“The first meeting is about forming a relationship,” says clinical social worker Sarah Downey, whose private practice is based in Hamilton, Ont. “Research shows that if change is going to happen, having a relationship is even more important than the modality the therapist uses. Just feeling heard and acknowledged can be really healing for people, so having an empathetic connection is powerful and can help you shift your perspective.”

WHAT SHOULD I EXPECT FROM THE FIRST SESSION?

“Therapy is collaborative,” explains Downey. A therapist should be looking to you to set the pace and, in the first session, explain in your own words what your issues and goals are. “Sometimes people don’t know where to start, so a counsellor should help you figure out what the priority is and gauge how much you want to talk without going too deep right away.”

WHEN WILL I FEEL BETTER?

“Change can happen after the first session,” says Downey. “The brain has an ability to rewire itself based on experience – it’s called ‘neuroplasticity’ – so if you get some active coping skills, like deep breathing or mindfulness, that can actually create change right away in the brain, which can be lasting.” Of course, more entrenched patterns – like, say, a lifelong habit of using avoidance as a strategy – will take longer to change.

I DON’T LIKE IT. SHOULD I QUIT?

“Give it more than one session if you’re worried that it’s not a good connection,” says Downey. But if you’ve worked with a counsellor for several appointments and the fit still doesn’t feel right, ask for a referral and move on. “If you feel like the problem is that you’re not making progress, have a conversation with your therapist rather than just dropping out,” she says. “The brain can be so sneaky. When you’re suffering from depression, PTSD or anxiety, your brain is not always telling you things that are objectively true.” Your brain might say, “Suck it up instead of getting help; you just shouldn’t be so weak!” But, says Downey, those are thoughts that take your strength away.

WILL I HAVE TO SEE A THERAPIST FOREVER?

“A therapist should be working themselves out of a job,” says Downey. When a client comes to her for anxiety, she might spend years working on skills like mindfulness and deep breathing as well as a host of behavioural tools used to shift someone’s perspective and help them regain control over their thoughts. “As they get stronger and more skilled, they can extend out from having an appointment once a week to every second week to once a month,” Downey adds. “They can continue to practise for longer periods before coming back to see me for some troubleshooting or a bit of a tune-up. That’s the ideal situation.”

This article originally appeared in the ELLE Guide to Therapy in the May 2020 issue of ELLE Canada. Subscribe here or buy a digital copy of the issue here.

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