Starting Therapy with Curiosity

Helen Wu, Advanced Clinical Fellow

When I see clients for the first session, there is usually a sense of excitement and curiosity in getting to know a new person and the concerns they are bringing into the session. For those new to therapy, it may feel a bit intimidating at first. I see therapy as a collaboration and a process of discovery. I am a guide helping the individual peel back some of the layers they have developed over time to hopefully gain a deeper understanding of who they are and why they learned to cope in certain ways. This work requires time, patience, curiosity, and most importantly, trust in the therapist and in the process.

This article is meant to provide an overview of how to prepare for the first few sessions with your new therapist, mentally and emotionally, and to demystify what actually happens in the therapy room.

Preparing Mentally and Emotionally

Before going into your first therapy session, it is generally helpful to have some idea of what your goals are, or what you are hoping to get out of therapy. Take a few moments to reflect and perhaps write down any thoughts that come up, before you step into the therapy room. These can serve as a starting point and may eventually open up other areas of your life that you would like to explore. You don’t need a complete timeline of your life or a perfectly polished story. It is also completely normal to feel nervous, awkward, or unsure of what to say. You can even tell your therapist about those feelings. And if you don’t have concrete goals, that’s fine too. Part of the therapeutic process is discovering what you want to understand, work through, or change. 

Some questions you might reflect on before your first session could be:

What feels most difficult for me right now?

Are there patterns I keep finding myself in that I would like to better understand?

What might my life look or feel like when I’m ready to finish therapy?

What would need to change for my life to feel more fulfilling?

In the first few sessions, the therapist is getting to know you and trying to understand your history, behavioral and relational patterns, and how you cope with stressful situations. This is part of the initial assessment. I generally like to conduct assessments from a biopsychosocial perspective, understanding your biological background, psychological development, relational and attachment history, and current environment. It is similar to taking a 360-degree, dynamic view of who you are.

Of course, the client has complete autonomy over how much they want to disclose in the first session. The first few sessions are also an opportunity for you to get a sense of your therapist—whether you feel heard and understood, and comfortable enough to gradually build trust.

Set Realistic Expectations

It’s important to keep in mind that therapy is a process, as much as it is a science. If there is an expectation of a quick fix or wanting to resolve everything within the first few sessions, you may be disappointed. Meaningful change often takes time, patience, self-compassion, and introspection. Therapy is also a learning process that requires curiosity and commitment. You may begin trying to understand why certain relational or behavioral patterns keep repeating themselves, what function they may have served in the past, and whether they are still serving you today. That said, I generally like to set goals together with the client and create a treatment plan with smaller steps that work toward those goals.

You may also find yourself continuing to reflect on conversations after a session ends. Therapy does not necessarily stop at the end of the 50 minutes. Over time, you may begin noticing thoughts, feelings, reactions, and patterns in your everyday life that you had not paid much attention to before. 

Understanding Your Relational and Attachment Patterns

There are many therapeutic approaches available today, and different therapists prefer to use different approaches. During your consultation call or initial assessment, you can ask your therapist about the approaches they use. I generally use an integrative, holistic approach and tailor various modalities to each client’s individual needs. For example, for issues pertaining to relational distress, I often use an attachment lens to explore a client’s relational history and patterns. This may involve looking at early relationships, family dynamics, impactful experiences, and how the client managed navigating closeness, conflict, trust, emotional safety, and expressing their needs. Attachment is only one lens, however, and may not be relevant to every client or every concern. The larger goal is to become curious about where certain patterns came from, what purpose they may have once served, and whether they continue to serve the life and relationships you want today.

You may already have a sense of what you want to work on in therapy, or you may still be trying to understand what feels difficult and where it comes from. Both are perfectly good places to begin. You don’t need to have all the answers before starting therapy, as these are the things that you and your therapist can continue to explore and discover together.