What Should I Expect From My First Therapy Session?
Published on
February 27, 2024

What Should I Expect From My First Therapy Session?

In this episode, Tyson talks with Dr. Dave McNew, psychological resident at Relational Psych, about what sorts of things someone can expect from a first session with a new therapist. They also talk about common concerns that new clients have about therapy, and why it might be worth giving therapy multiple tries if your first therapist isn’t a great fit.
Hosted by 
Tyson Conner, MA

**Disclaimer: Content Warning
Tyson and Dave have a discussion about suicidal thoughts and conversations about suicide that someone might have with their therapist. That discussion starts around 15 minutes into this episode and ends around 19 minutes into this episode.
That is the section to skip if that's not something you would like to be exposed to during this episode!

*Correction: Clarification
Dr. McNew is not yet a Clinical Psychologist. He is a Psychological Resident - which means he is in the process of becoming a Psychologist.

Tyson Conner  00:00

Today my guest on the podcast is Dr. Dave McNew. Dave is a psychologist who works for Relational Psych with me - a coworker. He earned his PsyD from the Indiana University of Pennsylvania and has practiced most extensively in University Counseling Centers, and also in community mental health and hospital settings, Dave practices from an interpersonal psychodynamic lens, incorporating mindfulness and self compassion practices. Welcome, Dave.

David McNew  00:28

Hi, thanks so much for having me.

Tyson Conner  00:29

And today, we are going to answer the question, What should I expect from my first therapy session?

David McNew  00:35

All right, let's dive right in. And please don't keep track of how many times I say "it depends," it's going to depend a lot. On a few different things, it's going to depend on what agency or practice you're going to - the setting, really - it's going to depend a lot on your therapist, and a lot of it's going to be on you. And those those three things are going to be interacting in different ways. So I'm going to take it a piece at a time and create kind of false barriers or points of distinction between these knowing that they really ebb and flow, and they're always mutually influencing each other.

Tyson Conner  01:15

So it sounds like what you're saying is, immediately the answer to the question, "What to expect in your first therapy session" is, "it really depends," and we'll be hearing a lot today. But the three major categories that we'll be talking about is Number one, the setting that you're in, because that impacts things. Number two, the kind of therapists you're seeing. And number three, what you are wanting from therapy. Are those sorts of the three broad categories?

David McNew  01:43

Totally. I think I'd like to touch on first, just how this might vary a bit by setting and I'll try to focus on what you could expect, here at Relational Psych with a nod to where I've practiced elsewhere to just arise out. So I think a pretty big difference across settings is if your intake paperwork is done online, before you even set foot in the office. Or, if that's not the case, and you deal with all of your background paperwork, your presenting concerns, what brings you in, that will likely be done in the first session.

Tyson Conner  02:29

So to back up half step intake paperwork is all of the beginning documentation that you want -- that you want to, like collect, to get started with a therapist. So like, when you go to your doctor's office for the first time or a dentist's office, you fill out a bunch of information about yourself. And a lot of that's the same as will be an intake paperwork with a therapist. But therapists like other doctors will have specific questions relevant to the kind of treatment you're going to receive with them. So what I'm hearing you say is, like, the first session is really different. In a situation where you've already filled out intake paperwork, you've taken it home, either like a physical copy, or something online, that you've like, filled out ahead of time, and your therapist has already had a chance to read it, versus a situation where maybe you're going to fill out the intake paperwork in the waiting room, or you're going to fill out the intake paperwork between your first and second session or something like that.

David McNew  03:33

Yeah, and there are even therapists who will kind of fill it out for you. While they have the conversations with you and it feels it feels almost like an interview with a pretty heavy focus on like who you are and how you came to be that way. A focus on your mental health concerns if that's central to why you're there. A lot of folks use this thing called the bio-psycho-social model. Oh, yeah.  Can you break that down for me? What is the bio psycho social model? Certainly. So I mean, one one's biology, one's like physical material self - things that are going well or not so well with you over the course of your lifespan. For the bio-psycho of course, the the life of the mind, or the the moods, attitudes personality that make up your interior world are part of this. And then the the social - a lot of our minds personalities or beings are shaped by people that we grew up with and around our caretakers, our friends, our family. And, you know, a lot of a lot of what we're living through right now, matters a great deal and those three, those three domains are constantly interacting to kind of shake out into, you know pain and pleasure and everything in between. And your your intake, your kind of interview tries to cover those domains to give you a map or a framework of who you are and what you want to work on.

