At a glance
You do not need to arrive with your difficulty already explained. Preparing for a first session is less about organising your history than about noticing what you most want heard. This article helps you walk in able to begin.
Clinical insights from 22 years in psychotherapy
I’m Mark Colclough, MA, psychotherapist in Copenhagen. Qualified at the Psychosynthesis Education Trust and the University of East London. 22 years of full-time, face-to-face clinical practice.
- The rehearsed opening. Clients often arrive with a prepared account, and what actually matters tends to surface once they stop delivering it.
- The detail they nearly left out. What clients call the trivial thing is frequently where the feeling is still live.
- What they hope for shapes the hour. Clients who come wanting something particular use the time differently from clients who come to be assessed.
Clinical notes: My observations are anonymised and compounded from my session notes since 2004.
What am I supposed to say first?
There is no correct opening, and the one you have prepared is usually not the one you need.
By the time you book, you have probably told the story several times. To a partner, to a friend, perhaps to yourself at three in the morning. It has acquired a shape: a beginning, a reason, a verdict. That shape is useful. It is what got you as far as booking. It is also, often, the version that leaves out the part you find hardest to say.
So start with the prepared account if it helps you sit down. I will listen to it. What I am listening for underneath it is the sentence you break off halfway through, or the thing you add while you are putting your coat on. You do not have to find that sentence in advance. You only have to leave room for it.
Should I write things down before I come?
Writing helps when it holds the thing you are afraid you will lose, and gets in the way when it becomes a script.
- Worth writing. The three or four things you would be sorry to leave without having said.
- Worth writing. Facts you know you will mangle under pressure: when it started, what changed around then, who else is involved.
- Leave out. A chronological history. The history will come, and it tends to arrive in a more useful order than the one you would have planned.
- Leave out. Your own account of what is wrong with you. Bring the observation rather than the conclusion.
If you do bring a page, say so at the start. A list held in your lap that you are quietly fighting to get through will take the hour away from you, and I would rather know it is there.
What if I cannot say what the problem is?
Not knowing is a workable starting point, and it is more common than the booking form makes it look.
People often arrive able to describe the weather of their life but not the reason for it. Something is flat, or tight, or too loud in the evenings, and every obvious explanation has been tried and found insufficient. You can come with that and no theory. Where the explanation is missing, the first sessions are for looking rather than for confirming.
Two things are usually true at the same time here. You want someone to tell you what this is, and you are wary of being told, because a name for it arrives with a future attached. Both of those are reasonable. I will not hand you a verdict in the first hour, and I will not leave you with nothing either.
Does what I hope for change what I get?
What you expect of the work appears to make a real difference to how it goes.
Across 6 trials holding 491 participants in all, people who rated their treatment as more credible and expected more from it tended to improve more by the end of it, and that link was no different whether the therapy was delivered at a distance or face to face.1 The trials pooled different difficulties and different measures, and the distance arms were guided written programmes rather than live sessions, so this is a direction of travel rather than a rule about any one person.
I read it as a reason to take your own hopes seriously, not as an instruction to manufacture optimism. If you arrive expecting very little, that is worth saying out loud in the first hour. Low expectation is usually protective. Something has disappointed you before, or you have been talked at by someone who was sure, and you would rather not be caught hoping. Said plainly, it becomes part of the work instead of a quiet drag on it.
What helps on the day, and when does preparing get in the way?
Arrive with enough margin that the session is not the thing you are late for.
- Leave the hour before loose. Coming straight out of a meeting means spending the first 10 minutes arriving.
- Decide nothing on the way in. You do not have to have chosen the topic, or settled whether you are staying in the relationship, or worked out what you want from me.
- Notice what you are hoping I will not ask about. That is usually worth naming early, even if you follow it immediately by saying you do not want to go into it yet.
- Give yourself somewhere to go afterwards. Some people leave lighter and some leave stirred up. It is easier when the next hour is yours.
Preparing stops helping at the point where it turns into managing me. If you find yourself building a version of the difficulty that will make you easy to work with, or editing out the part that does not reflect well on you, that effort is itself the most useful thing you could bring in. It is rarely only about me. It is usually how you have learned to be with people whose opinion matters.
Preparation is also the wrong tool for some of this. If the waiting is the hard part, a free 30-minute call before the first session is often enough to make the gap bearable, and it settles whether this is the right form of help before you commit to the work. And if you are coming because of something happening between you and a partner, the preparation that matters is deciding whether you want to be seen alone or together, which is a different question from what to say.
Questions people ask
Do I need to know what is wrong before I start?
No, and arriving without an explanation is a normal way to start. Bring what you have noticed, including the parts that do not fit together.
What if I cannot speak once I am there?
Then the silence becomes the thing I pay attention to, and the session is not wasted. Being unable to speak in a first session is common, and I will not leave you to fill it alone.
Can I bring notes into the session?
Yes, and it helps to put them on the table rather than keeping them hidden in your lap. Notes work best as a safety net for what you would hate to forget.
What if I want to work on something else by the time I arrive?
Say so, because what has become urgent since you booked is usually the better place to start. Nothing you wrote on the form commits you to it.
Can I ask questions before I book?
Yes, and a free 30-minute call exists for exactly that. Asking how I work, and whether I have worked with difficulties like yours, is a sensible part of choosing.
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Sources
How this article was written: I choose the subject and the angle. An AI assistant researches and drafts. I read the draft, correct and improve it and stand behind every clinical statement. The professional and clinical judgement is mine.
