What Should I Expect During The First Session?

 I briefly discussed the evaluation process in a previous blog (Expectations of Therapy: first Contact) but,  I will give a brief recap. 

 The evaluation is approximately 3-5 sessions depending on the nature of the problems and how many people are present.  During the evaluation, I would be gathering info about the nature and history of the problem.  I would also be asking questions about family history and previous therapy experiences.  At the end of the evaluation, I then give my thoughts as to what I believe is going on and what direction I believe would be most helpful.  The evaluation also gives the client(s) a chance to get some idea of who I am and, if we decide to continue, whether they would be comfortable working with me.  

The evaluation that I conduct is no different than an evaluation a medical doctor would perform.  If someone consulted a doctor for pain in their lower back, the doctor would want to first run a series of tests in order to find out exactly what the problem was before treating it.  The evaluation gives me a chance to learn about the nature and causes of the underlying problems rather than using conjecture and running the risk of misdiagnosis.


Listed below are some of the topics that I usually try to cover during the evaluation:

• The nature and duration of the presenting problem(s):  It is helpful for me to get the client's perspective on what they believe the problems are and when they originated.
• Employment:  I like to find out the nature and length of employment as well as how the presenting problem(s) may be affecting performance at work.
• Previous therapy experiences:  This will give me a good idea of one's familiarity with the process of therapy and what has and has not worked for them in the past.
• Expectations of treatment:  Right from the beginning of therapy, I implore my clients to think about what they want their lives to look like at the completion of treatment.
• Medical/psychiatric problems:  Certain medical problems, medical drugs, psychiatric problems and especially psychiatric medications can affect the process and outcome of treatment.  It is beneficial for me to know these things at the beginning  of treatment process.
• Family history:  I will usually ask about the family history of mental illness, addiction, and abuse.  I also ask clients to give me a glimpse of what it was like growing up in their family household as well as what their relationships were like with their parents and siblings. 

The first session is when I really try to get a good understanding of why the person decided to seek treatment at the particular time.  I also like to hear about the problems they have been struggling with and how they have tried to deal with them in the past.  My goal in the first session is to start establishing a trusting relationship with the client so they feel comfortable coming back to talk about further issues.  I also evaluate how comfortable the client is in the first session so I can taylor my approach and line of questioning to their level of comfort.  Everyone responds in their own unique way to therapy and I take that into consideration.  

The important thing in the first session is for the client to feel comfortable working with me and to realize that the treatment process is a team effort in helping them to create positive change in their life.