Tyson Conner  05:17

So it sounds like what I'm hearing you say is that a really common intake model is one that looks at your - this uses the psycho biosocial model, or bio psychosocial model, where you're paying attention to three domains of a person, right and this this reminds me a little bit of Daniel Siegel's work on like, his definition of a mind where he defines a mind as being made up of a body, a brain and relationships. And it sounds like this bi- psycho-social model it that's, that's how it approaches things. What's happening to you biologically? Do you have diabetes? If you have diabetes then your like, blood sugar changes, it directly impact things that a therapist is concerned about? Psychologically? Have you experienced major depression? Do you have trauma? Right? Are you experiencing anxiety? Those are sort of psychologically oriented questions. And then social questions. What's your social, social support network look like? Are you socially isolated? Do you have a lot of conflict? Are you in a romantic relationship where you're being abused? Right? These kinds of questions are all really relevant to a work you'll do with a therapist. And so they'll ask questions geared toward those three areas during an intake.

David McNew  06:41

Absolutely cool. And let's say that, you've knocked that out in the paperwork already, like you, like you would have it Relational Psych, the first session will feel a little bit different. But in either model, you're gonna get to the same stuff anyway. So don't sweat it too much. Here, we, we focus a bit on what you can expect from your therapist. They will likely talk you through who they are, how they work, what you can expect from them, how they tend to conceptualize and intervene and work with their clients. There's also of course, plenty of time spent on who you are, and what you're there for, and how you want to do it and where you're coming from. And plenty of time for any questions you have about the process. Nothing is off limits, be curious, ask anything. It is your time. Those in summary, I think are the main differences. The bottom line is, don't sweat the differences too much, because you're going to be answering the same thing, right? In either setting.

Tyson Conner  08:01

It sounds like the biggest difference is that in a situation like in our clinic, where to have a first session, you must have filled out intake paperwork. Right at Relational Psych, we have a electronic health record system. That's pretty common these days. When I got started, that was still kind of new. So but you know, I'm older than dirt. So here, we have this electronic health record system. Before your first session, you fill out the paperwork that answers a lot of those questions we were talking about before those bio psycho social questions you'll answer, like questions about the languages spoken in your house growing up, you'll answer questions about your history of trauma, you'll answer questions about how much coffee you drink, right, all those kinds of things. And so because that information is already gathered on paper somewhere, the first session is a little bit less structured. In situations where you haven't filled out paperwork ahead of time, your therapist will probably go through a questionnaire that asks all those questions directly. And there are positives and negatives to both right?  Our model is built the way that it is because that's how we like it. But there's also benefits to having that all that information come out in a conversation as opposed to typing it on the screen. And like, there's, they're they're kind of they're pretty evenly matched in like, I guess what I'm trying to say is listener, if you're therapy, whether your therapist has sent you intake paperwork or not... First of all, they should have some kind of intake paperwork because that's legally required. So if they don't have any whatsoever, and you've already had a couple sessions, that's a problem. But if someone's emailing you paperwork to fill out that's that's not a bad sign. And if someone's not, that's also not a bad sign it they're just two different ways of doing an intake.

David McNew  09:56

Absolutely. Yeah. Having having done it both ways I haven't really seen my clients react strongly one way or the other, they both seem to hold water. Well, let me let me transition a little into talking about what to expect of your therapist. Great. Okay. And as mentioned before, it's it's a little bit tricky to make definitive explanations here, because it's going to vary so much by who's sitting in front of you, and by the interaction that you personally have with your therapist, right. But generally speaking, just expect the person who wants to get to know you really, really well, yet who should also be comfortable with going at your pace. I found from being in therapy and doing therapy, that it's normal to expect more structure on the front end, as we're asking questions of presenting concerns and history that gradually gives way to more free exploration of why are there and what you want to get out of it. So you know, assuming you're in person, your therapist will come out to the waiting room, call you usher you back, open the door, pull up a seat, introduce themselves, welcome you. And at some point, go over some basic nuts and bolts. And these are, these are things related to kind of legal, ethical and safety concerns that you should just expect to get out of the way at some point early on.

