What to Expect from your First Couples Therapy Session

Our personal relationships with our partners are based off of intimate connections that often are very private, so the thought of inviting a complete stranger into your inner world may see extremely uncomfortable. While it is completely normal to attend therapy even when things are going well in our lives, seldom is this the case in the therapy room.  With couples therapy especially, individuals usually arrive when they feel their own efforts as a pair have failed or been immobilized and feel a need for another source of support to determine if the relationship can be repaired. Regardless of the unique circumstances that bring a couple into the therapy room, it can be an intimidating process, as it requires both partners to embrace their own vulnerabilities with their relationship. There may be some resistance from one or both partners in the initial stages of therapy, but if the individuals are willing to participate then there is potential to understand current relationship roadblocks and work to create new paths of connection moving forward.

What Does the First Session Look Like?

You and your partner have made the decision to attend couples therapy, but are uncertain on what to expect from the process and how to make the most of you time there. To reduce some of the pre-therapy “butterflies” or initial anxiety as you prepare to attend, here are some things you can expect from your first session:

1. Welcome

Generally, sessions begin with the therapists welcoming both partners to therapy and introducing themselves. This can include the therapist providing the partners with information about their qualifications, experience, as well as outlining their role in the process with the couple. It is difficult to open up to someone if you know nothing about them, so the therapist may use the first few minutes for you to learn a bit about them as a way to start building some foundation of the therapeutic alliance. This is a great opportunity for you to ask questions and see if they are the right fit.

2. Important information and Consent

It is important for the therapist to review any important information including the consent forms with both partners before proceeding further. Even if consent forms have been sent to clients ahead of time and they are already signed, it is good practice for the therapist to review the document in detail in the first session to ensure both partner’s understand and have an opportunity to ask any questions. This involves the therapist outlining:

• The nature and purpose of the proposed treatment and/or assessment;
• Benefits;
• Material risks, including foreseeable costs and any limitations to the treatment or assessment;
• Effects of the treatment or assessment, particularly those that a client might consider uncomfortable or undesirable;
• Alternative options available; and
• Consequences associated with refusing the treatment or assessment.

This process also involves the therapist highlighting any limitations they may have regarding confidentiality and the measures taken to maintain both clients’ personal health information.

3. Your Narrative

Once consent has been obtained from both clients to advance forward in the therapeutic process, the next step is to understand what led the couple to begin therapy. The therapist will try and understand each partner’s perspective on what they feel like brought them to therapy as well as uncover any expectations they each may have for the process. Each partner is invited to share their own story, as this is a good time to get an appreciation of any issues or concerns that either partner would like to be addressed in therapy. Previous therapeutic experiences can be explored for understanding of what was successful or unsuccessful, as well as uncover if any fears or worries for treatment are present.

4. Historical Relationship Interview

It is extremely important for the therapist to conduct a brief interview with both partners about the history of their relationship. This includes learning about how the partners met, what big events or experiences stand out for each partner as good times in the relationship, as well as how and when the relationship dynamic started to change. This sort of information can be tremendously helpful in understanding each partner’s perception and the strengths and weaknesses within the relationship. 

5. Family Histories

Next, the therapist may use this time to learn about each partner’s family history and relationships, including how they were raised and what the family dynamic was like for each partner. This information provides the therapist with a brief snapshot into how relationships were first introduced to each individual’s life early on and what a healthy vs. unhealthy relationship looks like to each partner. Evidently, additional detail on each partner’s family history can be collected in the next session as outlined in the bullet point below.

6. Instructions for Next Session

 In many situations it can be beneficial to schedule an individual session with each partner before moving forward. However, not all therapists choose to implement individual sessions. The benefits of conducting an individual session with each partner is to give each individual an opportunity to express their thoughts, feelings, and concerns about their relationship confidentially. Both individuals bring their own perspective of the relationship, so it is important for the therapist to gain a better understanding of each partner’s viewpoint, as both offer validity. It is also important to highlight to each partner that therapy cannot work with secrets and that the responsibility of the therapist is to both partners as their clients. If things aren’t working in the relationship currently then it can be difficult to feel comfortable being fully honest in session with your partner present. Therefore, the intention of the individual sessions are not for each partner to disclose secrets to the therapist, but rather to express their feelings and concerns openly.

7. Wrap-up

The final few minutes of the session are dedicated to learning how it was for each partner to share and participate. This is also a great time to stress how difficult it can be to share with a stranger and if they have any feedback on what could make the process feel safer for them to share going forward. Additionally, questions are always welcome at this time.

 Other Components

The list above is non-exhaustive and not all therapists follow it exactly, as each individual may like to add their own flare or personal touch to the process. An additional component that may be incorporated into the initial session includes providing assessments and questionnaires for each partner to complete separately. Again, this serves as a way for the therapist to collect information from each partner about their attitudes and perception of their relationship. Since the therapeutic alliance with the therapist is still young and only just forming, assessments can be an effective way for each partner to express themselves without fear of being judged or feeling pressured by addressing concerns verbally. Moreover, each unique therapist may have a number of alternative questions they prefer to ask during the first session, all with the goal of developing an understanding of the relationship and each partner through conversation and observation.

Initially, the expectation for the first session may be to have the therapist to jump in and begin problem solving, however this would be unhelpful for the couple as they problems may not be known. Rather, the initial session is a way to get to know your therapist a little better and for them to start to understand you and your relationship better. They do not know the history between you and your partner, so how can they be expected to dive right in with you? Your therapist needs to learn and observe the patterns of interaction within the pair by giving each partner an opportunity to share and participate. This will help lay the foundation in the alliance to begin working collaboratively on identifying negative cycles and patterns of gridlock in order to get to a position where new strategies and skills can be implemented to move forward more cohesively and connected.

References

CRPO. (2018). Quality Assurance Program: Informed Consent Workbook. Retrieved from https://www.crpo.ca/wp-content/uploads/2018/06/Informed-Consent-Workbook.pdf