First Therapy Appointment Jitters: How To Survive The “How Are You?”
/~ 5 minute read
I find for many of my clients, the first appointment brings a certain sense of dread.
This has to do with fears we all harbor around being exposed or judged, and fear of the unknown. People wonder, consciously or not, what exactly they are expected to do, or say, and just how one should “do therapy right”.
While the general concept of confessing to a stranger and asking for direction is ancient, therapy itself is a strange phenomenon, and one that many people do not have a template mode of operation for. "Am I meant to ask you how you are or not?" one client nervously asked. "Do I just start talking?" another queried.
There is certainly no right way to do any of it. Some people come in with lots to say, some with nothing. Some people want tools and techniques, some just want a safe space to talk and reflect, and others want advice, direction, or understanding. Some people prefer the light, chatty, and supportive conversation you might get from a friend, while others like to delve seriously into deep town. I have clients who are frozen in session, and may not speak at all, and I have clients who waltz in, kick off their shoes and happily engage in an hour long monologue.
All are fine. Any good psychologist will try to match you in style and meet you exactly where you are. Sure, it helps if you have a general idea of what you'd like to get from coming. But, If you really can't pinpoint it, that's fine too, we'll figure it out. The first session is usually a discussion about the things that were going on for you when you decided to make the appointment. From here, we can work out a bit of a road map of where you would prefer to be in your life, and what might help you work towards this.
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It’s also common to have the belief that needing help must mean you're either weak or crazy. Often people will say something like "I know it's not weak... for other people, but I kind of feel weak being here". This is fine, it just means you are likely a super competent person used to being the one who provides others with the answers, so being in a space of not knowing is a bit disorienting. I like to reassure my clients that I certainly don’t have all the answers, I just try to operate as a tour guide of less charted territories. Sometimes, I'll also refer people to research that suggests, far from being weak, people on the whole who experience anxiety and depression tend to be more empathic, self-aware, determined, successful, and intelligent than those who do not. At school we learn to hone our cognitive capacities, but the emotional and bodily elements of our awareness are left to run rogue. It's like expecting people to know how to drive without ever having seen a car or taken a lesson. The stronger these capacities are, the more off course they're capable of getting. Think of therapy like grad school for emotional intelligence. I've read most of all we currently understand about how the mind works, and trust me, it helps a lot to know. I also like to note that the fact this is a concern is a very strong sign you do not need therapy. You obviously know how to get through things. Instead, it's most likely you are just one of those brave enough to dare go in search of even more peace in your life. Truth be told, pretty much everyone would likely benefit from talking to a psychologist every now and then. Psychologists included.
Another common fear is of the therapist themselves. The psychologist can seem like someone with magical mind-reading powers.
People often suspect they become transparent in my presence, becoming uncomfortable should their deepest darkest secrets be revealed. The thought can occur that if the therapist doesn’t like me, or sees me in a certain way, then that must mean that is exactly who I am. "Perhaps all my greatest concerns and deepest fears about who I am are true and there is something very very wrong with me".
To this fear, I would comment that it is important to remember that psychologists are just people in a job. Like any occupation, some people are good at their role and others less so. Similarly, what one person looks for in a hairdresser, for example, might be quite different to what another person looks for. That is, someone might prefer dynamic creativity and amusing chit chat in their stylist, while another values someone offering technical precision, a consistent cut, and the space and quiet time to relax. Same goes with psychologists, if you don't vibe with me, try someone else out. It's probably me, not you.
You also don't need to believe, or listen to, anything I say. If I tried to convince you that Collingwood, for example, was the best football team in the league, and that I was concerned about your lack of support for this great side, you'd either agree - because you already barracked for Collingwood - or you'd completely disregard my opinion. You wouldn't go home and have an existential crisis about whether to throw all your Richmond scarves in the Salvation Army bin. Therapeutic insights, diagnoses, and recommendations are the same thing, they really are all subjective. Unfortunately, the truth is that psychology is a discipline very much in its infancy, and while there is a bit more evidence for the effectiveness of some approaches than others, there is not yet anything close to a consensus about the best way to understand or treat people. So if my utterings are helpful and feel good, great; if they don't sit well with you on any level, then walk out. You should leave feeling calm and acknowledged, not frazzled and judged. Your psychologist should feel natural. Psychologists that come across as either too analytical and prescriptive, or too agreeable and pitying, should be approached with caution.
