First counselling session - What to expect

What to expect from your first counselling session

Counselling (and psychotherapy) is a process of healing; a place where one can uncover various layers of a problem in the presence of a non-judgmental and qualified professional. Contrary to stereotype, counselling is not the same as getting advice (though most often people do find solutions to their problems when in counselling). It helps people to gain clarity about their issues and to identify potential solutions for the same.

There is a lot of ambiguity and apprehension among people when going for a counselling session for the first time. The main reason for this is lack of adequate information from reliable sources about the topic. To put your mind to rest, here is a quick guide about what to expect from your first counselling session.

In the initial session, a counsellor will typically will divide her time between the following activities:

a) Explaining how counselling works and setting ground rules

b) Understanding the client’s area of concern and background information

c) Agreeing on a set of goals

Even though part (b) takes up most of the session time, (a) and (c) are equally important, and should not be overlooked. They shape the relationship between the counsellor and client, and decide the future course of action. 

A counselling session lasts for 50-60 minutes (there might be instances when the duration would be longer, e.g. during a couples counselling session). During the initial 10-15 minutes, the counsellor will work towards making you comfortable and form a good rapport with you. She will give you a brief explanation of how counselling works or her own working style. You can use this time to ask any questions you might have about their qualifications or experience. You have every right to make an informed choice about your counsellor, so don't hesitate to ask. A counsellor is ethically bound to address any doubts you might be facing about the counselling process. 

This is also the time when the ground-rules or “contract” is discussed. This includes an assurance of confidentiality. It can also include agreeing upon the duration and frequency of sessions, session fees, terms for cancellation or rescheduling and other logistics. Some counsellors ask their clients to fill out basic information forms before the first session, while others prefer to take down this information during the first meeting. This includes information such as your age, marital status, and contact details. Depending on your area of concern, the counsellor may ask you to fill out some forms or assessments. 

Once the paperwork is out of the way, you will be asked to share the reason or concern that brings you to counselling. During this phase, your counsellor will encourage you to share your problem without inhibition. Sometimes you may not have the words to express a particular feeling or experience. Your counsellor will help you articulate these difficult emotions. She might ask you some questions to gain clarity about your situation, but will always maintain a warm, non-judgmental attitude. You have the choice of refusing to answer any questions if you feel uncomfortable doing so. 

Understanding your concern may require the counsellor to gain some information about your family, past relationships and significant life events. It may also involve sharing information about areas of your life that you have never talked about with anyone. Be mindful of the feelings that come up during the conversation. If you start to feel too uncomfortable or overwhelmed, share this with your counsellor. Remember, openness and honesty is essential for counselling to succeed. So make sure that you bring up any difficulty you might be facing in talking about various things. Avoiding or ignoring these will hamper your progress in counselling. 

When one begins to talk about emotional issues, it is quite easy to lose track of time. However, a counsellor needs to maintain time boundaries and will ideally remind you 10 minutes before the session time ends. This is essential for ensuring that the session does not end abruptly. It also leaves the counsellor with some time for summarising all that you have shared with her, and ensuring that you have been understood. 

Towards the end of the first session, your counsellor will summarise the key issues you are facing at the moment and arrive at a mutually agreed set of goals which you will work towards during the counselling process. These goals will be based on your narrative, and are not rigid or fixed. You and your counsellor can revise them at any point during counselling. 

Before the session ends, both of you would have ideally agreed on an appointment for the next session. Depending on your concern and their style of practice, the counsellor may suggest some tasks for you to undertake in the interim period till you meet again. 

Most people expect to leave the counsellor’s office with a sense of relief or accomplishment, however this is less common than believed. Don’t beat yourself up if you feel uneasy or stirred up. Counselling, like any change, needs time. Feeling unsettled and disturbed are natural responses to bringing up uncomfortable aspects of your life. This is also a sign that you are moving towards change and betterment. It is in your best interest to not get too overwhelmed by the negative feelings and discuss the discomfort with your counsellor in your next session with her. 

