Trying something new can be intimidating. This is especially true of something like therapy which may be unfamiliar and will ask you to step outside of your comfort zone. It may even task you with practicing skills you’ve never had to use before. If you’re reading this particular blog post because you have scheduled your first therapy appointment – or even if you’re only considering scheduling one – you deserve credit for your courage. I often tell my clients that it’s important to celebrate the small wins as well as the large ones. This means that some days you get a gold star just for putting on pants. Taking this step toward your own self care is most definitely a win, so it is worth celebrating. And if you did it with pants on to boot – look out world!

At this point though, you may be thinking, “what have I gotten myself into? What happens next?”  Let’s break down the component parts of the first therapy appointment, also called the intake, and spill the tea about what you might expect from day one of therapy.

Informed Consent

Though each therapist’s style will differ somewhat, nearly all therapists will begin the first appointment by covering a few basic topics as part of ‘informed consent.’

(1) They will inform you of your rights in therapy. This may include several things but will focus mainly on confidentiality. You can expect that your therapist will keep what you tell them between the two of you. Therapy is like Vegas, ‘what happens there stays there.’ There are only a couple of notable exceptions to this rule, which leads me to the next part of informed consent.

(2) Your therapist will explain their legal obligations as a licensed clinician. Therapists are ‘mandated reporters.’ This means that if you tell your therapist you plan to harm yourself or someone else, they will have to report that to the appropriate emergency service. If this occurs while you are in telehealth session with me at Rachael Gorton Therapy, I will make every effort to notify you in advance so there are no surprises. Furthermore, I will walk you through it every step of the way.

Another limitation to confidentiality occurs if you use your health insurance. Your therapist is required to share your diagnosis with your insurance company for billing purposes. They may also need to share relevant clinical information with the insurance company, upon request.

(3) Your therapist will also review any important information about practice policies with you such as their cancellation and no-show policy and their fee schedule. They may also review any questionnaires and paperwork you might have filled out prior to your session.

(4) This is also your opportunity to ask any questions you might have. Though your therapist must maintain appropriate boundaries, you are welcome and encouraged to ask any questions you have about therapy.

“Tell me what brings you in.”

Though you may have told your therapist – or their representative – a brief statement about why you are seeking therapy when you scheduled your appointment, they will likely ask you again to get more details. This might include information about your symptoms, the severity and frequency of those symptoms, and when you first noticed them. Additionally, your therapist may ask you about any life stressors or transitions you might be going through or about any traumatic events which you might have experienced. Additionally, your therapist may inquire about whether you have seen a therapist before or if this is your first time.

Just a note: at Rachael Gorton Therapy, I will never expect you to go into detail about traumatic events if you do not feel ready in your first therapy appointment, though I may ask in generalities. It is normal and expected for a person to not feel quite ready to go into detail about trauma before a stronger rapport has been established.

‘Your life story.’

In addition to details about your symptoms, your therapist may ask you questions about your support system (e.g. who you go to in your life for companionship, comfort, or help), your family history and if you are aware of any psychiatric illness in your immediate or extended family, and what your day-to-day life looks like. To further get to know you, your therapist may also inquire about education, employment, and hobbies – yes, therapists want to know the good stuff too!

If you are seen at Rachael Gorton Therapy, you can expect that I will welcome your quirkiest, most authentic self in your first therapy appointment and each and every session thereafter. I am eager to learn more about you and what brings you joy and relaxation as well as what brings you sorrow. Occasionally, I even incorporate some of my own hobbies in session, such as superheroes and other pop culture references. For those who want it, I most definitely create a space where you can let your ‘geek flag fly!’

Goal Setting

One of the most important parts of therapy is determining what you want to achieve with therapy. To do this, your therapist will guide you to identify what you want to change or improve in your life. Then they will help you to set related goals – which are both measurable and achievable – to help get you there. Though you will begin this conversation on day one, what you discuss in your first therapy appointment is not set in stone. Your goals can change and evolve, as needed, throughout your therapy journey. And if you’re not sure where to begin to identify your goals, don’t worry! Your therapist is skilled in helping people to translate their struggles into goals to create a ‘roadmap’ – called a treatment plan – toward healing.

Duration and Setting

Your first therapy appointment can vary in length depending on your therapist and their style. Usually, your intake appointment is slightly longer than the subsequent follow up appointments, clocking in around 60-120 minutes. If you pay out of pocket for therapy, this may mean that your first appointment is slightly more expensive than later appointments. My intake appointments tend to run only slightly longer than follow ups, running about 60 minutes instead of the standard 50 minute follow up session. I charge a flat rate for all my appointments, with no surcharge for the first session.

The setting will depend on whether your therapist offers in person visits or telehealth visits. At Rachael Gorton Therapy, all visits are telehealth and therefore take place in the comfort of the location of your choosing – so long as it is private and physically located in the state of Massachusetts. 

Congratulations on your decision to pursue therapy. Take a moment to allow yourself a mini celebration for this profound act of self-care. If you have additional questions about therapy -or- if you live in Massachusetts and want to schedule an appointment, please contact us! We can’t wait to hear from you.