Tyson Conner  11:39

Yeah. It seems to me the the nuts and bolts kind of fall into like two categories in my head. The one is like logistics, right? Because every, every individual practice, every clinic has its own procedures, and, and regulations around things like cancellation policies, billing practices, insurance, all those sorts of stuff. And like at Relational Psych, some of that conversation happens with an admin who's not even a therapist. She provides a lot of that information, Ally's great Hey, Ally, you're doing great. If you listen to this podcast, you should know you're really cool. And if you listen to this podcast, use the key key phrase muffin top, then I will send you a $5 gift card to Starbucks. So there you go. Treasure hunt for Ally. But everyone needs to talk logistics. It's just like, something that has to happen. Usually in the first session. Some people have those kinds of conversations and consult calls, but like, generally, that's the first category. But then the second category is this other piece that you're speaking to the like, the things that you got to legally and ethically do from the beginning. And a lot of this involves ideas of informed consent. And informed consent is the idea that if you're coming to see a therapist, they're providing you with treatment, and you have the legal right to know and understand as much as possible, what that treatment is, what the boundaries of the relationship are, what you can expect. And to a certain degree, you can't, you can't, we can't say everything, right? Like, a certain amount of therapy is kind of co-discovery. We don't really know where everything's gonna go. But we can tell you about like confidentiality laws and things like that, that are really important for you to know from the beginning. Because that's how you, like, set up the framework of like, what it's going to be to work together.

David McNew  13:48

Absolutely. And I have muddled a bunch of those together. And in no particular order, which is fair, because we don't know the order your therapist is gonna give them absolutely kind of organic,

Tyson Conner  14:01

I changed the order basically every time.

David McNew  14:04

Beautiful, yeah, just keep keep on their toes. But somewhere in there expect to have a discussion around confidentiality. That is, your therapist should tell you at some point that everything that you talk about is between you and them and will not be discussed outside the room. And the limits to confidentiality. In brief, those are if you tell your therapist that you want to end your own life and you're unable to keep yourself safe - they're legally and ethically bound to bring outside help in. If you plan to attack or kill another person, if there's suspicion or risk of child or elder abuse or of a disabled person. That is also grounds on which your therapist is legally and ethically bound to bring outside help in. And just have that very, very clear in the beginning. These are these are things that everyone hears your therapist has not singled you out because you said something that's a red flag. This is just, you know, bare bones stuff,

Tyson Conner  15:09

Right. Sometimes people will wonder, Oh, boy, I talked about how sometimes I wish I wasn't here in my intake paperwork. Is that why they're telling me that if I'm gonna kill myself, they have to call the paramedics? No, we're legally required to say this to everybody. And one thing that I say to folks, and this varies from therapist to therapist, but I think this is pretty common, at least around the Seattle area, is if something comes up where I am required, ethically to break confidentiality - where I have to tell someone, I let my clients know. If someone's telling me, "No, I don't think I can keep myself safe," then I will tell them, "Okay, well, you know, that means that like, I need to find someone who can." And with younger clients, that means I need to talk to your parents about this, let's call them right now. Right? Let's go out to the waiting room and bring them in and tell them like, hey, things are a little intense right now. With older people that can mean like, I'm going to call some paramedics who are going to give you a ride to a hospital. Or do you have a friend who can come pick you up to give you a ride to the hospital? That sort of thing. So confidentiality is really important, I think, because it's important for your relationship with your therapist to be protected and safe. And when a therapist is legally and ethically required to break confidentiality, they should be able to do it in a way that still makes your relationship protected and safe. And that's - I already described one of the ways I do it, but everyone does it a little bit differently.

David McNew  16:42

Yeah, that's huge. Very, very important point there. I wanted to throw in, too a notion about talking about suicide and safety, that I've come up around before. This is not to say that, if you have, if you've ever mentioned any thoughts about wondering what it would be like to not exist, or if you've had thoughts of ending your life in the past, like, they're surprisingly common. And there, there's a there's a distinction between having a plan and wanting to act upon it, and not being able to stop yourself from doing it. That-that's more the redzone. Just wrestling with the thoughts, generally, even if it is distressing, your therapist will likely not go call the paramedics. So just having the thoughts on their own is not a reason to like hide them away, because you worry that you're going to be taken to the hospital, it's not

