The First Session.

How to begin.

Therapy 1The questions I am most often asked by friends, family, potential clients, and even strangers at parties are “What is therapy like? What happens?” Some people who have never sat on the couch genuinely wonder what goes on behind that closed door. Others use this is as a way to tease out my particular therapeutic style. Most often, though, it is a question about what happens in the first session with any therapist. I certainly understand the question.

Picture it. Jonesboro, Arkansas. 1998. A young man goes to a therapist’s office for the first time. There was nothing that drove me to therapy. I was not depressed. I was not anxious. There had been no breakup. Work was good. School was good. I went to the therapist because it seemed like I should. Most of my friends were in therapy. Everyone had an “analyst” even if they had nothing to analyze. And then we analyzed that! Seemed very Woody Allen-esque to me.

I showed up for my first session and the therapist matter-of-factly asked what was wrong. When I explained that there was nothing wrong and I was perfectly happy, he had the unmitigated gall to accuse me of masking symptoms and living in a state of denial. Well now we had something to discuss! And we did. For three weeks. And I got bored. And then he got bored. We ran out of things to talk about. And I found other ways to spend money and be entertained.

I’m not sure if that was how my introduction to therapy was supposed to unfold. From what I hear from friends and colleagues, there is no one single way for a therapist and client to first connect. That’s certainly been my experience. In the last decade of working in mental health in various office, jail, and correctional facility settings, I have never found one sure-fire way to begin a therapeutic journey.

It’s perfectly normal and natural to feel nervous about your first counseling session, or your first session with a new therapist. I understand it takes a lot of courage to share your feelings and experiences with someone you just met. Our first interaction is really about establishing an initial connection. You deciding if I’m a good fit for you, and me deciding if I can help you. We work together to identify and understand your concerns and develop a plan to make changes in your life. This process usually takes several sessions. I think of it as the “getting to know each other” stage of our new relationship. This is a collaborative process, but ultimately you are in the driver’s seat.

Switchback at the base of Cape Smokey, Cabot Trail, Cape Breton, Nova Scotia.See, that doesn’t sound at all scary, does it? In my mind, therapy is a purposeful conversation between two people where one of those people happens to be in need of some assistance and guidance and the other one has some training to be helpful. We talk. A lot. We both talk. And I listen. A lot. We discuss. We explore. We. Both of us talking together. It’s a collaboration. And from my experience, if you’re able to talk to a friend then you’re pretty well able to talk to a therapist.

I know what you’re thinking….”does that mean you’re a paid friend?” Absolutely not! I am a paid professional who is good at relating to people and getting them to open up about what’s working and not working, and then helping them find better ways to problem solve and be happy. It sometimes seems like a friendship because there is genuine caring and a certain amount of back-and-forth in my conversational approach. But I am not a paid friend. I am a therapist and my job is to help you live your healthiest and happiest life.

But stop and consider this. If it often seems so friendly, doesn’t that mean it’s not really that scary? I sure hope so. I like to think I’m the least scary person on the planet. I take great pride in making people comfortable so we can effectively problem solve. I try really hard to lessen any anxious discomfort and allow you to focus on what’s happening. Does that mean it’s all laughter and giggles? No chance! There are tears sometimes. Every now and then you might even make realizations you didn’t want and consider throwing a brick through my window in the wee hours of the morning. I just ask you show up at the next appointment so we can talk about it and keep moving forward. And maybe that you wrap that brick in a reminder slip so I know who to bill. Just kidding. Sort of.

If you really want to get a feel for what that first session will be like, ask to talk to therapist for a few minutes over the phone. Most therapists are frequently quite busy and booked much of the day, but there are opportunities to return a five-minute phone call. Given that therapy is not inexpensive and requires some commitment, it only makes sense to me that you might want to chat me up for a few minutes before making an appointment. It’s similar to the “free consultations” offered by a lot of professionals, just briefer. Though it would be unreasonable to expect more than five or ten minutes, it’s a sensible request and one that I always honor.

From there the journey is something we navigate together. There is no one right way or one right path for all clients. See what happens. Take the chance. I don’t know the statistics on people dying from anxiety or fright in a therapist’s office but I’m pretty sure those are some low odds.

Happy SandSo back to the original question. When I went to therapy “for real,” the first session was nerve wracking. For all of about ten minutes. I didn’t know what to expect. It was a woman. And a very young one. Fresh out of school, in fact. But I went because someone I trusted recommended her. The interaction was professional, but friendly. She asked me so many questions I thought she was ghost writing my autobiography. We talked. We laughed. I cried. She comforted. I felt like she understood me. It still wasn’t that easy for me to open up, but once I did my life got a lot better. I returned. There was a lot of back-and-forth as I thought through issues and she made poignant observations and helpful suggestions. And from time to time I still check in as needed. Yes, therapists sometimes sit on the couch as well, but that’s a whole other blog entry. If you’re in pain or confused about life or want things to be different, go that first session. Walk through the door. Take that first step on a journey of enlightenment and improvement. It can be so worthwhile.

