This is the first time a third party will enter your relationship. What to expect at first couples therapy session.
If you have never been to couples therapy (or individual/family therapy), you might not know what to expect. The uncertainty might bring you some discomfort, so I will list some key steps on what to expect at the first couples therapy session and perhaps help lessen worry or hesitation.
Before you arrive at your appointment, you and your partner would have all documents electronically signed in my patient portal. You will sign different documents with the most important being the consent form. You will also fill out an intake form where I ask some preliminary questions about you, your health, and your expectations for therapy.
After documentation is signed, we will schedule an appointment for the couple to come together. The first session lasts 90 minutes and it does not cost you more than the agreed fee. All other sessions will be 50 minutes. Depending on your case, I will suggest some individual sessions, but the main work is done together.
We will go over your rights to confidentiality and the exceptions to confidentiality. We will also discuss any questions about the documents you signed.
Payment is due at the beginning of the first session. If you want to pay by credit card, I use a secure app that takes your credit card information and I do not keep records of your credit card. This app is used by therapists and is HIPAA compliant.
I expect that you and your partner might feel nervous or have some apprehension about talking to a complete stranger about your intimate problems. It is like I “descend into your relationship with a parachute”, but I have never seen a couple who was unable to feel secure in sharing after we meet.
Once we get the mechanics of the session taken care of, we move on to the reason that brings you to therapy. Couples start therapy by talking about what brings them in. A lot of problem-talk follows, which is essential for the therapist to understand the disconnect.
Content versus Process
It is normal for partners to start by talking about specific instances or examples of their daily lives to illustrate why your relationship is not working. We call this “content”. When partners discuss content, they will bring up a specific event in time and will describe (according to their view) what happened, what the other said, did, or did not do. In “content” talk, there’s a lot of facts, judgments, and frequent talk about the other. Very seldom do clients describe how they feel. Their ideas of change usually include their partner making the most changes.
Although listening to your content is important, therapists will be looking for patterns, or what we call “process”. We look for your negative cycle, we observe how you can be well and somehow you end up in a cycle that you are unable to repair on your own. The work couples therapists do for a relationship is in the “process” level and not in the “content” level.
If we could do this work by listening to problems and deciding who is right or wrong, we would. It would be very easy to listen to facts and judge. However, for long-lasting results, we need to talk about your emotions and your patterns. Facts, text messages, social media posts, problems in communication, etc are all on the surface. We need to understand what is beneath all of that.
What Couples Therapy is Not
As explained before, many clients believe that in therapy we chose sides. There’s a belief out there that a therapist is a “referee”; that we listen to both sides, decide which one is correct (based on some parameters of what is right or wrong), and tell each other what needs to be done.
This view of couples therapy is a myth!
In a relationship, there are two partners and a third component: the relationship between the two. A couples therapist is an advocate for the relationship, not an advocate for either one of you.
Couples start their conversation about their individual identities and how it conflicts with the others. It’s normal to hear a lot about each person’s individuality, what one person wants, and what makes one person happy.
But at some point, I want to hear “the story of us”. I want to hear how you talk about specific times in your relationship when you were able to repair problems. I want to hear how much you recall instances in your relationship when the problem was not present and what makes you stay together.
Sometimes, a “story of us” is not clear or has lost some momentum (granted, if things were so good, you would be solving problems on your own). In therapy, we help you uncover your values as a couple and how you can move forward.
Ending the session
In the first session, there’s a lot of “getting to know one another” between the therapist and the couple. It is important that you fill out as much information as possible in your intake documentation so we focus the session less on “content” and more on “process”.
Both client and therapist will assess if we are a good fit to work together. According to research, having a good therapeutic alliance is a good predictor of client outcomes, so if you don’t want to continue working together, there’s no obligation to schedule future sessions. I will also refer you to another clinician in case your specific situation does not meet my specialty.
From the first session, it is possible to get tremendous relief. There will be a lot of risk for you or your partner and many opportunities to feel hopeful. Regardless of what your intent might be for the future of your relationship.
To find more information, please visit my page about Couples. I offer couples therapy only in person (no virtual sessions for couples). I also provide therapy in Spanish or Portuguese. Contact me for a 15 min free consultation.