Tyson Conner  17:43

Exactly exactly the language that therapists are taught is we are required to report if we truly believe that there is an imminent risk of harm. And imminent means immediately, like, if I am worried that the person sitting on the couch is going to leave my office, and harm will occur whether to themselves or someone else, that's when I need to act. If there's someone sitting in my on my couch, this is a little dark **content warning for suicide. But if there's someone sitting on my couch, and I'm worried like oh, man, this person is so so depressed, I'm worried they might kill themselves someday. That's not a call to the paramedics, unless they're sitting there telling me, "I have a plan. And this is how I'm going to do it. And no, there's no way I could conceive of not doing it." It's not a call to the paramedics. So, just to echo what you're saying, like, yes, as therapists - I mean, again, this is a little dark, but as therapists I, I love when people are able to share that depth of experience with me. Because it's so important to be able to. And it's such an honor to be the person that people can talk to you about that sort of thing. It's not a good thing for my client, my clients going through hell, but it's a good thing for their therapy, because at least they've got somebody with them in hell, and that's sometimes that's the goal.

David McNew  19:14

Totally, which is why I wanted to bring up the distinction. To feel comfortable enough to go there with you. Really important stuff to to walk through with someone that you feel comfortable with. So thank you. I think that also falls into the notion of kind of communication and what to do in case of an emergency. This will vary a lot by clinic and by therapist. Some therapists have hotlines or community agency's numbers, they just give all their clients up front. Some clients give you their office number, their personal number, some not at all, and directions to call a hotline in crisis. You know, expect some conversation around that - their preferred method of communication, your preferred method of communication.

Tyson Conner  20:12

A lot of the first session is kind of a negotiation of like, okay, yes, we've got sessions, but also, we communicate outside of sessions. How do we do that? And how do we communicate when there's a crisis? Those are all things you want to have established from the beginning.

David McNew  20:29

Totally, yeah. And I think moving, moving back out of logistics and into just some of the meat of it, I think, of course, you're going to be asked, even if, and always, if you've written this on an intake form, "what brings you in." Just be expected to, to be asked about it, how it's affected you, what it's gotten in the way of in your life, like how you see it changing. Even if you've written in intimate detail before, it is such rich data, to see how - the how a person describes this the: if you're sad, ironic, hostile, bitter, joyous, whatever, all the things that you say, with your face, with your body, with your tone, kind of helps us see the relationship that you have to, to your pain, and the place in your life that it occupies.

Tyson Conner  21:32

Yeah, absolutely, absolutely. And a thought that I'm having that maybe we can edit, we can edit this out of this isn't relevant. But like, I'm aware that it's a big deal, to ask people to come in to meet a stranger, talk about logistics. And then they say, "So what brings you in?" And the answer is sometimes like, oh, just like the deepest pain that I've experienced in my entire life. Like, as, as therapists, even though every intake, we ask that question - Listener, please know, we do have a sense of how heavy a question that truly is. It's not one we take lightly. It's one we take very seriously. And, like, answer it as honestly, as you can bear in that moment. Right. That's, that's the request that I hope to have for my, my new clients is like, be as vulnerable with me as feels safe. If there's stuff that you hold back, first of all, everybody holds stuff back from their therapist. That's no biggie, don't worry about it. And I hope that you will feel comfortable enough to bring it up later, when when we've built more of a relationship.

David McNew  22:52

Yeah, I like that "as you can bear." It's really an unfolding. You know, ideally, as the relationship deepens, you'll feel more equipped and ready to, to bring up more depth of whatever it is that you're dealing with.

Tyson Conner  23:12

Absolutely.

David McNew  23:15

I think on a related point, it's pretty standard too to be asked about traumatic experiences from your past, and you don't need to go into detail if you're not ready. I mean, most folks are just fine by noting the presence or absence of trauma, maybe an estimate of the time it took place. If you want to, the nature of the event. It may be part of what brings you in, may not. But either way, it's useful for your therapist, to know for them to be better placed to help you.

