How to Be Prepared for Your First Counseling Session
Have you thought about going to counseling but are unsure of what to expect? In this post, I explain what a the beginnings of the counseling process typically look like and things that you can do as the client to emphasize growth during the process. After reading this post, you will be prepared for your first counseling session.
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Before your appointment
If you’re like me, before you made an appointment with a new health provider, you’ve checked out their website, social media, and reviews from others. This is often the first step to choosing any provider, including a counselor or a therapist, but it requires that you understand some of the terminology of the field.
Most of the time, helping professionals will have their credentials listed next to their name. Some of the more common abbreviations are LPC (Licensed Professional Counselor), LMHC (Licensed Mental Health Counselor, LMFT (Licensed Marriage and Family Therapist, and LCSW (Licensed Clinical Social Worker).
While these licenses denote different types of training and focus areas of experience, counseling from many of these professionals will be similar. Unfortunately, in the United States, each individual state determines what qualifications are needed and sets the license to be obtained. Check out your state’s counseling licensing board if you would like more information regarding your therapist’s title. Personally, I do not believe that it matters that much.
To earn a helping professional license in the United States, you must complete both a bachelor’s degree and master’s degree, practicum and internship, and residency following graduation which is often multiple years. Additionally, you must pass your state’s licensure exam, and sometimes the juris prudence exam.
Counselors with licenses have years of experience helping people improve their mental health. The training between licenses is generally similar.
Aside from the typical terms of “co-pay” or “coinsurance”, counselors consider some additional aspects of the managed care beast. Many therapists take a variety of insurances, but some are considered “self-pay” only. This means they have chosen not to pursue approval to accept insurance, likely for a variety of reasons. One of the main reasons to see a therapist who does not take insurance is to maintain confidentiality.
If you use your insurance to pay for your counseling, your insurance department will likely know a lot about your counseling journey, including symptoms, diagnosis, and progress throughout. They likely require this information to provide payment and require hefty justification that you actually need the counseling service.
If counselors do not accept insurance, or if their clients do not have insurance, they might offer a “sliding scale”. A sliding scale fee allows for lower income clients to receive the same services for a reduced cost. Sliding scales are often provided to best help meet the client’s needs and to promote ethical practice.
Choosing your Therapist
Once you’ve learned a little about counseling terminology, it’s time to consider which therapist would be the right one for you.
In general, all counselors will provide empathy, active listening, and desire to help you succeed. However, each provider will be different due to differences in personality, values, and education. Depending on their counseling theory, some counselors might be more directive or passive. Some might use more active techniques. Or some place more emphasis on verbal processing. Take a look at the counselor’s website or about page to learn more about the theory(ies) they adhere to and find one that might fit your personality or character.
After booking a session with your chosen therapist, you will likely have intake paperwork to complete. This paperwork is not that different from the documents you complete when going to the doctor. However, you can often complete this paperwork online prior to attending your session.
If you complete the paperwork online, you won’t have to arrive extra early to complete it in person before session. Check when scheduling your appointment if this is an option for you.
Generally, the intake paperwork will ask you various questions about your symptoms. Depending on the therapist, the paperwork might have formal assessments, ask background history questions, or simply be a checklist of symptoms.
You should expect to see mental health related items, but also items about your relationship histories, any significant life events, and even questions about your physical health. Counselors are thorough and take every aspect of health into account. The counseling profession by definition considers the individual holistically.
You will need to sign informed consent paperwork for the counseling practice. Also, releases of information for your insurance company and anyone you would like the counselor to speak with. Without informed consent, the counselor cannot provide services. This document can be intimidating and a little long. It’s important that you understand the policies listed, as the counselor will adhere to these policies throughout your treatment.
Items included in the informed consent include the counselor’s theory of choice, payment requirements, and confidentiality concerns. If you don’t understand, PLEASE ask. The counselor’s goal is to explain these policies accurately, and thoroughly, but also in an understandable manner.
Speaking of confidentiality, the counseling process very much respects your privacy. Without your consent on written releases of information, the counselor cannot tell anyone that they are seeing you for counseling, or what your sessions are about. This includes your insurance company.
If you want your insurance to pay, you must give them consent. This is the most important release of information that you will sign. However, if you would like to sign more for, say your spouse or your medical doctor, you are welcome to do so.
The First Counseling Session
Once your first counseling session appointment arrives, you will likely be greeted by a receptionist or administrative assistant. Like other medical practices, they will check you in and take any necessary payments.
The counselor will likely come to meet you in the waiting area at your appointment time and will walk you back to their office.
Feel free to sit anywhere. There are no assigned seats here. Get comfortable – some clients even take off their shoes!
In the first session, you should expect your counselor to ask what brought you to their office. In counseling terms, this is the “presenting problem”.
At this point, I recommend sharing whatever you believe that you need help with. Openness and honesty are key. As much as they would like to, counselors cannot read your mind. However, the manner in which you say something is just as important in the counseling session as what you do say.
A good counselor will start the counseling process here at the intake portion. Rather than a series of questions, it should feel more like a conversation. This intake will make up the bulk of your first session, but is vital to allowing your counselor a good understanding of your concerns.
Talk with your counselor as if you are telling your best friend about what has happened in your life. Their role is to listen, understand the extent of your concerns, and help you reach your goals through a comprehensive treatment plan.
Like what you see?
During this first session, you should also expect to speak with your counselor about your goals and begin creating a treatment plan with the counselor’s help. While I would encourage you to consider what you might want out of counseling prior to the first session, you will work with your counselor to develop a good understanding of your short- and long-term goals during the counseling process and might change your goals over time.
Your input is truly important in the goal creation process and the counselor cannot be client-oriented without understanding what you value and prioritize as goals.
While you might not solidify your goals in this first session, you will start the conversation and begin to work on these with your counselor starting with the next session.
After your First Session
After you and your counselor have said goodbyes and set up a second session, consider what you liked or did not like about the process. Think about things you might have forgotten to include in your story. Consider how working on your goals might improve your current wellness or health.
What aspects of the counseling process are keeping you from scheduling your first appointment? What would be helpful to persuade you to pursue the help that you need? Let me know in the comments what your first counseling session was like and what improvements counseling has allowed you.
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Lat Updated: October 1, 2020