What To Expect From Therapy
You can expect to be heard, cared for, and helped during therapy. You know you need help. You can't hide how you feel anymore, and the darkness is closing in. You still wonder if you can make it another day. You show up and do your job, but you are racing through the day to get to your car so you can fall apart. You know you need help, but you've never asked for it. You don't know how, and you don't know where to start. You feel as if you're alone and fighting a losing battle.
You are here, so you are asking the questions, and you wonder what to expect from therapy or counseling. Two factors make up the answer to that question. Who you are matters, and so does who your therapist or counselor is. No two therapists or counselors are the same, and no two therapy sessions are the same. You can expect some similarities, though.
What Happens in Your First Therapy Session?
Your first counseling or therapy appointment will consist mostly of you telling your story. You haven't been able to tell anyone how you feel. Maybe you've tried, but no one listens. You probably feel as if you can't talk without falling apart, and you don't want to do that. This appointment is meant for you to be able to fall apart. You get to cry and describe the black fog and how much you have tried to find answers. You get to describe your exhaustion and how you feel as if you have been beating your head against a wall. You can tell your story if you want to.
Maybe you would rather hear from me. You have questions. Hopefully, most of your questions were answered in a free fifteen-minute phone consultation. Click the link at the top of the page to schedule if you haven't. Maybe you have more questions. The first session is the time to ask them.
I usually want to help you relax, so I will use a relaxation technique from Accelerated Resolution Therapy to help calm you. You can take this technique home with you and begin practicing it to help with negative emotions outside the therapy office. We will also use the time to get the necessary history and make a plan for future sessions.
Your first session will last about 50 to 55 minutes and will consist of some basic housekeeping explanations. I also cover most of these on the intake summary you sign, and they are listed below with an explanation of their purpose.
What Business Will We Cover?
I cover the practical things that protect you and your care: how you found me, your safety, scheduling, cancellations, billing, insurance, and how we track your progress.
You will be asked some version of, "How did you find out about me?" This question is about marketing. You are the only one who can tell me how I am doing in the community and who is sending people my way. I want to work with people who want to work with me, and your privacy comes first. There may be a way to simply say hello and thank someone for referring you, but never if it puts your privacy at risk.
Many people who enter therapy or counseling are experiencing a crisis. You may even be on the brink of doing something drastic, such as taking your own life or someone else's. Maybe you feel that way, maybe you don't. You likely can agree that no one wants that to happen. You want to get a plan in place to prevent it. We will figure this out in the first session. I rely upon local emergency services and encourage you to call one of the following numbers: 988, 911, or Mobile Crisis: 865-539-2409. You can also go to the nearest emergency room. I monitor the phone during regular business hours for current clients with urgent needs, but I encourage the use of crisis numbers for true emergencies.
You will already know by your first session that you can log into your portal and change appointments as needed. The window for changes without contacting the office is forty-eight hours. This allows me the opportunity to ensure newly requested times are available.
The first session will include a conversation about emergency and inclement weather cancellations. I will text or email you about any cancellations. These will be done through TherapyNotes, the current electronic health record for the practice. I may also send you a personal notification and prefer to do so with your permission. A cancellation notice will be rare, and a notice less than twenty-four hours before your scheduled appointment will be extremely rare and only done in the case of an emergency. Your time is valuable, and you deserve the respect of advanced notice if canceling becomes necessary.
We will discuss the cancellation policy as well. Appointments canceled less than twenty-four hours before the scheduled appointment time will result in a charge of the full session fee.
We will discuss billing. While therapy is affordable, the cost can feel overwhelming. The Lion's Lamb Family Therapy, LLC currently charges $175 for a fifty-minute session. Sessions lasting more than sixty minutes are prorated to account for the additional time. Payment is expected at the time of service to prevent falling behind.
We will discuss something called a "Good Faith Estimate." You need to know what charges to expect. We have become accustomed to insurance paying our medical bills, and insurance is changing in such a way as to throw some of that cost back on us. Treatment for mental health is no different.