Tyson Conner  23:49

Absolutely. That feels important. That just that like a lot of times we talk about and deal with trauma, and your therapist should never be pulling trauma out of you or asking you to disclose more than you feel comfortable disclosing. Even if you're there to address trauma. If you don't feel comfortable talking about it, then the therapist's job is - whatever modality they're using whatever like approach they're using, - is to help you feel comfortable enough to be able to talk about it. That's, that's where we start. So if you ever feel like your therapist is trying to pull data from you, something's gone sour, and you know, talk to them about it or just, you know, cut and run and find a different therapist.

David McNew  24:32

Yeah, yeah. You're always free to decline to answer questions. And if you're feeling up to it, maybe talking about like, what makes it hard to do.  You don't have to - But the therapist should not be bending your arm. I think it's, um, there is. There's a bit of a difference between them just asking standard questions and trying to pry.

Tyson Conner  24:59

Right

David McNew  25:00

So don't, don't be shocked and put off by the question itself, but more kind of where it goes and how it's handled,

Tyson Conner  25:09

Right. Yep.

David McNew  25:12

Last thought or two hear about what to expect from the therapist: like after, after they've kind of guided you through the intake, or what brings you in and covered some logistics and so on, there likely will be a bit of a discussion about how they work and what you can expect from them, and how that might inform what you do together. And I kind of think it's helpful that much like, different martial arts have different ways to take down an opponent and score points. Different modalities of therapy also have different ways of thinking about pain and suffering and well being. And we'll also have different techniques in the room that you can just expect. So, you know, your therapist may be pretty cued into how you construe reality and make meaning. Or they may talk about building insight. Or they may be looking at the unconscious motivations for your feeling and behavior and relationships and trying to find ways to make that more conscious so that you can be more deliberate and free in your living. Or if you're an interpersonal dynamic therapist, you may be really trying to mine the relationship that unfolds between you and your client and use that as kind of a thumbnail sketch of how they are out in their lives. So ask about it. Talk about it, it really, it can feel really grounding to kind of know what you're getting into and what to expect.

Tyson Conner  26:51

Yeah, yeah. Because even if you don't know what's going to happen in the course of therapy, when a therapist tells you about how they practice, they're telling you about the things that they will be paying attention to, right? You're getting a glimpse into a little bit of how their mind works. And that I think can be really helpful, especially because like, if you're still trying to figure out, 'do I want to work with this therapist or not?' If someone says to you in the first session, "I practice," like we do here "relational psychoanalytic psychotherapy. And so I don't really do a lot of homework, I don't find worksheets, I can teach skills, but I'm more interested in like your life and how you make sense of it. And like how that plays out in our relationship and patterns and unconscious..." All these kinds of categories that I usually talk about during an intro session, you might be over there, like, 'you know, I want coping skills to manage my anxiety, and all that stuff sounds like a waste of time to me.' And you know what, that's valid. If that's your response, there are other therapists who might fit you better, right? Someone who's a cognitive behavioral therapist, or someone who's using, like a mindfulness based approach, like, there's a bunch of other options, and hearing from your therapist -- So when I do an intake, I do it kind of like you described, right? We start with like, basic, like logistic stuff. And then I'll go into, like, what brings you in, and then I'll tell people, what I imagine it'll be like for us to work together, based off of what the presenting problem is based off of, you know, the symptoms they're experiencing, and what they've said they want from therapy, I will say, you know, I can't tell you how many times I've had people come in, and they describe like, a little bit of like, maybe some disordered eating stuff in their history, and I'll tell them right away, like, I'm not a specialist in eating disorders, I can refer you out. But like, if that's our main focus, I'm probably not the best person for you. However, you also talked about all this complicated family history stuff and your struggles with singleness into your 40s and like, Yes, I can, I can help you with that. And this is how I would. And that's when there's a lot of room for those questions you were talking about. Right? And some some clients have no questions. They're just like, 'okay, when do we start?' And some people have a lot, 'okay, what does that mean? Okay, what if this happens? Where did you go to school?' You know, all these kinds of questions. There should be room for in that first session.

David McNew  29:31

And, and I would humbly submit and encourage you to not automatically just like cut bait and run if your therapist describes the way that they work not being a like complete one to one correspondence with what you want. Because chances are, they've been trained or they've gotten some exposure to a handful of different tools and you know, often times like I, you know, I could not count the number of people that have benefited from using just important coping skills and lifestyle changes in order to just slowly, gently come down to a level at which they can do more depth work and more processing. So like they have absolutely both have their place. And you likely will not reap the full benefit if you're just - if you think to yourself, "This isn't going to work, I'm going to leave." Give them a chance to respond and work with you a little bit. It's a give and take sort of thing.

