Your first therapy session: what to expect?

By: Ntshediseng Tlooko

A first date is always strange. You spend hours getting ready, making sure you smell good and trying to get your teeth to sparkle more than usual. You want to make the right impression, but also stay true to yourself. Often you do not know what to expect, and you go on that date with blind faith and a lot of moxy. There is always an understanding when you go on a first date that it could go either way. It could be a-kiss-good-night-and-will-call-you-tomorrow good or you could end up lying about not feeling well and needing to leave the date effective immediately. Fail!

“The first therapy session like a first date, which can be formally called the first interview can be very daunting, especially because a lot of the time patients have no idea what to expect.”

In the same way the first therapy session like a first date, which can be formally called the first interview can be very daunting, especially because a lot of the time patients have no idea what to expect. There is always that vague idea that there will be a couch and the therapist will constantly ask, “And how did that make you feel?” Although this is a small part of what we do as therapists, it is not the entire picture.

Patients are often surprised to see two chairs in the room, instead of a couch. Often therapists prefer to use chairs instead of couches. The seating arrangement is also a peculiar one, instead of the normal sitting in front of the doctor’s desk, with the doctor on the other side, our seating is arranged in a V formation, often with no table between us. This is to allow for openness and to help the patient feel comfortable.

In relationships we are accustomed to a two way relationship where both parties share their life experiences and divulge their secrets to one another. The therapeutic relationship is however different from the conventional relationship, in that it is one sided. What I mean by it being a one sided relationship is that the therapist will know everything about the patient, while the patient knows very little about the therapist. This is important because it helps to keep the focus on the patient and the therapist can think as objectively as possible about the patient. If it were any different, then the therapist and the patient may as well be sipping coffee and having a friendly chat somewhere.

“I always equate therapy to parenting in the early years of a baby’s life. It is very important for the baby to feel secure and the only way baby can feel that way is if he or she can trust that mother will be there when baby needs her.”

Normally the therapeutic relationship is structured and timed. The therapy always takes place at a particular time for 50 minutes, on a specific day of the week, every single week, unless otherwise specified. This may appear anal, but it is a necessary and critical part of therapy. We call this the frame. The frame is important because it helps to contain the patient and keep them psychologically safe.

I always equate therapy to parenting in the early years of a baby’s life. It is very important for the baby to feel secure and the only way baby can feel that way is if he or she can trust that mother will be there when baby needs her. Therefore mother needs to be consistent. If mother feeds baby every 2 hours for the first few months of baby’s life, and responds whenever baby cries, then baby can trust that mother is good and she will respond to his/her needs. Consistency is key here and baby needs to feel that mother can be dependable.

(Psychologist) Ntshediseng Tlooko
(Psychologist) Ntshediseng Tlooko

Consistency is also important in therapy. The patient feels secure knowing that every Tuesday at 9 am I have therapy and my therapist will be there every Tuesday at 9 am. This also helps build and strengthens the therapeutic relationship.

Often the biggest issue with going to therapy for the first time is trusting a complete stranger with your life story. It is not easy to bear all to an absolute stranger, and often we worry that we will be judged or misunderstood. That is why it is sometimes an act of courage to go to therapy, just as much as it is an act of courage going on that first date. However, what I can assure you is that what you will get out of going to therapy is a rich and rewarding experience that will enrich your life, just like any good relationship. As the old adage goes, in therapy, it is the relationship that heals. So take a leap of faith and go on that first interview.

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