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First Therapy Session

Your First Therapy Session

In this open letter from a therapist to a new client, licensed clinical social worker, Mindy Blumenfeld reveals the look and feel of your first therapy session experience. In this letter you’ll discover answers to some of the most intimate questions that accompany the psychotherapy journey.

What you learn about me in your first therapy session:

You walk in to my office for the first time. It is an interview, for both of us, and we both want to make a good impression. There is much you learn about me although I reveal nothing verbally. My office reflects much of who I am. Four walls. A chair. A couch. A sand box and figurines. A children’s book, There’s No Such Thing as a Dragon, a subtle lesson about denial and relationships. Rocks. One that has the words, “consider yourself hugged” inscribed onto it. Another, “good enough mother,” and yet another, “lake something-or-other” a gift from my yoga teacher upon her return from India. A sequined pillow to soothe, a large gray elephant (in the room!), a slinky, a fidget spinner, collage materials, a dollhouse, a weighted blanket with the scent of cinnamon. And, a 3-D tiger hidden behind my desk.

Books line the shelves of my waiting room. They tell the story of what interests me. They reveal the theories and philosophies that inform my orientation and work. My diplomas and certificates are framed, hanging quietly on the wall. You know now where I attended school, that I graduated with honors and how many years I am practicing. I do not wear my wedding band, but my wig gives you information about a marital status that is or once was. As your eyes run over my dress, my lack of jewelry, the make up I wear—or don’t – depending on the time of day your appointment falls out (at 5pm I have eaten the last of my lipstick snacking on pomegranate seeds, its container tucked away in the corner of my desk). You evaluate me, judge me, wondering if I am too frum, frumot frum enough; much too quiet, or not silent enough; intelligent, or not savvy and world-weary as you.

What I learn about you in your first therapy session:

I learn much about you too, not only in the words you use, but in those you do not. When you choose the couch over the chair, you are telling me that you are comfortable in my room, maybe that you are surrendering to the therapy experience, or that you are a child wanting the mother-therapist to hold you. You choose the chair and you are asserting yourself as an equal, perhaps holding back, or protecting yourself from the threat in the room represented by the therapist.

Sometimes you sit down and you keep your coat on, your pocketbook securely attached, your shopping bags on your lap. You will not let down your guard even for the therapy hour. Sometimes, you methodically take off your coat, hanging it over the chair, place your bags and your phone nearby and settle into the couch as if parked here for the day.

For some of you, I am not a real person. You would not recognize me on the street should we meet. You expect me to listen; but I am only a mirror to you, not a separate person with whom you are forming a relationship in this room, in this special space. For others, I am a person to entertain; you try to make me laugh, to share your life, you expect me to care about your successes, children’s birthdays, and the business deals that collapsed.

There are so many questions. Questions you are perhaps uncomfortable to even ask, or not even aware that you have them. They remain unarticulated and manifest themselves in your body language, in the details of your story you choose to share.

Questions that accompany your first therapy session:

Do you care about me? Can you help me take away this pain? Do you understand my pain? Do your kids make you cry? Do you fight with your spouse? Have you ever felt alone? Were you abused as a child? Were you ever a failure? If I wouldn’t be your client, would you still want to be my friend? Or, if I couldn’t pay you anymore, would you still see me? How long will therapy take to heal me? If I come to therapy does it mean I am really crazy? Would you ever go to therapy? How does therapy work? Does therapy even work?

Your questions are powerful and although I do not have answers for all, I have thoughts about some.

What informs my work?

I am an object relations therapist. I believe that most people come to therapy for problems in relationships and how they manifest themselves in every aspect of their lives. I believe that the roots of these problems are in primary attachments. I do not believe, as early therapists did, that the quality of early attachments determine mental health. But rather that attachments throughout infancy and childhood play a role in effecting and affecting our positive and/or negative functioning as adults.

Positive attachments that are ruptured create dysfunction later on just as negative attachments that are repaired can reverse the early damage. As a therapist, my role is to create a holding environment that can repair the dysfunction of early attachments, allowing a relationship within the room to evolve that can be generalized to the client’s world outside of therapy. In this vain, I believe that the relationship between the therapist and client is crucial.

As a religious existentialist, I believe in the inherent meaning of life. I believe that we all grapple with the fears engendered by the certainty of death and our need to live life authentically and with significance. I am attuned to how these concerns surface in the therapy experience.

