What happens in a first session with a psychologist?

A review of what happens during the first psychotherapy session, useful to know what to expect.

Nowadays and with increasing frequency, a considerable proportion of the population has or will at some time seek the services of a psychologist. Although in the past it was frowned upon and many people were ashamed or were singled out for it, this stigma has been considerably reduced over the years, leading more and more people to seek this type of service in case of need.

Despite this, it is still a type of service that is seen as something strange and to which most people have some reluctance, not knowing exactly how it works or what is going to be done. One of the moments that generate more uncertainty is the first contact with the professional, often not knowing exactly what is going to be done or what to expect to happen. What do you do in a first session with a psychologist? It is this topic that we are going to talk about in this article.

What is done in the first session of psychotherapy

The first thing that we have to bear in mind is that the first session is, with the possible exception of a first telephone contact or by Internet, the first contact between therapist and patient.

This means that at this moment we still know nothing about each other, beyond having read the center's website or opinions about the professional, and especially in the case of the therapist, who will not have any knowledge about his or her patient.

In general, we have to keep in mind that the general objectives of the first session will be to make contact, to get to know the case in question and to generate a good therapeutic relationship..

This last aspect is essential, since deep aspects of the psyche are usually going to be treated. Without an adequate level of trust between professional and patient, the user will not be able to express fears, doubts, emotions and thoughts, resulting in an unproductive relationship and hindering the success of the therapy.

However, the positive rapport or good therapeutic relationship will be built not only during this session (in which it is common to be somewhat self-conscious) but throughout different sessions.

First contact with the patient

The first thing will be to welcome the patient, to make him/her sit down and to make the pertinent introductions. It is common to try to break the ice with the patient to generate a positive and trusting atmosphere, to gradually explain what is going to be done during the session.

It is also common to mention at some point during the interview (although many professionals do not say so directly, taking it for granted or having informed the patient in previous forms or contact channels), whether at the beginning, during or at the end, that all the information provided will be absolutely confidential.. The only exceptions are that there is an order or request from a judge or that there may be serious harm to the life or integrity of the subject or third parties.

Anamnesis

After the presentation, an interview will be conducted in order to obtain information about the case itself, generally through the process called anamnesis. This is the method by which the most relevant information about the specific case is collected.including the problem in question that has made him/her come, life and social habits and history and basic data of the subject.

Generally, we will start by asking about the problem or demand that the subject has, focusing on the current situation, as well as what specifically made him/her come here and now. We will also ask about aspects such as when the problem started, what it is associated with and the feelings it generates, what specific difficulties it generates in the patient's life.

This is produced even if the professional has a report on the matter (for example if it is derived from the doctor or by court order), so that the professional can see what the subject's demands are and, if there is a problem, how he/she experiences and expresses it, getting an idea of his/her approach. The patient is asked to express his/her demand/problem at the present moment,

Having done this or just before it (the specific order depends on how each professional approaches the order and the characteristics of the patient), in order to get to know the patient better and obtain more information both about the problem and the circumstances surrounding it, a series of general data about the patient and his or her life that may be of interest and related to the problem is usually requested.

In this sense it will be useful to to know the presence of possible antecedents so much own as familiar of the same problem or of any that may have had a specific effect on the subject. Basic information about the environment is also usually asked: if there are children or siblings, marital status, relationship with parents and their occupation or in general the family structure with which he/she lives. Also about social life, whether or not there is a partner and the status of the relationship or work life.

It is not a matter of just asking questions and getting to know all the aspects of your life, but rather of asking questions to get to know the general situation. The collection of information must respect ethical limits: the professional will focus on those aspects that are relevant to approach and address the reason for consultation, being able to address any topic in greater depth if deemed necessary.

Obviously we are in the first session, being a dialogue that aims to obtain information but not to be an interrogation. but it is not an interrogation eitherIn fact, many times important elements for the case will be discovered during the sessions that were either hidden or not considered relevant at this first moment. The information given is not unmodifiable and should not be too exhaustive, as this can be exhausting and even aversive for the user.

The professional will listen to what the patient has to say, although he/she may ask for clarification of key aspects and will make sure that he/she understands and assesses what is being told. The therapist's attitude will be one of active listening, paying attention to what the patient wants to say.listening to what the patient wants to tell him/her (and also to what he/she does not say, which also provides a lot of information), empathic and cordial. He/she will also try to be authentic and professional, and at all times will try to make the patient see that he/she will not be judged regardless of what he/she says, generating a climate of trust and acceptance.

Assessing expectations and setting objectives

Once the situation has been assessed, the professional will discuss with the patient the patient's expectations and objectives with regard to the reason for the consultation and the fact of seeing a professional.

It is important to assess this aspect given that the initial objectives or even what is expected of the professional may be unrealistic or even not assess the real overcoming of the problem but of a specific difficulty that it generates. Based on all the information acquired, the general objectives will be negotiated the professional relationship will be negotiated and the roles of each one will be established.

Evaluation with quantitative instruments

It is possible that in a psychology service or practice it may be necessary to use some type of assessment instrument in order to evaluate the presence of a disorder or to assess a phenomenon, symptom or difficulty at a quantitative level. However, even if this is the case, the information from these instruments must be collated and evaluated according to the interview, and the results are not absolute.

An example of this would be patients attending a neuropsychiatry service, and it is common for their capacities to be assessed in the same session. Also in a psychology consultation it may be considered necessary to evaluate the level of anxiety or to assess the extent to which a personality trait is present. assess the extent to which a personality trait is present.Although it is not as common as one might think in a first session. Moreover, not all professionals will use them in clinical practice or in all cases, depending on each specific situation.

Recapitulation and orientation towards the following sessions

Before the end of the session there is usually a recapitulation of everything that has happened during the session, in order to help the patient to establish a mental scheme of what has been done and talked about and to assess whether the professional has understood all the information.

In addition to this, it is possible that a small preview of what is planned for the next session is made. Also, depending on the problem and the professional some general psycho-educational guidelines can be established.in the absence of a more in-depth study of the subject.