Here's some handy information for anyone attending their first appointment with their psychologist.
In your first appointment, your therapist will start by discussing some administrative topics, including:
- Clinical consent and the limits of this (harm to self, others, and/or legal request for your records), and;
- The general process of how they conduct therapy.
Then, your therapist will want to get to know you, your present concerns, your mental health history, your family history, and your goals for therapy.
In your sesion, you can talk as much or as little as you like, and it is completely up to you as to what you share with your therapist. Although, the more you share, the better the picture your clinician can build and the better they can direct therapy.
Your psychologist may ask lots of questions but this is normal, and you can ask questions too.
Your clinician will keep notes, and you can keep notes too!
There’s no need for extensive preparation for your first therapy session, although this is completely up to you! Something that may be helpful is to consider your goals: What do you want to get out of therapy.
Setting goals for therapy
If you would like to do some preparation work, you can think about your goals for therapy, although your clinician will work on this with you if you’d like support.
Setting SMART goals in therapy helps you define your intentions and put them into practice.
The acronym “SMART”:
- S - specific
- M - measurable
- A - attainable
- R - relevant
- T - timebound
For example, you may wish to be “happier” at the end of therapy. However, think about how behaviours “happy” show up in your life. Does this mean you will be visiting friends more, worrying less, have a sense of freedom, go to work with less resentment and take fewer sick days, or make playing with your kids or friends easier? Notice how “happy” is hard to measure but having fewer sick days is easy to measure.
As treatment goes on your therapist will make a treatment plan in collaboration with you.
Making a formulation and treatment plan
In collaboration with you, your therapist will make a formulation and treatment plan. This plan should include the number of sessions you expect to need and preferably, booking these sessions in advance. This process enables you to have some assurance about your treatment plan.
In making this plan, your therapist may be conducting a bio-psycho-social case formulation through recording and evaluating the 4 p’s:
- Predisposing factors - What is your genetic and family “set up?” What were you working with initially?
- Precipitating factors - What acute event happened and how did it affect you?
- Perpetuating factors - What chronic things are going on for you that keep the mental health issue going?
- Protective factors - What is protecting you and keeping you well? What are your strengths?
Risk and reporting
Your therapist is bound by confidentiality. Everything that you and they speak about, they are professionally bound to keep between you and them. This is so that you can feel confident to speak about whatever you need to speak about.
There are a couple of conditions on that confidentiality. If your therapist had good reason to believe you were going to hurt yourself or someone else, they would need to engage emergency services to keep you or that other person safe.
Another condition is if the psychologist or psychiatrist receives a subpoena for your records, they must follow this legal mandate.
Finally, they are also bound by mandatory reporting requirements for when a child is in need of protection due to:
- physical injury
- sexual abuse
- emotional or intellectual development
- physical development or health
- abandonment or parental incapacity.
Each state has different mandatory reporting requirements and the psychologist must make the report according to the rules of the state you are in.