Also, how strict your parents may have been. Seriously though, the fastest way to identify perfectionism in younger adults is asking how they feel if they got less than an A in school.
Oh, we’ll also ask about any childhood (or adult) traumas that you may have experienced. This one is hardest for people to discuss out of the gate, but trust me, if you have some underlying, untreated trauma it could be seriously impacting your life. Frequently when we treat any traumas, it results in symptoms of depression and anxiety lessening too. Meaning that if your anxiety is mostly rooted in trauma, if we don’t treat the trauma, the anxiety will more than likely persist. We don’t like delving into your traumas as much as you don’t like it, but as counselors, we see the importance of going through it and reclaiming your life after it. We also never want someone to feel alone in facing their traumas which is why we are willing to face it with you.
Another huge and sometimes personal thing that counselors will ask about is substance use history and current use. It may feel scary to answer honestly and you may start having Amy Winehouse’s Rehab go through your head, but we only ask so we know how often you feel the need to alter your state of mind in order to survive the shit in your life. We really do have a nonjudgmental mindset when we are working with clients so it's not about your past life or choices, but more so how we move forward despite those. Normally, people use substances out of a desire to escape or avoid. So by asking about substances, we get some insight into if you are feeling like you need to escape or avoid something in your life.
A counselor will also ask about family history of substance use and mental health issues. We do this to examine if there are any genetic factors at play that may make you more predisposed to certain issues. There is a huge genetic component to the development of mental health issues, so it is natural to explore if others in your family are struggling with similar concerns. It can also convey to us your family’s perceptions of mental health such as whether or not they believe in it or counseling. That can definitely impact a person’s willingness to get help and have supportive people in their lives while they are getting help.
The other aspects of your life that we may touch on are your medical history and current (or previous) medications. We do this to see if there may be any compounding factors that are impacting your ability to improve your mental health. For instance, if you have a chronic pain disorder, it may make it very difficult for you to remain positive and future-oriented.
Other aspects counselors discuss in that first session: your legal history and your occupational history. We go over these to get a better understanding of life circumstances you may have dealt with and whether or not you feel stability in your life.
We will eventually start to dive deeper into why you’re sitting in our office. We discuss how your mental health is currently manifesting and the history of your mental health. We ask what makes it so distressing for you and how it may impair your current life. We want the nitty-gritty so we can truly understand how difficult it is for you. So don’t worry about crying, sobbing, going into too much detail, or whatever you may worry about when divulging mental health. That’s what we are here for. We signed up for this career knowing that we would discuss the worst elements of someone’s life with them. There’s no need to apologize for feeling your feelings.
Part of that deep dive will also include the primary players in your life. We want to hear about the significant relationships you currently have and whether they are healthy and supportive. Relationships can either significantly improve mental health or they can cause our mental health to crash and burn. You don’t have to worry about portraying your partner(s) in any light. We understand that people are whole people, meaning that your partner has to have some redeeming qualities in order to have landed you in the first place. So even if you are describing them in a negative light, normally we can keep in mind that what you say initially in session isn’t the full picture in your head of your partner(s).
This is the part where I mention that, legally, we have to ask if you’ve had suicidal thoughts or attempted suicide before. We also are legally required to ask if you’ve had homicidal thoughts or actions. It can worry people when we ask those questions, but it is covering our legal basis for ensuring that we are keeping as many people safe as possible.
Lastly, but most importantly, we will talk about you and how you identify yourself. We will talk about your strengths, your hopes and dreams, and your interests. These all can be utilized over the course of counseling to help improve your mental health and your life. It allows us instant tools. We also get to see the parts of you that make you light up which can be super refreshing.
This may not be the most comprehensive list ever in terms of what might be covered in a first session, but it’ll at least give you a good idea of what to expect. It is natural to be nervous and intimidated by the prospect of opening up so much to a stranger. That’s okay. Even if after reading this blog, you’re still nervous, that’s still okay. We are taught to hide and conceal vulnerability. Not wear it on our sleeves. So you’re not alone in feeling that internal discomfort of bearing your soul to someone.
How Can You Prepare for Your First Session?
Prepare to feel like you are going into an excessive amount of detail. The more detail we have, the better we can help
Don’t feel the need to apologize for talking about yourself too much, going into too much detail, rambling, or crying. Seriously, I love it when people ramble. It actually makes my job easier because rambles allow for dialogue whereas sometimes too many questions without enough rambling starts to feel like an interrogation. Tears are a natural part of deep diving. There’s nothing to be ashamed of if you cry in therapy. We are super accustomed to tears so it doesn’t bother us in the slightest.
Depending on how long your internal distress has been building or how many experiences you’ve left unspoken prior to counseling, it may be a good idea to have a self-care day (or at least a couple of hours) on the day of your first session. Sometimes, people leave that first session recharged and ready to start rebuilding their lives. It can be helpful if they have some time that day to just bask in that feeling. Other times, clients can feel 100% drained after their first session. Pretty straightforward why a self-care day may be nice after a draining examination of everything you’ve been avoiding for a while.
Write down any questions you may have. It can be tough to remember any of your questions after giving your entire life story. Writing them down can help ensure that any questions you have are answered. This is an element of you getting informed consent of who is treating you and why they may have the expertise you need for your healing process.
Start to think about how you define “better.” One of the trickiest questions therapists ask is “what would your life look like if things were better.” We ask this in a variety of ways, but it is all to achieve the mark of how we actually know you are living the life you want to live. If you don’t know how you define happiness, we can’t help you get there. Happiness is a very subjective experience for people, so we need a definition to get you to your happiness.
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