A similar fear is that of being controlled. One of my clients revealed that while she knew it was silly, she had a fear that I might somehow implant an idea in her head, or take away her free will. This fear makes sense to me, and I may have had a similar concern, had I not actually become a psychologist and discovered first hand that there was no lecture at university on mind control. There's no way I could implant an idea into someone's head, or direct them to do something they didn't want to; no matter how cool of a party trick it would make. It would certainly be a heck of a lot easier to help people feel good about themselves if magical trickery was an option. On the contrary, most people can sniff out any approximation towards advice giving or persuasion a mile away, and promptly pull me up on it - which I very much appreciate.
Related to this point, clients commonly reveal they are afraid they'll end up crying. These are usually people who have been very strong, holding it together for a very long time. A new client, Joan*, came to me recently for support with a separation after 20 years in an abusive marriage. She described how her husband is making it impossible for her to move on, and is threatening to end his life if she doesn't return. She has been working two jobs and supporting her three children throughout the process, almost without missing a beat. While telling her story, tears welled up in Joan's eyes. "You must think I'm so silly for crying", she said. Even though I hear a version of this comment nearly every day, it never ceases to startle me. Because this is usually the opposite of my experience: I'm sitting there in absolute awe at this strong and loving person, so grateful for the opportunity to hear their inspiring story. I have worked with some prickly people, including many corrections clients, who have done some very prickly things, and I am still waiting to see if there is a person who, after getting to know them, I don't come to really like on a whole, and develop a deep respect for their struggle.
It's a common misconception that emotions run on an exponential curve. People can fear that if they open the door to their emotions, they'll get flooded by them, and be unable to ever pull themselves out. But really, the opposite tends to be true. Emotions need to be felt, they rise, and then they bring an energetic release and subside, just like a wave. Our tears are a valuable biological mechanism - like sweating - and analysis of the chemical composition of tears has revealed that tears contain stress hormones, such as cortisone and adrenaline, which the body needs to purge so as to return your nervous system to homeostasis following exposure to stressors. I told Joan that I could count on one hand the number of people I've seen who haven't shed a tear, and that it would be strange if she wasn't emotional with everything that's going on. Once people give themselves permission to cry, any associated embarrassment, and often the urge to do so itself, tend to dissipate.
Another genuine concern is about what might be lurking beneath the surface. Maybe ignorance is bliss right? People can fear the therapist will push them to dredge up old stuff: stuff that they would really rather not disturb.
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This fear makes complete sense. Most of us are taught things that make us feel afraid are best avoided at all costs. We become pretty good at distracting ourselves from uncomfortable thoughts, memories, or feelings, with work, the internet, relationships, food or alcohol, or any other of the other countless options offered by modern society. People most commonly come to therapy when their life stops going the way they want it to: work is becoming a drag, alcohol use is a problem, or relationships are falling apart. It makes sense that from here, they want fixes for these issues: a set of instructions, steps that if performed as requested, will force life to stop being so disagreeable. This is definitely a big part of what therapy does. Tips for managing anger, stress, or urges, for increasing self-esteem, or for communicating with your partner, are helpful, and are the first step in most good therapeutic approaches.
In full disclosure, however, some dredging may take place. Sometimes as people discuss their concerns, they discover that it is a bit of a pattern for them. You know your concern is the result of subconscious pattern when it is something you believe you understand, yet are powerless to stop. You might find yourself thinking "I hate when I do this, and can't understand why I keep doing it". In these situations, tips and strategies alone are unlikely to result in lasting change. When this is the case, I will check in to see if you are comfortable having a bit more of a think about the ways in which this pattern is able to take hold in your life. This usually involves reflecting on how you relate to your own thoughts and emotions, and may or may not involve talking about the past. While this process of therapy can be a bit raw at times, it doesn't tend to feel heavy or depressing, and always goes only as deep as you want it to, and at a pace that the psychologist knows is safe and comfortable. I like to liken the process to a video game, there are things that might pop out at you, but it's kind of exhilarating. Like pacman, when we turn towards, rather than away from the parts of our self we are afraid of, we can gobble them up and get the cherry.
