Mental health is a complicated, intimidating state to navigate. That was true before the novel coronavirus pandemic, and it’s true now. The difference between the past and present is that Covid-19 has both exacerbated pre-existing issues and introduced new stresses. In turn, surveys taken over the summer indicate mental health has worsened during the pandemic.
The silver lining, however, is that some people are taking a difficult but beneficial approach to their mental health: They are seeking therapy, and they are seeking therapy in larger numbers than before. A YouGov poll from this month indicates that 23 percent of 18 to 24-year-olds in the United States have said they’ve sought counseling during the pandemic, an increase from 13 percent of the same population in April. Meanwhile, some therapists report that switching to teletherapy during the pandemic has increased client attendance and their willingness to open up.
Of the many roadblocks to therapy, including affording it and finding the right therapist, there are the emotional nerves surrounding actually going to your first appointment. To demystify the process, I interviewed four therapists: Monica Lyn Thompson, PsyD, LPC; Jennie Marie Battistin, LMFT; Jaime Castillo, LCSW, and Alyssa Mancao, LCSW.
Entering the space — If you’re going into a therapist's office, Thompson recommends getting there at least 10 minutes early to complete any paperwork you haven’t already completed online. This paperwork is likely to cover areas including, but not limited to, your medical and/or mental health history, your insurance and billing information, and your primary concerns. You’ll also be asked to give informed consent — an ethical and legal requirement that covers clients’ rights and counseling policies.
After you finish filling everything out, she recommends that you “take a few deep breaths and remember your presence here is about taking better care of yourself.”
What therapy offices look like can differ, but they are often designed with the aim of putting people at ease.
“We have a couch for clients, and the therapist usually sits in a cozy accent chair,” Battistin explains. “I like to say ‘it is like going to your best friend’s house for a cup of coffee or tea, but you get to do all the talking and decide on the topic; it is your space every week to just talk about what is on your mind.”
The first appointment: What do you talk about?
“The first thing I do with new clients is verify their name and pronouns, and I introduced myself and let them know I’m glad they made it, because I know it’s tough to take this kind of step toward healing and making change,” Thompson says.
After introductions, she goes over confidentiality: making sure that clients know everything they discuss will be confidential unless the client is threatening to do harm to themself or someone else. She explains that every therapist will have their own way of discussing confidentiality, “but it is something every client should hear from their therapist in an initial appointment.”
Castillo lets clients know in the first session that she’ll be asking them questions about general areas of their life, like their work status and family dynamics — factors that could be contributing to their current challenges. She emphasizes to her clients that they are free to answer the questions at their own comfort level, and she keeps her questions more at a surface level. Castillo also asks new clients if they have gone to therapy before, how familiar they are with the process, and if they have any questions for her.
“The first session is introductory in that it starts with some small talk and getting to know one another,” Castillo says. “Typically, there’s an ease and a flow, where I can get some good clinical information while allowing it to still feel conversational.”
Still, conversation can vary depending on your therapist, and Mancao notes it is important to ask your new therapist how they facilitate their first session at the start of your meeting. Typically, Mancao’s first sessions involve goal-setting — going over what the client wants to work on or accomplish while in therapy.
These goals, however, do not need to be well-defined, notes Battistin. She explains that the first session is also your opportunity to see if you “gel” with your therapist.
“Ideally, you want to walk away feeling like I can trust this person to discuss my most significant worries, ugly thoughts, or challenging life experiences,” Battistin says. “When it is the right ‘fit,’ you will probably walk away saying ‘wow, I told them more about myself that I thought I would.’”
How are first appointments during Covid-19 different?
Details may change depending on if you are going in person or using teletherapy, but generally, the experience is very similar.
“Overall, the relationship between the therapist and client remains the same whether in person or virtual, and there is definitely a factor of convenience for both therapist and client when it comes to not having to commute to an office,” Mancao says.
Still, factors like technical difficulties and the inability to read body language are some challenges to navigate. She notes that what has remained the same through virtual therapy is the ability to be effective and have productive sessions, but it is necessary to talk over with a client that they have privacy, feel safe while communicating, and have access to stable wifi.
Castillo notes that some of her clients (and herself) initially felt resistant to teletherapy but have found that it can “feel even safer to open up and share personal things because of the safety of being in your own space.” She does some teletherapy — other clients still have a strong preference for in-person sessions because they may not have a private space at home where no one will overhear them.
Battistin has seen clients in the office since April, wearing a face shield and mask, along with the utilization of a UV sanitizer system, sanitizing spray for furniture, disinfecting wipes, and hand sanitizer. Her office is in California, and they offer both video and in-person, depending on the client’s comfort level.
Advice for people nervous to make their first appointment
“It’s totally normal to feel intimidated by the first meeting,” Castillo says. “We aren’t programmed to share the most intimate details of our lives with a complete stranger and therapists understand that.”
She emphasizes that you don’t have to divulge everything in your first session, and you don’t have to trust your therapist right off the bat. Most therapists also offer free 10-minute phone consultations before the first appointment — something she highly recommends taking advantage of. Sometimes it takes shopping around to find the right fit, and it’s worth the effort, Castillo says.
Mancao endorses the idea of scheduling an initial consultation and recommends talking to friends who are in therapy about their experience. “It’s normal to feel intimidated by going to therapy and it’s normal to feel nervous,” she says.
All you need to bring to therapy, Battistin says, “is a willingness to be open and honest.” “An experienced therapist will guide you through the process. It can be such a relief to have a safe space to talk to someone who doesn’t have a bias or a stake in your personal life like your friends and family.”
This has been Sunday Scaries.