Tyson Conner  30:39

For sure, for sure. Agreed.

David McNew  30:43

And from here, I would pivot into the final aspect of what to expect in your first session. So much of it is going to be really coming from you. I would say first and foremost, you can expect some degree of anxiety.

Tyson Conner  31:01

Yes, absolutely.

David McNew  31:04

And that, again, for the umpteenth time, it doesn't mean that anything is wrong, I think it's, it's completely normal to expect it. Your therapist may have a little bit of anxiety too, like it comes with meeting new people.

Tyson Conner  31:17

Absolutely.

David McNew  31:21

So I mean, you can even name it out loud during your first session. Nothing is off limits, it can even bring you closer and start the work then and there. I would expect to be engaged. Therapy is not a passive process. It's something that - it's not something that the therapist does to you. It's something that you that you co create together.

Tyson Conner  31:43

Right, a first session with a therapist isn't like the first session with a massage therapist, where you have a brief - you have a conversation about what you're looking for what you need, and then you lay down and the therapist gets to work on your body. Right. With a psychotherapist. It is more interactional. So you should expect even from that first appointment to be, like you say engaged. I like that point. That's a good point.

David McNew  32:09

Yeah, and it's, it's totally okay to warm up to that. And to talk about why it feels hard to do or what gets in the way like that, too becomes part of the work.

Tyson Conner  32:19

Yeah, absolutely.

David McNew  32:23

I think too, I would mention that, you know, if you've had therapy in the past, it can be very, very useful to talk about what went well or not so well. It could potentially save a lot of time and knowing what to avoid doing or where to focus your efforts. Like if you had a past therapist who was way too directive, and you just wanted to process your feelings or experience. Or, you know, if your therapist wanted to explore and you just wanted concrete things to do. Definitely bring it up.

Tyson Conner  32:55

Yeah, absolutely. I, I sometimes get-  I feel myself getting too curious, when new clients talk about their previous therapy experiences. Too curious in that, like, as a therapist. I mean, honestly, part of the reason I like this podcast is because I get a glimpse into how other therapists work. Because like, it's just the two people in the room, usually maybe a third if you're doing you know, parent-child work or couple work. But I get really curious when people come in, and they've been in therapy before, because I'm not their previous therapist, maybe that's a good thing. Maybe that's a bad thing. Maybe they had a really good therapy experience, and they know what works for them. And they can tell me what works. Maybe I had a really bad therapy experience and they can tell me what I ought to avoid, to prevent from triggering some trauma, right? I love hearing about previous therapy experiences. They satisfy my curiosity and in ways that are maybe a little selfish, but -

David McNew  33:58

Oh, same. Join the club, join the club

Tyson Conner  34:01

Therapists: still human. More human than otherwise, as the saying goes

David McNew  34:06

I like that. If I may be so bold, I saved this next nugget here. I've underlined it in my mind, and I would paint sparkling glittery stars around it. I think it's really important. Pay attention to how you feel. Pay attention to how you're making each other feel. Because fit is a huge deal. Your relationship between you and your therapist, like that's really the crucible of change and you're simply not going to be as open or real with someone who feels off or if you don't think you feel comfortable with them. And I should throw in a caveat here too: therapy is often by its nature also uncomfortable because pain and challenge are painful. And because like, no one is perfect, we're gonna bump up against insights about ourselves that are not always pretty. But that discomfort is qualitatively different from the connection you have with the other person in the room. So ideally, feeling as if they 'get' you, and they're on your side. And they and they want to know what you're feeling and feeling with you. That makes baring the normal discomfort of therapy, so much more doable,