Impact of client & counsellor culture on the therapeutic process

I have had the privilege of getting my counselling training in a country whose culture is very different from the one I grew up with. It was only when I interacted with people from diverse cultures and backgrounds that I realised the impact culture has on everything we do and think. As long as you are confined to people and places belonging to your ‘home culture’, you tend to assume cultural norms as facts. For example, putting the family or community before oneself is an integral part of a collectivist culture like India. However, assuming that this is the right thing to do for all people is an error. Similarly, a commonly held belief in predominantly white western cultures is that talking about one’s feelings makes one feel better. This again, is a cultural norm and not a universal truth, some cultures place greater value on being able to keep one’s feelings to oneself.

A counsellor needs to be sensitive to minute cultural details such as these. Recent research has focused on the need for cultural competencies as one of the core skills required in counsellors. This does not imply that a counsellor should know everything about every culture, but means that she should not base her interventions and practice on assumptions. As a practitioner of person-centred approach to counselling, I believe that the client is the expert on her life and I try not to make any assumptions about her on the basis of culture, gender or any other group that they belong to. This encourages me to be inquisitive about their life situation and ask clarifying questions whenever needed.

Social psychology research indicates that people generally prefer to associate with persons who they perceive to be similar. This similarity could be on the basis of appearance, worldview or affiliation to a group or culture. The obvious implication of these findings to the field of counselling is that clients would tend to prefer therapists who are from the same ethnicity as them. However, a meta-analysis by Cabral & Smith (2011) reports that despite client preference for counsellors from same background, ethnic matching does not improve therapeutic outcomes.

Reflecting on my prior experience with clients from diverse backgrounds, I think that positive change in a person depends a lot on the therapeutic relationship that develops between the client and the counsellor, and not on how similar they are. Considering the social psychology findings I mentioned earlier, it is natural for clients to want to work with counsellors from similar ethnicity. However, the presumption of similarity on the basis of cultural affiliations can lead to disappointment. For example, despite sharing the same nationality or ethnicity, the counsellor may be very different from the client, and vice versa.

A benefit of working therapeutically with a counsellor from a different country or community is that the counsellor can maintain an open stance of ‘not knowing’, thereby giving the client complete authority to narrate their situation with minimum risk for bias. Differences can promote insight – your counsellor may be able to suggest to you things you overlooked because of your conditioned beliefs. The most important thing is that a counsellor treats you with respect, and does not make stereotypical assumptions about you.

Seeking help..a sign of weakness or a mark of strength?

Many of my counselling clients, apart from the issues they are struggling with, have an additional difficulty: they beat themselves up for 'needing' counselling. A lot of people grapple with the guilt of not being able to 'snap out of it'. Maybe you are familiar with the feeling that you are the only one who can't deal with this problem; maybe at some point you have had the nagging thought, that you are making it worse by overthinking it. This could be worsened by the fact that there is no evident cause for how you are feeling, or that someone else in a similar situation reacted differently, or the people around you don't quite understand what's going on or how to help you.

I want to clarify this to all the people contemplating seeing a counsellor, and those who are thinking of dropping out of counselling - the fact that you decided to seek help is a mark of great strength. I am not just saying this to encourage you, I really and truly believe it. For any sort of positive change to occur, the basic pre-requisite is accepting that something needs to change or is not going as well as it could.

A lot of people live in denial that there is an issue to be addressed because it is too painful to admit otherwise. Probably you have denied this in the past too (or are still doing it). And you know that the discomfort that you feel while revealing your innermost fears sometimes feels much worse than pretending that everything is ok. Where is this feeling stemming from? Seeking help is a sign that you are accepting that something beyond your capacity is bothering you. It requires you to feel vulnerable. And that definitely is not easy.

When I say that seeking counselling or any sort of professional help is a strong positive in your favour, I mean that it is a first major hurdle crossed. It may not be an easy progress, and it may be something that takes up more time than you first imagined, but I assure you that if you persevere, you will come through it stronger and more fulfilled.

All the best!