The First Session.

How to begin.

The 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.

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.

So 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.

Living behind masks

When I was in high school I became enamored with a drama class. It was purely happenstance, as there was no other elective available for the last period of the day besides Spanish. In Arkansas two decades ago, I didn’t feel a great need to know Spanish. Drama won out.

I am secure enough to admit I was a horrible actor. I never got cast in any production. My projection was weak. My suspension of disbelief was lacking. Still, I was intrigued by the notion of disappearing into a character. Exploring a whole other world and living the life of another person. Being something other than I was. Something better, more interesting, more enjoyable. The drama masks, smiling and frowning, represented a world a possibility limited only by the imagination.

I forgot all about the drama masks until the mid 2000’s, when I met a drama therapist by the name of Lori Yates. She was a social worker at North Texas State Hospital, a maximum security forensic hospital. Lori is quite the therapist, willing to try anything and everything. Plus she is quite the cut up. Drama therapy obvious was a fit for her. One of her techniques was to have patients craft masks and then wear them during productions of their own creation and direction. Some of the masks at the hospital were extraordinarily beautiful, reminiscent of Mardi Gras or a masquerade ball. Others were dark and scary, and clearly represented pain and tragedy. All were intriguing.

Masks do serve a purpose. In sports, we wear masks and faceguards to protect delicate features and reduce the risk of injury. More often, though, masks are for hiding our identity…which can be a variation on protection if we think about it in terms of protecting ourselves from the ramifications of our choices. Superheroes were masks to protection their friends and family. Criminals and various bad guys where masks to keep from being caught. At Halloween we wear masks to be rewarded with candy…and as adults to (hopefully) hide some of our suboptimal behavior.

This past New Year’s Eve, I myself wore a mask. The whole night I disappeared behind this mask, surrounded mostly by strangers who had no idea of my identity. It was quite liberating. I danced more freely than I had in years. I was not afraid to look around and see people. I didn’t shy away or avert my gaze. I observed. I witnessed. And then I imagined that probably most people wearing masks were having a more free experience than usual, just like me.

When I saw the pictures from NYE, I was struck by the thought that we live our lives behind masks. Physically invisible, but role-defining nonetheless. I “act” a certain way during therapy sessions. I’m different when playing softball. I’m more liberated when dining and drinking with friends. Somber and contemplative in church. At home with my partner and cats, I am probably something very few people have ever seen. Each role of my life is a variation on the core of who I am as a person. The physical masks may be gone, but still I live as different people depending who needs me and what I need.

I’m not sure I like this. As therapists, we frequently advise our clients to live genuine and authentic lives. We say this from an authoritative role of expertise based on training and experience. And quite likely there is the assumption that therapists live mostly perfect lives because of out training and experience. (If you only knew!) Who you are should be consistent in your life, or so we say. Imagine the shock and awe of having my best friend point out that I was willing to tolerate deplorable manipulative behavior from another friend because I was afraid to rock the boat. My bestie pointed out that this was not the first time, and I had tolerated similar behavior on the softball field. Though he did not make all the connections for me, I was well able to see it in myself. In my different roles, while wearing different masks, I had set up different standards of how I was to be treated.

We all do it. Thinking about your roles. Think about the masks you wear. What do you expect as a wife or a husband? As a mother? As a child? How about as a manager or an employee? As a parishioner? Neighbor? What about as a friend? Now here’s the real question….are your expectations for how you are treated consistent across all those roles? Does it change depending on what mask you wear? Do you wear masks to hide from your own disappointment that you are not living your values? If I’m honest, this definitely applied to me. I didn’t realize it for a long time. And now that I think about what Lori was doing with those masks in the hospital, I see the real impact. Those patients had to express their needs wearing the masks so that they felt safe to build up to making healthy and assertive demands without the masks. Lori was teaching them to not hide behind roles and masks, and to see themselves as whole persons. Not broken and fragmented, and not having to play games to meet their needs Intellectually I get it; practically, I’ve been lacking in my own execution.

Today I’m giving myself the same homework I’d give a client. I’m making a list of my core values and beliefs, what I want for my life and my world. And them I’m making a list of all my roles. Each role where I am not living my truest life gets a higher level of scrutiny so I can see where I’ve sold myself out. With insight and awareness comes the need to change something. Either my expectations or my actions. I’m pretty confident it will be my actions and that all of my roles will firmly reflect who I am as a whole and healthy person and I can stop wearing masks. I invite you to try this exercise as well. Let me know what you discover about yourself when you stop hiding behind the masks.