What is a first visit with a therapist like anyway?

So, yes, people often do not know what to expect when you visit a therapist’s office.

It can be an awkward, vulnerable, and just a very different sort of conversation than you usually have. If you were going to a general practitioner, then you may get asked questions about your injury, your cough, the possible infection. There are blood tests and urinalysis. And the subject of the visit generally stays there.

Therapy can feel like a conversation, but a conversation with a purpose.

On a initial visit, you will typically be asked to fill out a questionnaire that asks you about your symptoms (e.g. sadness, anxiety, fears, sleep, appetite, substance use, other behaviors). There will be questions about how you grew up (or stressors in your current growing up). There may be questions about any sort of family history of substance abuse, mental illness, or trauma, as we know that we are a complex combination of genetics and environment.

Then the conversation begins.

And while some of the questions may be difficult, remember that this person is trying to help in the end. Oftentimes you may not say everything in the first session; and that is OK. In fact, there is a phenomenon called “flooding” where sometimes people tell everything in the first session, feel that they have then shared too much, feel embarrassed, and then do not return.

Therapists are trained professionals and will typically guide the conversation in such a way as to get the information they need to make a diagnosis, but also begin to guide you toward a plan for how to tackle the difficulty at hand.

As you get to the end of the session, there is usually a summing up and a plan.

Most therapists in the state of Georgia can diagnosis mental illness. These are illnesses such as depression, anxiety, schizophrenia, bipolar disorder, and ADHD. While therapists are able to diagnose, there are some entities such as school boards and government agencies that may require further testing to meet their requirements. So by the end of your session, you may have a preliminary diagnosis. And I use the word preliminary, because diagnosis of mental illness does change over time as new symptoms present themselves and some initial symptoms become less important.

Mental illness is more challenging to diagnosis because most of the information is based on history and questions, not blood tests and brain scans.

And while there are very good folks working on using blood tests and brain scans, it is not technology that is widely available or financially accessible for most folks at this point.

So at the end of your first session, you may have a referral to a psychiatrist or back to your general practitioner so that you can discuss medication for an illness or other tests to rule out other possible causes of your symptoms like thyroid disease or diabetes. We may have a discussion about certain lifestyle changes that we know can help us physically as well as mentally, such as changes in diet and exercise. And your therapist will likely give you some homework that involves noticing certain thought patterns that may be contributing to your symptoms or a writing assignment like “the miracle question.”

It is OK to ask your therapist about these next steps, how long they expect treatment to last, and what you can expect as a patient/client.

And somewhere in this process, you should be given in verbal and/or written format some idea of privacy practices, about what to do in case of an emergency, and when you can schedule another appointment, if you wish. Because this last part, is potentially the most important. There is good evidence that the “type” of therapy is less important than that you feel comfortable with and trust your therapist. While their skills and knowledge base are what got them there, if you do not feel that you have a good, trusting relationship with that person, the most knowledgeable and skilled provider will not help near as much, if at all.

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