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Bibliotherapy – Or How I Learned to Write What I Feel

Over the past few weeks, a popular prime time television series has included a plot line about adult siblings meeting for the first time. Part of the story has included their deceased mother’s journals. Box after box of journals. Journals documenting nearly every day of her adult life, from the mundane to the extraordinary. For some reason watching those episodes made me think of the oft-used phrase “Dear Diary.” That, in turn, let me to think about the excitement of adolescent diaries along the lines of “Dear Diary…I met a boy…” And welcome to the windmills of my mind. The life of a therapist always making connections.

Bibliotherapy is a rather unfriendly word for a relatively simple act – the expression of feelings through the written word. We’ve all done it in some form or fashion. Don’t believe me? Ha! I dare you to look at your Facebook posts or Twitter feeds. Complain about a bad day? Participate in the annual fall tradition of 20, 30 or even 40 Days of Thanks? Share really great news that made you happy….including the emoticon? Congratulations! You are well versed in bibliotherapy.

For the sake of simplicity, if for no other reason than I prefer to avoid “psychobabble” when at all possible, let’s talk about journaling instead. This blog is my personal form of journaling, though not my only effort. Journaling is a great way to explore your feelings and experiences over time. Just about every self-help book and pompous daytime talk show circuit “expert” recommends journaling. Research has shown that effective journaling can be a good tool in your toolbox of psychological wellness. And I firmly believe it’s critical for me to “know myself” before I can know anybody else or how to include them in my life.

So now I write a blog. I’m just starting this new project, but I’m excited and hopeful others will at least get a chuckle every now and then, if not find something useful. I also keep a private journal on my MacBook (Day One app, available for iOS devices). Just the other day I wrote an email to an ex who was my first love. Classic unsent letter exercise. It still sits in my draft folder for me to tweak until I’m satisfied. I doubt I’ll ever hit the SEND button, but that’s not the point. The point is for me to explore my feelings. Often times it’s easier if I write them down rather than having them swirl around in my head in what I imagine looks like a satellite view of a hurricane approach the shore. Yes, there is a metaphor buried in there what would amuse Freud. Journaling, in whatever form, is for me. And it can be for you, too.

Why do it?

  • Gives you a chance to sort through all the clutter in your head by getting down on paper. Then you’re better able to concentrate on your wants and needs.
  • Allows you to step back and evaluate your thoughts, emotions, feelings, actions, and reaction.
  • Express thoughts that sometimes you are too scared to say out loud.
  • Explore your core values, and learn to bring your emotions and desires in line with those values to live your best life.
  • Step back and see things from other perspectives.
  • Explore a creative side of yourself and turn negative energy into positive energy.
  • Look for recurrent themes in your life that are holding you back, and recognize the things you do well that propel you forward.

How do you do it? Where do you start? How do you know you’re doing it right? Will it help? Those are great questions I often hear from clients when I assign journaling as homework. That’s right…I give therapy homework. Sometimes clients resist and roll their eyes. Eventually they give in. And in many cases, they have continued their journaling well after we have finished using it in therapy. I bet most of them even continued after their therapy was over.

There are lots of books and guides you can buy, borrow, rent, or download. And they are totally unnecessary. If you completed junior high, you already have the skills you need to journal. It’s writing. That’s it. Pretty simple, huh?

I’m serious. There is no right or wrong way to begin this. Some people begin in a very structured way using a diary app or similar format. Others carry a notebook with them and jot down thoughts as they occur. Some people write long and winding narratives for hours on end. I’ve seen great work come from what we call “stream of consciousness” writing where you start with whatever words land on the page and continue without thought until you run out of words, with no regard to punctuation or structure or style. To my mind, and based on my experiences with clients and my own life, the way you do it is far less important than the fact you are doing it.

I like to occasionally review what I’ve written to start looking for common themes. Do I feel depressed the same time each year? Am I writing a lot about hurt feelings with my friends and family? Do my thoughts about my work sound like maybe I want to make a change? Are there lots of mentions about something that excites me that maybe should be a new hobby? What’s working and not working in my life? What do I want to be different?

As with most things in life, practice does not necessarily make it “perfect” but does make it a lasting habit. Try and develop a regular writing habit and see what you learn about yourself.