Today, and increasingly so, a considerable proportion of the population has sought or will seek the services of a psychologist. While in the past this was frowned upon and many people were embarrassed or singled out because of it, this stigma has been considerably reduced over the years, causing more and more people to be encouraged to seek this type of service if necessary.
Despite this, it is still a type of service that is seen as something strange and to which most people have some reticence, as they do not know exactly how it works or what it will do. One of the moments that generate more uncertainty is the first contact with the professional, often not knowing exactly what is going to be done or what to expect. What do you do in a first session with a psychologist? This is the topic we are going to talk about throughout this article.
What to do in the first psychotherapy session
The first thing to note is that the first session is, with the possible exception of a first telephone or internet contact, the first contact between therapist and patient .
This means that at this moment we still do not know anything about each other, beyond having read the centre’s website or opinions about the professional, and especially in the case of the therapist, who will not have any knowledge about his patient.
In general, we have to take into account that the general objectives of the first session will be to get in touch, to know the case in question and to generate a good therapeutic relationship .
This last aspect is essential, since usually deep aspects of the psyche will be dealt with. Without an adequate level of trust between professional and patient, the user will not allow the expression of fears, doubts, emotions and thoughts, resulting in an unproductive relationship and hindering the success of the therapy.
Of course, the positive rapport or good therapeutic relationship will be built not only during this session (in which it is usual to be a little self-conscious) but throughout different sessions.
First contact with the patient
The first thing will be to receive the patient, make him sit down and make the relevant presentations . It is usual to try to break the ice with the patient to generate a positive and trusting atmosphere, to gradually explain to them what is going to be done throughout the session.
It is also common for it to be mentioned at some point during the interview (although many professionals do not say this directly, assuming that it is understood or having reported it in previous forms or channels of contact), either at the beginning, during or at the end, that all the information provided will be absolutely confidential . The only exceptions are that there is an order or request from a judge or that there may be serious damage to the life or integrity of the subject himself or of third parties.
After the presentation, an interview will be conducted in order to obtain information about the case itself, generally through a process called anamnesis. This is the method by which the most relevant information of the specific case is collected , including the problem in question that made the subject come to us, life and social habits and the history and basic data of the subject.
Generally, one will begin by asking about the problem or demand that the subject has, focusing on the current situation, as well as what has made him or her come here and now. We will also ask about aspects such as when the problem began, what it is associated with and the feelings it generates, what specific difficulties it generates in the patient’s life.
This occurs even if the professional has a report about it (for example if it is derived from the doctor or by court order), so that the professional can see what demand the subject has and in case there is a problem how he lives and expresses it, getting an idea of his approach. The idea is that the patient expresses his/her demand/problem at the present time,
Once this has been done, or just before that (the specific order depends on how each professional approaches the order and the characteristics of the patient), in order to get to know the patient better and obtain more information about both the problem and the circumstances surrounding it, a series of general data about the patient and his or her life that may be of interest and related to the problem is usually requested.
In this sense, it will be useful to know the presence of possible antecedents, both personal and familiar , of the same problem or of one that may have had a concrete effect on the subject. Basic data are also usually asked about the environment: whether they have children or siblings, marital status, relationship with parents and their occupation or, in general, the family structure with which they live. Also about social life, whether or not there is a partner and the state of the relationship or working life.
It is not a question of just asking things and knowing all the aspects of your life, but it will be questions to know the general situation. The collection of information must respect ethical limits: the professional will focus on those aspects that are relevant to approach and address the reason for consultation, and may, if he or she considers it necessary, address a subject in greater depth.
Obviously, we are in the first session, being a dialogue that aims to obtain information but is not an interrogation either : in fact, many times important elements for the case will be discovered during the sessions that were either hidden or not considered relevant at this first moment. The information given is not immutable and should not be too exhaustive, as this can be exhausting and even aversive for the user.
The practitioner will listen to what the patient has to say, although they may ask for clarification of key aspects and will make sure they understand and appreciate what they are being told. The attitude of the therapist will be one of active listening , paying attention to what the patient wants to say (and also to what they do not say, which also provides a lot of information), empathy and cordiality. He or she will also try to be authentic and professional, and at all times will try to make the patient see that he or she is not going to be judged regardless of what he or she says, generating a climate of trust and acceptance.
Assessment of expectations and setting of objectives
Once the situation has been assessed, the professional will discuss with the patient the expectations and objectives that the patient has with regard to the reason for the consultation and the fact of going to a professional.
It is important to value this aspect since the initial objectives or even what is expected from the professional may be unrealistic or even not value the real overcoming of the problem but a specific difficulty that it generates. Based on all the information acquired, the general objectives that are sought with the professional relationship will be negotiated and the roles of each one will be established.
Evaluation with quantitative instruments
It is possible that in a psychology service or consultation it may be necessary to use some kind of assessment instrument to evaluate the presence of some disorder or to evaluate some phenomenon, symptom or difficulty at a quantitative level. However, even if this is the case, the information from these should be collated and assessed on the basis of the interview, not the absolute results.
An example of this would be patients who come to a neuropsychiatric service, and it is common for their abilities to be assessed in the same session. In a psychology consultation, it may also be considered necessary to evaluate the level of anxiety or assess the extent to which a personality trait is present , although in a first session it is not as usual as might be thought. Furthermore, not all professionals will use them in clinical practice or in all cases, depending on each specific situation.
Summary and orientation to the following sessions
Before the end of the session there is usually a summary of everything that has happened in the session, in order to help the patient establish a mental framework of what has been done and talked about and to assess whether the professional has understood all the information.
In addition, there may be a small preview of what you plan to do for the next session. Also, depending on the problem and the professional , some general psychoeducational guidelines may be established , in the absence of a greater depth in the subject.