The first couple of psychotherapy sessions are especially important for you. The rapport you develop with your psychotherapist determines, not only if you will return for another session, but also if you will continue seeking therapy at all. Although telling your problems to a stranger can be often difficult and awkward, intuition tells us early on if the relationship is going to work or not work.

You may not get it right the first time.

Sometimes it can take you a couple of sessions with different therapists before you meet someone you feel comfortable working with. It is a good idea going to your first session with that possibility in mind. When you feel that you don't have a good rapport with your counselor, it is perfectly fine to let them know that he or she is not a good fit for you. Your counselor wants what is best for you and oftentimes they'll recommend someone else with whom you may feel more comfortable.

Gaining your trust.

Trust with your counselor is a crucial aspect of psychotherapy, and it will affect how much you are willing to share and collaborate in your own healing process. It usually takes more than one session to establish that trust but, in general, it is more likely that you will trust someone who you view as genuine, and who listens, understands, and supports you without judgement.

You have a right to be informed from day one.

Clarity about what psychotherapy is, what your goals are, and what the expectations, tools, and techniques your counselor uses should be discussed in the first session. Your counselor's responsibility is to provide you with statement of "Informed Consent". According to the American Counseling Association code of ethics, the informed consent should include the following:

"Purposes, goals, techniques, procedures, limitations, potential risks, and benefits of services; the counselor's qualifications, credentials, and relevant experience. Counselors take steps to ensure that clients understand the implications of diagnosis, the intended use of tests and reports, fees, and billing arrangements. Clients have the right to confidentiality and to be provided with an explanation of its limitations (including how supervisors and/or treatment team professionals are involved); to obtain clear information about their records; to participate in the ongoing counseling plans; and to refuse any services or modality change, and to be advised of the consequences of such refusal." (downloaded fromhttp://www.counseling.org/Resources/CodeOfEthics/TP/Home/CT2.aspx).

Are you going to diagnose me?

Remember that if you are paying your psychotherapy sessions with health insurance, your psychotherapist will be required to write a diagnosis for you in order to be covered by your insurance company. Diagnosis codes come from the Diagnostic and Statistical Manual of Mental Health Disorders Revised IV (DSM IV). Talk to your psychotherapist about how a diagnosis can be beneficial or detrimental to you. Your participation during the diagnostic and decision making process is the best way to alleviate any anxiety about what goes into your records.

For more information about what the DSM IV is, visit the American Psychiatric Association website:
http://www.psych.org/MainMenu/Research/DSMIV/DSMIVTR.aspx

Professionalism is caring.

Ethical and professional psychotherapists take their time with you seriously. Expect them to arrive promptly, hold the session with you for the full-time allotted and give you their undivided attention during your time together. If your psychotherapist is taking non-critical phone calls during your session, it might be the first sign of looking for a new psychotherapist.

On a final note: therapy helps you grow.

Counselors help you realize that you are the master of your own life. They don't give you solutions to problems, but instead assist you with attaining clarity about yourself and the choices you can make to improve the quality of your life. You decide when to begin and end your psychotherapy. You decide what issues are important to talk about during sessions, and you determine when to stop talking about anything that makes you uncomfortable at any time. Psychotherapy may be sometimes an uncomfortable process, but the healing and trusting relationship you and your counselor establish will contribute over time to a more fulfilling and rewarding personal experience of growth.

Eva Malia is a licensed mental health counselor in Providence, RI. To schedule a time to work with Ms. Malia, fill out her inquiry form.