Tyson Conner  35:33

Right? We want to have uncomfortable experiences and comfortable relationships, right. That's the goal. Like to figure out how to work through the uncomfortable things, while feeling secure, and safe. We've talked about it before on this podcast we'll talk about again, I don't actually know if that's true. I don't know what order we'll be releasing episodes in, who knows, maybe we've talked about it before, maybe, you listener, will hear about it in a few weeks. But I want to reiterate this idea of fit, because it's a really important concept. And what it boils down to is, people are different. People, personalities are different, how they show up in a room is different. And sometimes I think I'm a pretty good therapist. And there are some people for whom I would be a really bad therapist. Because my personality and their personality combined doesn't make safety. I try to make safety with as many people as possible. But at the end of the day, we are still human beings. And we can't be everything to everyone. And the person who knows, oftentimes, pretty quickly, is the client. I have had clients who didn't come back to see me because they didn't feel like we would make a good fit. And I think they were right.  I've had clients who didn't come back to see me because they didn't think we'd be a good fit. And I'm like, I could have made it work. But at the end of the day, it doesn't matter what I think what matters is that they felt safe or not. I could disagree and say, "Oh, we can make it work." But that kind of goes against the whole theory. like nah, if they don't feel safe, they don't feel safe. So it doesn't matter where you think, Tyson.

David McNew  37:15

Yeah, fit. Fit is huge. Pay attention to fit. It's it's being built on an every, every moment of every session. Even even during the intro nuts and bolts stuff, it's always there. So another piece that I would throw out about your first session it can be, it can be useful. If it appeals, it's not for everyone, but it can help orient the work. To think about the goals you have for your time together. Maybe think about what you would like to have changed about your circumstances. It can really help your therapist to be better placed to be of use to you. You know, you might want better insight about yourself or your challenges. Or you may want help navigating a specific problem or challenge. Or you may have certain mental health symptoms that you would like resolved or some combination thereof. So definitely bring it up and talk about how you can get there together. But under underneath that, to underscore, just be curious. You can ask your therapist about anything, nothing is off limits. And don't worry if you don't get to it all, because there's always next session.

Tyson Conner  38:22

Yeah, yeah, absolutely. I had a couple of thoughts about some of that in terms of like, goal setting - you spoke to this. And I think I wanted to underscore like, if you don't know what your goals are, that's okay, too. And like, tell your therapist that, like that's, you want to be transparent about goals, especially if you don't know what they are. Because if you don't know what they are, then you and your therapist have a great place to start. Let's figure out some goals. Alright. Also, in terms of nothing being off limits, you might ask a question that your therapist doesn't feel comfortable answering, right? That's okay. If that happens, your therapist should be able to handle it. Right? My my default, when people ask me a question that I'm curious about, will be to say like, "I will answer your question. But before I answer it, I'm curious to know why you want to know, what does it mean to you?" If someone asked me "Do you have kids, right?" Does it change things if I have kids? Does it matter? And I will answer but I want to know why you're asking first. Right? And part of that is because we practice from the psychoanalytic perspective where we're curious about the unconscious. And if you ask where's the question coming from, you can get to a lot of those unconscious and unspoken curiosities, thoughts, beliefs, these sorts of things. And if you ask a question that your therapist is uncomfortable asking and they get weird and uncomfortable and strange about it then maybe you're not a good fit. Or maybe your therapist just needs a little bit of practice. Right? I've been caught off guard by a question from a client before. And I'm sure I've been weird before. And the goal is to feel like you can ask a question without being shamed. Right? If your therapist comes back with a, "I'm not going to tell you that. Why would you ask that?" That's not super helpful. You should feel like you could ask anything. And like, if your therapist doesn't answer you, that you don't feel shamed about it,

David McNew  40:33

Totally, I mean, your therapist is a human being too. And if it gets awkward or stilted, or if something you know, needs qualification, or, or so on it, it doesn't mean that things have failed or that the fit is bad, I think being able to navigate those impasses or quandaries together can be incredibly fruitful. I'm not suggesting that you try to go out of your way just to like, throw your therapist off and see if you can catch them off guard. But just it is worth finding a person that you can feel comfortable enough, maybe getting a "where's that question coming from? And how can we get through this together" on? So yeah, I think all of these things that we've been going through from the the intake, the setting, things to expect from your therapist, and what you bring to the table, and how they're all going to be playing upon each other in session one, likely a little bit in session two, and further on, really set the stage for where you're going. But I would encourage you to come in, I think it can be useful too, to talk to talk to friends who've had first sessions; talk to family, your therapist has likely had a first session. There are a lot of ways to find out about this, but the best way is to come in, try it yourself, we're here for you.

Tyson Conner  42:11

Absolutely, the best way to learn is by doing. And the best way to begin is by beginning.