Another reason many people get anxious when approaching a psychology appointment, is that they're confused and unsure as to how to present their concerns, story, or thoughts to another person in a coherent way. It's not a common social experience to sit down and attempt to tell your life story; private woes, secret hopes, and all; in an hour; to someone you've never met. Our minds are actually pretty chaotic places when you really stop to listen to the chatter. For example, Paul*, an architect, had recently been struggling to get himself off to work. When I asked what was going on in his mind on mornings he was lying in bed, he answered "I don't know, I just feel anxious". I then offered Paul what I know to be a "normal" sort of inner dialogue, and wondered whether he could relate in any way:
“I’m too tired and anxious to go to work this morning… I need to go or else my boss will be pissed and I’ll disappoint my colleagues… but it’s not fair, I always do everything just to please other people, no-one even appreciates how hard I work… I'd feel better If i could go... what’s wrong with me, I should be able to go to work… I have an overdue mortgage repayment and credit card to pay off… why do I always spend more money than I have… I am so messed up!... I feel terrible, I couldn't face anyone... I definitely can’t go to work today”.
Paul agreed, and we concluded that this mental cycle happens so quickly for most people, that they are often not aware of all - or any - of the components, and just notice the overarching sense of anxiety.
A large part of what I do in therapy involves helping people to become aware of the various thoughts, feelings, bodily sensation, and behavioral urges that they have at any given moment in time, and developing the ability to watch them unfold. By paying attention to yourself in this way, you're able to bust what some psychologists have called the myth of the monolithic personality. Instead, when we begin to look inwards, we start to notice that in fact, we all have a set of different brain-body neural connections that fire together, and produce what psychologist Richard Schwartz calls “parts”. Most of us regularly speak about having work mode, or holiday mode, and describe our experience in part language. For example, you might casually tell a friend that “part of me wants to go to the movies with you, but another part of me just wants to stay home tonight”. However, most of us relate to ourselves as though we should have a consistent set of beliefs and desires. When we notice these parts of us contradicting each other in more important areas of our life, we become overwhelmed, and assume something must be wrong with us.
One of the primary therapeutic approaches I use with people is called Internal Family Systems (IFS) therapy, and I use it because it offers fantastic tools for helping to relax parts of ourselves that may be in extreme roles, and integrate those which are in conflict with other parts, causing polarization. So if you find yourself in therapy, you can comfortably say to me, “Well, part of me wants to learn more about my fear of intimacy, but part of me thinks you look scary and wants to beeline for the door”. Usually, when this happens, we can have a bit of a laugh and I'll ask if there is anything I could do that would make you more comfortable. I love hearing client's responses to this, and enjoy the clients who come in with their various rituals. Some like to put their feet up on the ottoman, others want the lights turned down, or heater turned up. Some want to ask me a few questions about who I am, and what I have been up to, and others just like a bit of time to acclimatize before talking too much at all. I've had clients lay down rules like "I want you to call me out on my bullshit", and "don't give me any of that textbook crap", which I am always grateful for. Then, we will spend as long as it takes discussing each and every one of your concerns or hesitations about being here, until you either get comfortable enough to reveal the things that really bother you, or you get bored.
That’s the great thing about (good) therapy: all parts - thoughts, feelings, and urges - are welcome. That's not to say there aren't limits and structure, but whatever presents itself in your awareness will be witnessed, explored, and appreciated as the valuable barer of information that it is.
So, maybe you will decide to take yourself off to therapy, or maybe you would prefer to work on things yourself. Either way, any anxiety can be armed with the ability to speak for parts. Whether it's the psychologist or the checkout guy at the supermarket who asks “…and how are you today?”, instead of a small meltdown when considering which part to answer from, you can find comfort in the fact that any answer you choose doesn’t have to represent the totality of who you are, or capture every element of your experience; you are simply speaking for the most present part in the moment. If more people in everyday life became comfortable talking for parts, I think the world would naturally begin to make a lot more sense to everyone. But if you're considering making an appointment to talk to a psychologist, do your research, choose someone you like the sound of, take them for a test drive to see if it feels like a good match, and most importantly... enjoy the ride.
* Names and some details have been changed to protect confidentiality.
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