Insurance may be discussed as well. The practice does have contracts with some insurance companies at this time. It is working on learning to bill out-of-network insurance, and until that happens, I can print the completed document for you to send to your insurance company for reimbursement. With the contracted insurance, you will be billed at the contracted rate.
A couple of other miscellaneous topics that come up occasionally are about court and professional letters. The practice currently charges $25 to write professional letters. I do not complete FMLA paperwork or service animal letters; you need to talk with your primary care doctor about those. The practice does charge to attend court and will discuss those fees as needed. Generally, the practice currently charges double the hourly rate and includes preparation time as well as travel time.
I will also introduce you to an outcome-tracking tool called MyOutcomes. The purpose of the tool is to help ensure your success. We will use this tool at the beginning of each session to evaluate your progress through the week and at the end of each session to determine if your goals are met during the session. I want you to get better, and while there are many tracking tools and evaluation tools available, MyOutcomes tracks one of the most important factors to your improvement, and that is the quality of your relationship with your therapist or counselor.
You Weren't Meant to Do This Alone
Your first session is packed with business, but the most important business in that appointment is you. Therapists and counselors talk about being client-centered. The recognized standard of care for therapists and counselors is that your needs and desires are the focus of the session. Throughout your journey in therapy or counseling, there should be constant evaluation and checks to ensure that you are making progress. Your therapist or counselor will establish a treatment plan with your goals, and you will work together to accomplish those goals. Therapy and counseling are a collaborative effort between you, the patient or client, and the provider with a common goal to help you grow past the debilitating life events that have created this heavy darkness that is driving you to despair.
Both therapy and counseling are challenging. Pausing to look inside your own heart and your motives to figure out the thoughts, beliefs, and attitudes that are causing you to drown in hopelessness is not easy. You can do it, though. You weren't meant to figure life out alone. You weren't meant to hurt alone, and you weren't meant to carry hurt, anger, bitterness, and resentment for the rest of your life. Therapy and counseling, depending on your needs and circumstances, can open the door to hope and healing for you and those you love.
I am Vickie, a Licensed Marriage and Family Therapist in Maryville, TN, and I help people from Knoxville and the surrounding communities heal from their trauma and the bad stuff that happens. I can help you. Click the link at the top of the page so we can talk.
Frequently Asked Questions
How long does the first therapy session last? About 50 to 55 minutes. Most of that time is you telling your story, with some time set aside for basic housekeeping: how to reach me, the cancellation policy, billing, and how we will track your progress. If a session runs longer than sixty minutes, the fee is prorated for the extra time.
Do I have to talk the whole time? No. The first session is built for you to be able to fall apart if you need to, but you are never forced to speak. You can tell your story, or you can start by asking me your own questions. I often begin with a relaxation technique from Accelerated Resolution Therapy to help you settle before we go further.
What does the first session cost? A session runs about fifty minutes, and payment is expected at the time of service. You will get a Good Faith Estimate with the current fee before you begin. The practice has contracts with some insurance companies; if it is in network with yours, you are billed at the contracted rate.
Crisis Resource
If you or someone you know is in crisis, call or text 988 (Suicide & Crisis Lifeline) or go to your nearest emergency room. If you are in immediate danger, call 911.
Clinical Content Disclaimer
All clinical content on this website is written or reviewed by Vickie Starkey, LMFT, a Licensed Marriage and Family Therapist in Tennessee since 2005 (License #579). Vickie holds a Bachelor of Arts in Psychology and Sociology from Carson-Newman College (1989) and a Master of Divinity in Psychology and Counseling from New Orleans Baptist Theological Seminary (1995), and is a Certified Master ART Practitioner since 2023. This content is for educational purposes only and is not a substitute for professional diagnosis or treatment. Verify my license here: https://internet.health.tn.gov/Licensure/
References
Wampold, B. E. (2015). How important are the common factors in psychotherapy? An update. World Psychiatry, 14(3), 270–277. https://doi.org/10.1002/wps.20238