David McNew  42:17

I would love to throw a thought experiment your way, kind listener. And, to me, this sums up a lot of why it depends for so much of what we talked about. I sometimes I think about during my training back at the lovely lovely Indiana University of Pennsylvania with my training cohort of 15 other budding therapists. And at one point, it dawned on me that we were all taking the same courses, going to a lot of the same lectures, having similar practicum kind of training experiences. Yet, if you were to have a first session with each of us, you would have 15 different experiences and 15 different courses of therapy.

Tyson Conner  43:04

Absolutely.

David McNew  43:07

I guess seen another way: When I when I sat back and thought about what to expect when you're expecting your first therapy session, I think about friendship in a way too. Like we've all had people come in and out of our lives, right. It's, it's normal to to meet people, we think it's gonna go somewhere and for whatever reason, it just doesn't quite line up. And they're they're no longer in our lives. I think that most of us would would agree that it would sound funny to say, "Yeah, I was really cool with Mike. But um, you know, we don't really talk anymore. So I tried this friendship thing with with him. It didn't really work out. So friendship isn't for me."

Tyson Conner  43:54

Right? Yeah.

David McNew  43:56

Yeah, that like the, the fit, the feel of the first session? It's it's going to vary. There's - I think the the variation is as endless as there are people practicing therapy. So it doesn't necessarily mean that the enterprise itself is somehow wrong or bad. It just means that there are other folks out there that would be a better fit for you.

Tyson Conner  44:22

Yep. Yep. A therapy relationship is a specific kind of relationship. And just because one relationship with one therapist didn't work for you, doesn't mean that there isn't one out there who will be a good fit. So if you tried it before, and you're thinking about trying it again, you're saying give it a go?

David McNew  44:41

Absolutely.

Tyson Conner  44:42

Officially endorsed by Dr. McNew.

David McNew  44:47

Wonderful. Yeah, I would say so.

Tyson Conner  44:49

And what about for if we have listeners who are interested in this topic of like getting started, what's therapy like? Do you have recommendations for further learning that they might be interested in.

David McNew  45:04

In fact I do. There are two books that I think would be worth a look. The first is Love's Executioner by Yalom.

Tyson Conner  45:14

Irvin Yalom?

David McNew  45:16

Irvin Yalom.- the man, the myth, the legend. Quite a guy. And second being The Examined Life by Grosz. And these are not necessarily about first sessions per se. The reason that I bring them up is because I think that they are two very just fun engaging accounts of the - inside the mind of very caring, thoughtful therapists. So if you want to know what to expect from the person sitting in the chair, or in the other couch or what have you, this is a really great way to kind of step into that world and see how they, they organize their thinking and feeling. And it can help to demystify the process a little bit and they're just beautifully written interesting accounts of therapy itself. So give them a read.

Tyson Conner  46:14

Absolutely, fully endorsed. I love both those books. Lovely. Well, Dr. McNew, thank you so much for joining us today. And this was delightful.

David McNew  46:27

It was a pleasure Tyson. Thank you for having me.

Tyson Conner  46:32

Special thanks to Dr. Dave McNew. Dr. McNew can be found at Relational Psych: link's in the show notes. If you're interested in either of the books that Dave mentioned during the further learning section, Love's Executioner by Irvin Yalom and The Examined life by Stephen Grosz. Links to both of those books are also in the show notes.  The Relational Psych Podcast is a production of Relational Psych a mental health clinic providing depth oriented psychotherapy and psychological testing in person in Seattle and virtually throughout Washington state. If you are interested in psychotherapy or psychological testing for yourself or a family member, links to our contact information are in the show notes. If you're a psychotherapist and would like to be a guest on the show or listener with a suggestion for someone you'd like us to interview, you can contact me at podcast@relationalpsych.group. The Relational Psych podcast is hosted and produced by me, Tyson Conner, Carly Claney is our executive producer with technical support by Sam Claney and Ally Raye. Our music is by Ben Lewis. We love you buddy.

Further Learning:

Love’s Executioner by Irvin Yolam: https://www.goodreads.com/book/show/21027.Love_s_Executioner_and_Other_Tales_of_Psychotherapy

The Examined Life by Stephen Grosz: https://www.goodreads.com/book/show/18378023-the-examined-life

Dr. Dan Siegel: https://drdansiegel.com/