What to Expect on Your First Day in Therapy

One of the biggest regrets of my life is all the time I’ve wasted in therapy waiting for my therapist to explain me to myself and not get it all totally wrong. It’s strange, looking back, how obvious it the answer was, and I’d really like to save a few other people from making the same mistakes I’ve made.

Therapists are trained to be highly passive in most situations. When I was young and I would go to therapy, I didn’t understand this. I thought a therapist was like a doctor, and I just answered the therapist's questions. At no point did I take any initiative to advocate for myself in a mental health situation. This was disastrous for my life, and most of the time we just ended up acting out my mother's fanciful wishes for who I was. Needless to say, my mental health deteriorated throughout my teens until I left home to live with my father, at which point it stabilized, but also stagnated for over a decade until I revisited therapy at a much later stage in life.

It is a simple truism that the therapist can’t read your mind. In order for any sort of mental health professional to help you, you have to speak openly and freely; not just free from shame or fear, but free from distractions or expectations. If you walk into a therapist describing criticisms that authority figures have leveled against you, your therapist is going to start working on their goals, not yours. If walk in describing the priorities and goals you’ve heard are important to other people, the therapist is going to start working on other people’s goals, not yours. You have to tell the therapist the truth about your beliefs and your goals. You have to do your best to speak as clearly as possible about what you are feeling and what you wish you were feeling instead.

If you truly change your beliefs as a result of work you have done with a therapist, that’s great. That is a common expected outcome of therapy. But if a therapist is just telling you you are wrong about something and you know you’re not, it is your responsibility as a patient to continue advocating for yourself until you and the therapist reach some sort of agreement, even if you agree to disagree.

The first and most primary job of a therapist is to repeat back to you what you said in their own words, just like you would have to do in a history class to prove you understood the lesson. The reason for this is partially for you to assess if you are communicating accurately, if the therapist is listening accurately, and if the therapist is really the right fit for you, but the biggest reason is actually for you to gain insight from hearing your own thoughts articulated in a different way. This experience, when completed accurately, is the simplest and greatest relief in mental health healing. If you are in therapy with a skilled professional who is right for you, you should be able to walk out after your first session feeling noticeably better than you did when you walked in. When I found a good therapist who I liked I walked out of his office laughing every week for the first year.

It was a hard won victory though. I’ve met with many a so-called professional who didn’t help me, didn’t respect my goals or methods, and made all kinds of statements during sessions that didn’t contribute to my progress whatsoever. It’s important to remember that it’s okay to dump your therapist (politely) if they aren’t helping you. You will want a therapist who has certain things in common with you, depending on what your issues are. In my case I wanted to manage my attention deficit disorder better, and I really benefited from a therapist who had a personal history of dyslexia. Some people aren’t comfortable with male therapists, but I am. You can look for a therapist who has the same or similar racial identity as you, or who is from the same generation as you are. It’s totally okay to require these kinds of things.

Remember, your mental health is really about your happiness most of all. Happiness doesn’t just come from getting what you want in life but from the empowerment of building yourself up, overcoming obstacles, and gaining the rewards of your efforts.