This is the second in a three-part blog series geared to help you prepare for your first session in therapy ever, or just with a new therapist for the first time in a while. This article will cover what to expect from your first session (also called an intake), as well as some things the therapist is assessing for during an intake.
(Bet you didn’t think there was so much to consider before you even walk in the door for your first session! But, you’ve made it this far. So, let’s say you’ve followed some of the advice laid out in the first edition of this topic, you’ve found one or more therapists who seem like they might be the right fit, and maybe you’ve even reached out and scheduled an intake or two. What’s next?
What to Expect in an Intake:
Your therapist is going to have a LOT to get through within the first session. They have to cover intake documents, informed consent, limitations of privacy laws, and tell you all about how they tend to operate and what the attendance expectations are. Then there’s the fact that they have to get an idea of what you’d like to achieve in therapy, and assess your supports, strengths, coping skills, safety, connection to community resources, your day-to-day life, and establish rapport while simultaneously being as genuine as possible and starting to formulate rough ideas for goals and treatment plans if you choose to continue beyond the intake. They also have to make sure they get releases to talk to doctors/lawyers/agencies/other providers if necessary, and assess whether they are the best fit for you and your needs. That’s a TON to get through! Needless to say, it often takes two or three sessions to get a basic idea of what therapy with the clinician would actually be like. To help with some of the time management, many practices are starting to require electronic signatures of paperwork prior to the first session, then quickly covering the necessary points during the intake. My practice does this, and requires the paperwork to be completed with insurance and credit card information submitted electronically a minimum of 24 hours prior to the scheduled appointment, or the appointment will be cancelled.
For the rest of the rapport building, treatment planning, clinical assessment, and collaboration on goals- the process can be several sessions long. I have many clients on my caseload for several months where we focus on establishing trust, rapport, and safety- often because there is significant attachment trauma and they need to experience me as consistent and nurturing for a length of time before they’ll truly feel safe exploring further and doing some of the deeper work. Be patient, trust the process, and don’t expect to be cured or even given an idea of how many sessions need to happen before you feel relief from your symptoms. You get out of therapy what you put into it. Don’t give up on the potential right fit therapist before you have a chance to actually start doing the real work to meet your goals.
What Your Therapist is Assessing for:
This is going to vary depending on the type of therapist you’re seeing and the type of therapy you’re looking to do. But some general topics I usually assess for include:
Safety:Is this person going to be able to tolerate deep work? Are they likely to continue their work through daily practices outside of treatment appointments? Do they have the distress tolerance to handle it, or should we first focus on resourcing and rapport building through various interventions before we do the trauma work? What community and natural resources are needed outside of therapy, and how accessible are these things? Does the person need a higher level of care than I’m able to offer? What are their needs, and do they have healthy insight into some ways to get those needs met, or are they too traumatized and invested in more comfortable/maladaptive ways of meeting those needs? Who are supportive people they can turn to? Can we make a plan for when they’re feeling close to a crisis, so that they can call on those people? Are they familiar/in contact with local crisis services?
Goodness of Fit:
As a Licensed Professional Counselor, my licensing board and the American Counseling Association, as well as the EMDR International Association all have various versions of the same ethical requirement that states I need to refer clients elsewhere if they’re not a good fit for what I feel able to provide. Most behavioral health governing bodies have some version of this same guideline. If I feel as though my relational style or specialty is very different from what I perceive the client’s needs to be, it’s my duty to best serve the client by referring them to someone much more suited to handling that specific issue than I am. For example, while my license allows me to work with children and I have done so as a pre-licensed therapist, this is not my passion and I have not had continuing education in working with children. I know that I can probably do decent work with children, and that I have before, but I also know that there are some excellent colleagues of mine whom I would feel much more comfortable referring minor clients to (and for the record, I’m more than OK with this- I know I excel at the work I do with my adult clients and I am highly specialized in something I am passionate about). So, rather than taking on minor clients anyway, I refer them to the colleagues whose work I am familiar with, whom I trust and who specialize in working with populations I don’t. The client’s needs are thus met by a provider more equipped to give them what they need. If your new therapist is making it seem like they’re a jack of all trades but a master of none, they may be skilled and intelligent but may not be the best fit for what you specifically need.
From here, the therapist’s assessment will really start to depend on the therapist you’re meeting with. For example, I am a strengths-based, person-centered trauma therapist specializing in attachment trauma and dissociation. So, I’m assessing for trauma, especially hidden or repressed trauma, certain buzzwords and telling phrases, trauma narratives, symptoms and how they are presenting in daily life, what those symptoms are interfering with that caused the client to want to meet with me in the first place, what about me stood out for them in selecting me as their therapist, feelings of being “checked out” or not being able to remember significant periods of time, and ego strength/distress tolerance. If there needs to be some ego strengthening, I’m getting an idea of how we can collaborate on that together in order to set a strong foundation for the deeper trauma work. I’m also assessing for strengths and skills because I believe those are going to provide the foundation to build up some of the things that are in need of improvement to facilitate healing.
Other therapists, however, will have different approaches and specialties and will be assessing along those lines. A substance abuse counselor, for example, will want to know about length of use, substances of choice, any periods of sobriety, positives that would help the client maintain sobriety, etc. Those who specialize in working with children will be looking for some indication of boundaries and expectations in the home and at school, social engagement, and possible reasons behind behavioral disturbances (depending on age).
This is certainly not an exhaustive list of what each therapist assesses for or how they operate during intake sessions, but I hope it has provided some useful information that will help you prepare for your first intake. It’s also totally fine to write down some thoughts/lists of things you want to work on, and maybe make some mention of the work you’ve done to start trying to address this stuff on your own. It’s helpful for the therapist to get an idea of what’s realistically going to translate from therapy into your daily life, so this would definitely be a great tool!
Rebecca L. Toner, MA, LPC
Freer of Souls. Connector to Purpose. Healer of Lives.