Counselling: What Actually Happens When You Begin?
What usually happens in a first counselling session?
Each session is always different, and a good therapist will respond on a case by case basis, as they will have a deep appreciation for the singularity of each person, so there is no script for a session.
In a first session, the therapist will usually encourage you to speak about what has brought you there.
Typically the therapist will ask some questions about your current situation, personal history & experiencers, previous therapy, and what you are hoping for from the work.
They may also explain the basic framework for therapy, including the principal of speaking as freely as you possibly can, session times, fees, and how ongoing communication can take place.
What happens after the first session?
After the first session, you may decide to continue with the therapist. You may take some time to think. You may feel relief, uncertainty, sadness, or a sense that more has been opened than expected.
There is no correct reaction.
Some people leave a first session feeling lighter because they have finally spoken. Others feel unsettled because they have touched something they usually keep away from. Some are unsure what they feel. Therapy does not always announce itself as progress in a simple or immediate way.
If you continue, the work develops through regular sessions. The therapist begins to hear more of your history, your repetitions, your way of relating, your fears, your desires, and the particular words through which your life has been organised.
More importantly though, over time you begin to hear these events in a different way, and start to relate to them differently.
What if I feel nervous before the first session?
Feeling nervous or anxious before a first counselling session is common.
For some people, speaking to a therapist feels exposing. They may worry they will be judged, misunderstood, or told that their problem is too small. Others worry that once they begin speaking, they will become overwhelmed. Some people fear silence. Others fear what might come out if they stop managing everything so tightly.
These anxieties are almost always part of the work too. Being able to continue the relationship, and the work, despite our anxieties creates a foundation to move beyond them.
A first session does not require you to say everything. It is not a confession. It is not a test of how articulate, self-aware, or emotionally fluent you are. You can begin with what is easiest to say. You can also begin with what feels most difficult.
Sometimes the most important sentence in a session is very simple, and represents an opening.
“I’ve never said this before.”
or:
“I don’t know why this upsets me so much.”
Counselling, therapy and psychotherapy: why do the words overlap?
People search for many different words when they are looking for help. ‘Counselling,’ ‘therapy,’ ‘psychotherapy,’ ‘talk therapy,’ a ‘psychologist.’
These words often overlap in ordinary use. A person searching for counselling may be looking for the same thing as someone searching for therapy or psychotherapy. They most often are not trying to make a technical distinction. They may simply be trying to find a professional place to work through their issues.
There can be differences in training, approach, depth, and how different practitioners use these terms. Counselling is sometimes associated with support around a specific issue or life event. Psychotherapy is often associated with deeper or longer-term work around recurring patterns, symptoms, relationships, and the person’s history.
Nevertheless, a good psychotherapist should be able to guide you through the work at a pace and level that is appropriate to the moment.
What brings people to counselling?
There is no single reason people come to counselling or therapy.
Some come because of anxiety, depression, grief, panic, eating difficulties, relationship problems, family strain, stress at work, or a recent crisis. Others come because of something more difficult to name. A recurring feeling. A pattern in relationships. A sense of being trapped in the same position again and again. A life that looks functional from the outside but feels strangely uninhabitable from within.
In therapy, people often quickly learn that the stated reason for coming is important, but rarely the whole story.
Someone may come because they are anxious at work, and over time begin to hear how that anxiety is tied to a much older question about being seen, judged, or found wanting. Someone may come after a breakup and begin to notice that the same kind of suffering has appeared in different relationships. Someone may come because they cannot sleep, and slowly discover that night has become the place where unspoken things return.
The first reason was not false. It was the place where the person could begin.
Clinical Reading:
- The Instance of the Letter in the Unconscious, in Écrits. – Lacan [1]
Counselling
Eating Disorders & Body Dysmorphia