I am a somatic therapist, tracking your body activation (and mine) so I can help you regulate and stay within your window of tolerance.

I am a trauma specialist, using the somatic work of somatic experiencing and sensorimotor therapy, IFS (internal family systems), EMDR, and psychodynamic talk therapy to help you heal.

I have an eclectic arsenal, borrowing techniques and tools of other theories and orientations when needed. Narrative therapy, cognitive-behavioral therapy, solution focused therapy, play therapy, motivational interviewing, and structural therapy. Some therapist and theorists, among many others, who have impacted my work are Viginia Axelrod, John Bradshaw, Victor Frankl, Karen Horney, Peter Levine, Salvadore Minuchin, Stephen Mitchell, Dick Schwartz, Francine Shapiro, Margaret Thayer Singer, Bessel Van Der Kolk, D.W. Winnicot, and Irvin Yalom.

Do I understand your pain?

I cannot promise I have experienced precisely your pain, but I can only say that most therapists are drawn to this profession from their own places of pain. Our pain has propelled us to want to help others. When you use words, your body, and play to describe your pain it helps me understand as I enter your world.

How long will therapy take to heal you?

When you enter my office, and ask how long until you are healed, this is what I will tell you:

Within 2-4 weeks you will feel immediate relief from the presenting problem that drove you to therapy.

Within 3-6 months, and sometimes even as quickly as 6-8 weeks, the presenting problem will be mostly resolved.

After 6 months, you will either leave therapy, satisfied that what you came for has been worked through. Or, you will realize how effective therapy is to alleviate pain and work through issues, that you will decide to work through other problems you have avoided.

Usually after a year, the underlying issues that have caused the presenting problems will begin to surface and that is when the truly painful work of therapy begins. At this point, you may choose not to stick around and witness it. Each person has their own threshold of what constitutes their equilibrium and after the crisis passes, each person is satisfied with a different level of functioning. This threshold may change with age or life stages/changes.

Would we be friends under different circumstances?

To ask if I would be your friend if I would not be your therapist is an unfair question. This is because I have very few friends, each painstakingly acquired and maintained. I can tell you though, that I am enriched by our relationship and by the opportunity to work with you. There is no need to test me, to ask if our relationship is based on monetary value, simply because it is not a question you would ask a surgeon who is removing a cancerous tumor from your brain. It is true we charge for our services, but it is more that we have chosen to dedicate our lives to a work we believe in beyond its monetary compensation.

Do I really care about you?

I care about you, but never more than you do. I will not work harder than you do to effect functioning. I will let you lead. When you are ready to make positive changes in your life, I will be there, but I will not push you where you are not ready to go because it is what I think you should be doing, thinking, or feeling.

I trust you and because I trust you, I will let you do the work of therapy. So do not be angry at me when it appears that I won’t tell you what to do and give you advice. Nobody knows your life or your abilities better than you yourself do. Despite the inherent unequal balance of power in the therapy room, I am not so arrogant to think that I can think for you.

You wonder how you can be special in this room if I have so many clients. I tell you that each session plunges me into another chapter of one of the many books I am in middle of reading. The threads of each book wrap me up and the ending only concludes satisfactorily with termination of therapy. I may be sorry to close the book, but the memories of the book will linger on.

Some of you speak in metaphors, your words like strokes upon a canvas, the colors brilliant despite the black that threatens to blanket the paintings of your lives. Others are silent. In the silence is the beauty of strength, of a life lived courageously defying the pain that cuts deeply but makes no sound. I understand both languages.

To all of you who come through my door, this is what I want you to know:

I respect you for your courage in refusing to accept a life shadowed by pain. I am humbled by your trust in taking a chance with me. A therapist creates a new therapy with each client and I am changed by each encounter. I feel privileged to be allowed along your journey as you reach for life.

Note: This was previously published in Ami Magazine ten years ago in the beginning of my journey as a therapist; and subsequently revised to reflect my own growth as a therapist. 

Want more on this topic? Here goes…

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This Post Has One Comment

  1. This really gives great insights from a personal view from the other side . Plus it really breaks down the fear of the unonown to many about what therapy is all about. Ty for a well written article that can hopefully open many minds about the advantage of therapy

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