Your therapist may take for granted how difficult it is for most people to actually make the decision to seek out treatment for a mental health concern. A therapist will typically see anywhere from 6 to 8 people a day, everyday, and mental health concerns are their lifeblood. They often don’t understand the anxiety and fear most people have in making their first appointment, much less keeping it. This article will help explain what to expect from your first psychotherapy appointment.

You’re In a Boatload of Anxiety

It’s not like anybody wants to go see a therapist or psychiatrist. It’s not the type of thing someone wakes up in the morning and says, “Wow, I’ve been missing something in my life. I’d love to chat to a stranger about my innermost personal fears, thoughts, and feelings and see exactly how screwed up I really am.” In fact, most people think just the opposite about almost any health or mental health appointment. Most people avoid them like the plague. Or avian bird flu. It’s just not something you want to deal with.

There are no easy ways to “get over” this fear and anxiety. Such anxiety is a normal part of our lives, and lets us know that what we’re about to embark on is indeed a scary journey of self-discovery. Learning things about oneself and bringing the light of day to shine on them is not always all joy and butterflies. Sometimes our demons need to come out as well, or those behaviors we almost wish nobody in the world knew about.

So instead of fighting these feelings, its best to just accept them as a part of the process. That acceptance becomes one of the very first steps of not only getting help, but also the psychotherapeutic process of change. Because without making changes in your life, you’re just going to keep on feeling bad.

Make the Appointment

You’ve decided you want to talk to someone about your feelings or thoughts that are really causing you concern. They are interfering with your ability to interact with your significant other, family or friends. You can’t function at work or school any longer. You feel very much “out of it,” not living your life so much as observing yourself living your life. You may feel detached and unable to explain your emotional reactions to everyday events.

Indeed, a professional can help you sort these types of things out. But making that first appointment is the first step. And it can be a doozie.

Most people who’ve come this far usually have some idea of what is going on in their lives. That is, you know whether you’re suffering from anxiety or severe depression or are manic. These symptoms are so common in today’s society, and the information so readily available, many people often end up “diagnosing” themselves long before they seek out professional assistance.

Most people will end up seeing a psychotherapist, counselor or psychologist for this first appointment; it’s fairly rare to see a psychiatrist for a first appointment unless you can schedule one directly with them. A therapist is often a good starting point for therapy, because if they believe that medications may be of additional help to you in your situation, they can readily refer you to a psychiatrist for a prescription.

Plan for two hours, although most initial evaluations (also know as “intake appointments” or “intake assessments”) will take about 90 minutes.

Tell Your Life Story

Your first appointment with a therapist is primarily an information-gathering session for the therapist. He or she needs to learn a lot about you and your history in a short amount of time in order to properly evaluate your concerns and arrive at a possible diagnosis. Since diagnosis often helps guide treatment, it’s an important part of the process.

Your story is indeed your own and a very personal one at that. Despite what you may have read, a person is not simply a diagnosis. Nor do professionals look at people who come to them that way. They look at each and every person as a unique individual who is in pain and needs help.

The only person who can tell your story is you. So when you enter a therapist’s office for the first time, you should remind yourself that you are your own life’s expert. The therapist isn’t there to judge you, or to tell you how screwed up he or she thinks you are. No, in fact, their main job is to simply listen to you, and become the world’s second-foremost expert on you (you being the first). So feel confident that they don’t know you as you know you in that first session, and tell your story — what brings you in today?

Therapists of course want to hear what the current problem is and where it all started. That helps address your immediate needs and what brought you in that day to see the therapist. But the therapist also might ask you a bit about your childhood and family background, not in some “lay down on the couch and tell me about your mother” way, but just to understand your development a little better.

You, being the expert on yourself, can share as much or as little as you’d like. While therapists will often say, “Tell me everything,” the truth of the matter is that you have a limited amount of time in session. You have to focus on what’s most important to you and try and stick to it. Many times you will leave your first session thinking you left out something important. Not to worry, it’s something you can always talk about in your next session.

Many people will leave their first session alternately feeling: relieved, horrified, peaceful, even more anxious, and hopeful, or any combination of these feelings and more. Get used to that feeling, because psychotherapy is an experience unlike any other in this world. It is powerful, but it can also be a little scary and intimidating. Most people who try psychotherapy end up liking it, and appreciating their time with their therapist as a chance to explore new ways of being, of thinking, of feeling.

What Happens Next

At the end of your first appointment, the therapist will often arrive at a tentative diagnosis for your problem. This is usually a necessary evil, if for no other reason than in order to be paid by your insurance company (they won’t pay without a diagnosis). Diagnoses can often help guide a professional in helping you formulate a realistic treatment plan, and inform whether medication may be helpful or necessary. If the professional you see doesn’t share the diagnosis with you, you’re always welcomed to ask — it’s your right as a patient to know it.

Some professionals don’t feel entirely comfortable in making a final diagnosis after just one session, so know that they may update or change your diagnosis after additional sessions in getting to know you.

If the therapist believes medication might be appropriate, he or she will also provide you with a referral to a psychiatrist for a medication evaluation. A psychiatrist is the only professional who can decide if medication will be right for you, and if so, what specific kind of medication may be most helpful.