106. Maximizing Your First Counseling Session with Carrie Bock, LPC-MHSP

Christian Faith and OCD, episode 106. I wanted to do a show on maximizing your first counseling session, and I’ll tell you a little story about where the idea for this episode came from. Sometimes, I have people who come in, and they feel the need to tell me absolutely everything or for me to understand the totality of the story. There’s like this pressure or urgency. And I gave this analogy to Steve. I said it’s almost like somebody comes in with a play. The play has about ten characters, but all the pages are shuffled, so they’re out of order. Somebody dumps it on the floor, and I’m trying to make sense of what’s happening in this story.

If you’re going to your first counseling session, I want you to relieve yourself of some of that pressure to get all of the information out in one 50-minute session. It’s just impossible. I mean, think about it: I’m 40 years old. I could probably write a long book on my entire life story, and to believe that I could somehow share all the pertinent pieces with someone in a 50-minute session is unrealistic.

The first session is for your counselor to get to know you, for you to get to know your counselor. Having a general big picture of what’s going on in your life, how you spend your time, if you’re working, going to school, what your family life is like. Maybe you don’t have a family and come home to snuggle with the dogs.

That’s still relevant because maybe that’s a robust support system for you to have that comfort of your animals. So, trying to get a big picture, overarching view of where are the strengths in this person’s life? What do the support systems look like? What do the relationships look like?

Sometimes, people can get bogged down in a particular story. And they were jumping around to different timelines of that story. It may be helpful if you have a lot that you need to get out; maybe jot down what you feel are the most important things. Now, depending on how your counselor does their paperwork process, I often have opportunities where people can go into more depth in my intake paperwork. Some people use that to do that, and they feel more comfortable with it. Other times, people don’t want to put much information down, and they glance over that. But sometimes, that paperwork can at least provide the frame of reference. Who are the players in this play, and what’s the general overarching theme of the space versus having to figure it out by a bunch of different stories where somebody is all over the place just verbally vomiting? I wanted to make everyone aware that you don’t have to talk about things you don’t want to talk about in the first session.

That’s important to capitalize on because counselors are naturally nosy, and we want to know certain things, so we may ask questions that are more personal or vulnerable than you want to go in your first meeting with your therapist. It’s entirely okay for you to say, “I’m not quite ready to talk about that,” or, “I know I need to go there, but I don’t feel comfortable yet. Can we address that in a future session?” Often, people go into these counseling situations not knowing what to expect but not thinking through their needs and wants. For the session, I think this doesn’t just apply to the first session but can also apply to other sessions.

Sometimes, I’ll ask people, “What do you think is the best use of our time today?” Or, “What would you like to get into or process today?” Because you have a sense of that inside. Maybe you need to bounce some ideas off someone and get feedback like, “Okay, is what I’m thinking off base? Or is it a normal experience that I’m going through?”

Sometimes, you need to vent, for lack of a better word. You need to get all of your thoughts and feelings out and run them by somebody so the person can kind of help you can summarize and give it back to you in a way where you will gain new insight on it. And so there’s certainly, definitely value on that. There may be other times where you say, “What I need today, this kind of tuning in is I need to learn some skills to manage this situation in my life or be able to manage this relationship.” And then, by diving in and asking more questions, we can get more information.

I’m always hesitant to give people advice right off the bat. Let me caveat that because it depends on the situation, but we don’t always have enough information in the first session to give you certain levels of guidance on something, and maybe that’s a really good topic. Let’s ask these questions and explore that a bit more; ultimately, you are the decision-maker in your life.

I’m not the person who will be dealing with the consequences of whatever choice is made. So, I know that can be difficult for some people because they want the counselor to go in and tell them precisely what to do. And all that does is make you dependent on somebody to get answers. You can do this with pastors, parents, and other people.

If you say, “Okay, I have this problem. What do I do? Go to that person. They give me advice. I follow it. Next time I have a problem, I go back to that.” You want to come to a place where you can think critically and make decisions independently. And sometimes, when dealing with anxiety and OCD, you don’t have the confidence or comfort to make those decisions alone.

If there’s one thing I would want you to know, it’s that your first counseling session is about building a safe and healthy relationship with your counselor so that you feel you can do the work together that you need to do. I recently took my daughter to a new pediatrician because hers left the practice.

Steve and I were able to process because he also went to the appointment that we didn’t feel 100 percent comfortable after that first visit that this will be our child’s long-term pediatrician. However, we decided to give her another try. It’s like, did we have this interaction, and it was an off-interaction?

Maybe she had a bad day. Maybe I was extra sensitive today. Whatever the situation, or was this just somebody, I got a negative feeling. I didn’t feel safe or comfortable with them, and I don’t think I will be able to handle my daughter’s whatever health concerns she has come up with.

Maybe this is not the person I want to help us walk through any of those, and that’s a hard call, I think, sometimes to make after the first session. So, say you go to the first session, and there are some things you feel good about and maybe some things you don’t feel good about. You might want to refrain from judgment until perhaps the second session.

Think about this as any other relationship that you run into. So, for example, maybe you and a co-worker get off on the wrong foot, or you and a roommate get off on the wrong foot, but then perhaps the next time you meet up and talk, things are a little different, or you see where they were going with it, or their perspective is different.

Ultimately, you want to feel a sense of safety and comfort to open up and talk about hard things. I know people who have been in counseling for several sessions and still don’t feel that sense of safety and positive connection with their counselor after a month or two. At that point, it’s okay to say this may not be a good fit.

As a therapist, I must accept that I’m not what everybody wants. I try to be as compassionate as possible. Still, I can sometimes be very direct and aggressive because I want to help people move toward their goals and improve. I’m not the right therapist for someone who wants to come in every week and complain about the same things but not be willing to do anything to change those things.

