THE FIRST SESSION: The Assessment
This post is one of ten in a series of posts that introduce counselling and psychotherapy. This series covers topics ranging from what to expect from a psychotherapy appointment to signs it might be time to consider seeing a counsellor or psychotherapist.
This post reviews what to expect from your first psychotherapy appointment.
Doing something for the first time is often accompanied by angst and worry. This post reviews the general format of a first psychotherapy appointment to familiarize people with the process.
Each psychotherapist will have their own way of delivering their craft influenced by their training and playing to their strengths.
The goal of the first appointment remains the same: The psychotherapists must assess if their skill set could benefit this client.
They do this by collecting information.
Please note that this appointment can be emotionally heavy. All the data collection is fatiguing, and the content of the Q&A is draining. Often people are being asked to think about (and speak about) topics they have avoided for years (possibly decades). Plan some good self-care afterwards. It is worth the discomfort.
Most initial appointments will begin by reviewing the intake form. They may have the client confirm their identification by stating their name, address and date of birth.
They collect demographic data (age, gender) and socioeconomic data (employment, relationship status, living arrangements, finances.) Different risks are associated with different stressors, and being informed guides psychotherapists in assessing the client's risk factors.
Background information is also collected to provide context to their situation. Past and current treatments, family history, and medical and psychological history help psychotherapists identify which interventions best suit this client.
The context of someone's problem is important to the experience of their problem. This is why psychotherapists ask questions seemingly unrelated to their reason for seeking psychotherapy.
I don't know how many people already know this, but there are physical health conditions than can have mental health symptoms. This is why we collect data on medical and psychiatric history. We ask about family history because some mental health conditions have a genetic component.
Developmental history is incredibly important to mental health treatment. Developmental history includes our gestation (when we were in the womb), infancy, childhood, and adolescence. This part of our life is a major contributor to how we experience the world around us and can give us clues about why the client might be having problems.
In the biz, we call this the chief complaint – the main reason the client is seeking psychotherapy. Possibly before or after background, the psychotherapist will ask the client a series of questions related to their chief complaint
People often delay seeking psychotherapy until they have several problems they can no longer ignore. It is rare that someone walks into psychotherapy and says, "this is my problem," - though it does happen (especially when they have experience with psychotherapy.)
We have to determine what is the problem and what is a symptom of the problem. To do this, we ask questions, many questions.
What brings the client to psychotherapy?
How long has this been occurring?
How often does it occur?
Is there anything that makes it better or makes it worse?
We will ask the client to recall a recent experience of their symptoms:
- What did the client think when this occurred?
- What did the client feel emotionally?
- What did the client feel physically?
What happened after?
The End (of the Session)
The data helps the psychotherapist formulate an image of the client's situation and determine if they possess the skills to treat this client.
Once the psychotherapist better understands the client's main problems, they may provide some education relevant to their situation. Maybe the psychotherapist walks the client through a grounding exercise or recommends resources for the client to access (books, support groups, topics to research).
If their psychotherapist feels they can help, they will discuss the next steps, including:
- The general format of appointments
- Frequency and duration of appointments
- How to book or reschedule sessions
If time allows and the client is not too emotionally overwhelmed, they will likely leave with a homework assignment to be completed before the next session.
The End (of this Post)
Every psychotherapist has their own method of collecting the data they need and moving through their first appointment so their experience may not flow the same.
I believe everyone would benefit from counselling and psychotherapy, but not everyone is ready for it. The timing matters. Motivation matters. Now might not be the right time, but if you feel ready to try psychotherapy, contact us at your preferred coordinates (online, email, phone) or click here to book your free consultation today.
LAH Counselling is not a crisis service. If you are experiencing a medical emergency, mental health crisis, or there is a concern you may hurt yourself or someone else, contact 9-1-1 (for residents of Ontario) or go to your nearest hospital emergency department. You can also click here for a list of crisis services.