Therapy 101: First Sessions & Intakes
Why First Sessions Are Important
Instills hope in the client for change (or hopelessness for change)
Impacts the client’s relationship and perception of therapy and future help seeking behavior
Core Themes To Consider With First Sessions
Rapport building
Setting expectations and ground rules
Assessment
Evaluation
Mental status exam
History gathering
Questions and answers
Narratives and stories
Asking for feedback
And more
Things To Try Out In A First Session
Establish the therapeutic alliance and build rapport
Introductions
Let clients know about how you structure a first session
Discuss how you work and your therapeutic approach
Inquire about previous experience in therapy
Normalize feelings of anxiety if first time in therapy
Validating the client
Inquire if they have any questions or concerns before starting
Inquire about client’s history, family, formative life experiences
Inquire about living situation
Inquire about support system
Inquire about family history of mental health issues
Inquire about suicidal ideation, homicidal ideation, self harm
Inquire about client’s best hopes and goals for therapy
Inquire about how client have managed their problems so far
Assess for strengths
Assess for barriers and challenges
Summarizing what the client said
Paraphrasing what the client said
Clarifying what the client said
Informed consent such as limits to confidentiality, treatment plan, diagnosis
End with a preliminary verbal treatment plan on observations made so far
Inquire if they have questions or concerns before ending session
Let clients know how to contact you outside of session and boundaries around outside contact
And more
Statements And Questions You Can Try Out
What are your best hopes from therapy?
What are your expectations from me?
What’s getting in the way of what you want?
How would you know when it’s time for us to end therapy?
Miracle question: If you had magic powers and woke up tomorrow, what would you magically fix/solve/get rid of?
Do you have any questions for me that would help you feel more at ease?
What helps you feel more comfortable when meeting a new therapist?
Would you like me to lead the conversation today or do you have things you want to bring up first?
What’s been your experience working with someone who looks like me?
Questions To Reflect On
How do I want clients to feel after their first session?
How have I felt before, during, and after my first therapy session?
When did I feel most understood, heard, and validated in therapy?
How do I want to structure my first sessions? More formal? Informal?
Resources