That’s not a valuable use of my time or theirs. Questions to ask yourself after the first session. Is this counselor someone that I feel safe and comfortable opening up to? Can this counselor help me with the issue I’m bringing into counseling? Hopefully, you can answer this by looking at their website or having a short conversation with them via email or phone before your first session.

Ideally, you’d want to make sure that’s an area that your counselor works with. Sometimes, though, people will have experiences of a counselor saying, “Yes, I can work with you on OCD, or Yes, I can help you with anxiety reduction.” But you may not feel comfortable with the way they’re doing that.

I started using more parts of language and inner child work a few years ago. And had a client tell me, “You know, this just isn’t working for me.” And it was good. It was helpful feedback that let us discuss what she was looking for in therapy and who might be the best person to give that to her, even if it wasn’t me.

There are some times when we can change directions in therapy. Maybe I’m trained in something different, or I see how another therapeutic technique might be beneficial, and sometimes it’s me, and sometimes it’s not, and that’s okay. Another question you might want to ask is, did I feel comfortable with the environment that I saw my therapist in?

Thinking about my therapeutic experiences, I know some environments I felt much more comfortable in than others, based on where the building was located, how the waiting room was set up, and what the counselor’s office was like. Some of those things may seem minor. But if it’s someplace you will go to repeatedly, you want to ensure you feel comfortable with some of those elements.

Otherwise, that may be a barrier to getting what you need, and you don’t want that to happen. I would encourage you to think about the timing of your first session. Would it be better for you to do that on a day off or a day that you can leave work early, especially if you don’t know how you’re going to react or respond, you don’t know what emotions are going to be stirred up for you, and that is something that can be hard to deal with especially if therapy is new for you. I remember one time I was practicing with some other therapists on different techniques, and we were doing an awareness exercise that wasn’t supposed to be particularly troublesome or triggering, but in the process of that Awareness exercise and the feedback that I received from the other therapist. I got super triggered, which shook me up for a good chunk of the day afterward. It was completely unexpected, something that came out of nowhere. Think about your timing in terms of going to therapy. Because something may trigger you or upset you, or you may become aware. That you didn’t see coming.

You want to be able to work with your therapist on coming up with a goal for yourself. And even though it may not be fully clarified in the first session, it may take a little while to tune in and realize this. You want to ask yourself, “What do you want or hope to get out of that time?”

Often, people will make generic comments like, “I want to feel better,” “I just wish not to be anxious,” or “I want to be less depressed.” And in those situations, we’re focusing so much on reducing the symptom. We’re not focused on what’s behind that, what’s beyond the symptom for you, so when you feel less depressed, can you connect better with your spouse? Does that mean you can leave the house more and attend your kid’s sporting events? Does it mean that you’ll feel more confident to present at work? What does it mean? If you can dig a little bit deeper and answer some of those things for yourself, that might help you know what’s getting in the way of you feeling better.

Even if all you can see is the symptom right now in front of you because it’s so big or so bold, trying to imagine what life is like beyond this symptom can give you and instill in you a sense of hope that even though you may, for example, struggle with anxiety later in your life, it’s not something probably that’s going to be magically cured or gone away. What would it be like if you had a different relationship with it where it didn’t hinder you from being the person you want to be or doing the things you want to do? That may be hard to imagine at the beginning of therapy, but if you can, it will help push your brain toward that more hopeful track; I can have a better experience than I’m having right now.

Another consideration would be, what are you willing to do to get what you want? So, if you’re saying that you want less anxiety, are you ready to practice relaxation strategies outside of your counseling process? Are you willing to take the time to journal about some of your triggers?

Are you willing to expose yourself to challenging situations appropriately so that you can let your mind and body know that you can do these hard things that it doesn’t believe you can do? And if you are willing to do those hard things, what kind of support might you need from your therapist or others in your life to do the hard things that will help you get to a better place with your mental health?

There may be something that your therapist says or does that isn’t necessarily wrong or unethical in some way. It’s just off-putting. So, for example, I had a therapist, I think, that was a little bit more of a behavioral bent. I saw her only for one session. The reason was that she had this timer. That went off 15 minutes before the session ended and then again 5 minutes before the session ended. It felt superfluous and unnecessary to me, and I felt a little bit like I was being treated like a child. I’m pretty sure she sees other clients who don’t have a problem with it, or they may feel like, in their situation, it’s helpful to them to keep them on track. Maybe the therapist feels that way for herself.

It helps her keep track of her session ending and wrap-up time. I think more than a personal preference of just not liking it was that I didn’t feel like I had any say or choice in the whole-timer situation. It might have been slightly different if she said, “Is it okay if we try this,” kind of like inviting me into the process?

Is it okay if we try this timer and see if you find it helpful, or do I find the valuable timer for me? Would it be okay if we tried it out? It was just kind of something that was thrown in there.

In closing, the last thing I want to say is that if you don’t find a good therapeutic fit on the first try, that’s okay. Don’t give up; get up and try again. We do the same thing with doctors we might not feel comfortable with or dentists we might not feel satisfied with. We go out and find a different provider. At that point, the worst thing we could do is say, “Oh, well, maybe therapy’s just not for me.” That’s like saying, “Well, maybe I shouldn’t get my teeth cleaned because I didn’t feel comfortable with that dentist.”

Hope for Anxiety and OCD is a production of By The Well Counseling. Our show is hosted by me, Carrie Bock, a licensed professional counselor in Tennessee. Opinions given by our guests are their own and do not necessarily reflect the views of myself or By The Well Counseling.

Until next time, may you be comforted by God’s great love for you.