first therapy session, goals and the contract - an interview with Dr. Hayden Finch


This is the second time I am asking Dr. Hayden Finch for answering some of your questions. This time it is about the first therapy session, goals and the contract with your therapist. Of course, I will share with you my experience but I decided it would be great to start from something not so subjective to give you professional feedback. Dr. Hayden Finch is an experienced psychologist who supports a lot of people on their inner journeys. Take under your consideration the things she shares are based on therapeutic experience in the United States. If you live somewhere else, some things can be different.

Unfortunately, there is the entire ocean between us, so we communicate via emails and you will not listen to the nice voice of Hayden on the record. If you prefer listening than reading, I will tell you every word Hayden shared with us there!

How the first session with a therapist look like?

Hayden: Each therapist conducts their first sessions a little bit differently, and the first session is usually very different from subsequent appointments.  Usually, at the first appointment, you’ll start out by completing paperwork that’s pretty typical at any type of healthcare appointment. Then, the therapist will talk to you about confidentiality and basic office policies.  After that, they will usually ask you to talk about your primary concerns, like what you’re struggling with that brought you in for an appointment.

Usually, most of the first session is spent discussing what’s bothering you, your thoughts about it, and how it’s developed over time.  Often, the therapist will also ask you a few general questions about your family history, medical history, medications, education, work, etc. so they can better understand you as a whole and start to put some of the pieces together in terms of what you’re dealing with and what the best treatment approaches would be.  

The appointment typically ends with time to ask the therapist any questions you have.  Sometimes in that first appointment and sometimes in the next appointment, you and your therapist will set goals for therapy, talk about treatment options, and decide on a plan for reaching your goals.  

What kind of goals we can have during therapy?

Hayden: Your therapy goals will be unique to you.  Practically anything you’re struggling with emotionally, behaviorally, or cognitively can be a goal for therapy.  Most often, people set goals in therapy to change something — face a fear, replace an unhealthy habit, improve their relationships (with themselves or with others), etc.  

People also use therapy to get feedback about whether they even have a problem that needs to be changed.  

Sometimes people come to therapy because someone else has encouraged them but they aren’t really sure they have a problem; you can set a goal in therapy to explore whether there really is a problem that would be helpful to solve.  

One of my personal favorite therapy goals is to learn new skills.  This includes more effective coping skills and healthier ways to think about and approach life.  Mental health conditions sometimes distort the way we think about and experience the world, so therapy can be a great place to undo that distortion.  

What is a contract with a therapist?  What can we expect there? Can we have an influence on what it looks like?

Hayden: A therapist will probably have you sign multiple contracts. If you’re using health insurance to cover the cost of therapy, you’ll sign a contract that says it’s okay for the therapist to ask your insurance company for money on your behalf and that you agree to pay anything your insurance company doesn’t pay.  You’ll also sign a contract that says you understand that your information will be kept private, that you understand the risks and benefits of therapy, and that you understand the cost of the services. Those contracts are very similar in every therapist’s office and everyone works with signs the same contracts. If you have questions about anything on the contracts, be sure to ask.  

Therapists will also develop a contract that goes over what your specific therapy relationship will look like… what your goals are, how often you’ll meet, what types of homework assignments you’ll have, etc.  Most often, this isn’t written down on a contract you’ll actually sign; instead, it’s more of a verbal agreement that can change over time. But some therapists will actually have you sign a written contract about what you’ll do in therapy.  

Regardless of whether it’s a verbal or written agreement, you should expect this type of contract to be developed collaboratively with your therapist.  If there is anything on the contract you do not agree with, don’t sign it. If the therapist is unwilling or unable to change details you don’t like, discuss the implications of that and then decide if this is the right therapist for you.  For example, if the therapist encourages you to do weekly therapy homework but you’re not a fan, discuss why the therapist thinks homework is so important and then decide if you’re on board with that approach or not.

More information

If you look for more information about therapy, recovery, personal development look at the blog haydenfinch.com and find Hayden on Youtube, Instagram, and Twitter!  Hayden, thank you very much for sharing your knowledge with us <3!

Check other interviews with Dr. Hayden Finch: 
How to choose a therapist? 
How could I know that I have a good therapist?

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