What to expect from your first couples therapy appointment?

By Emily Short Steiner, LMFT

Scheduling and attending your first couples therapy appointment creates a high level of anxiety for many people. Couples often feel a deep sense of shame surrounding their challenges. Many people I work with fear that the therapist will declare them the “bad guy” of the relationship. Many people also worry that if they are going to couples therapy it means they will learn their relationship is “bad.” Because of these anxieties many couples wait a long time before finally scheduling that first session. This article outlines what that first couples session will be like to help couples feel more comfortable about the process and to address some common myths.

1. Paperwork

There will be some forms to fill out regarding consent to treatment, therapy policies, brief medical history, and confidentiality.

2. Getting to know you

I will ask questions surrounding your history as individuals and as a couple. One of my favorite parts is asking couples to share the story of how they met together!

3. Getting to know me

I will share information about myself as a therapist and what to expect from our sessions. I will answer any questions or concerns you might have.

4. Tell me about the good things!

Often people fear couples therapy will only make things work because we will only talk about the negatives. My belief is that every couple has some positives that are going right and it is essential that we build on those positives from day one in therapy! Maybe you are wonderful parents, run a business together, always have meals together, share the same sense of humor, or support each other’s careers. Although these positives can seem small, they will be the starting place for repair in your relationship.

5. What about taking sides?

Before we switch to talking about relationship challenges I will talk about how “taking sides works in couples therapy.” It is important for me to feel connected and understand the perspective of both members of the couple. I always stress that just because I can understand your partner’s perspective doesn’t mean I can’t understand yours as well. Just because people have different opinions doesn’t mean one is “more right than the other.” I will always do my best to create balance in my therapy sessions and will create space for both people to be heard.

6. What are the challenges that brought you in today?

This is the point in the session where both people will be given equal time to talk about what challenges they have in the relationship. The most common challenges that people bring up are trust, communication issues, feeling disconnected, feeling an unequal balance in the relationship, recovering from an affair, sexual intimacy issues, constant fighting, feeling unloved, and parenting concerns.

7. Talking about the scary stuff

I always address intimate partner violence and substance use as part of the first session. If there is active violence in the relationship I will refer couples to individual services first such as anger management or domestic violence services. Couples therapy will only make violence worse if individual work is not done prior. Additionally if there is active, serious substance abuse couples therapy cannot proceed until this is being treated.

8. Creating Safety

Finally we will begin the conversation about how to make the therapy environment safe. I will ask permission to cut off serious fighting, blaming statements, and put-downs. It may be hard to break these habits at first, but therapy will be more effective if you leave those negative interactions at the door. In our first few sessions we will identify de-escalation strategies to help maintain safety in the home setting as well.

My hope for couples is by the end of the first session that they feel more confident that they will be supported in a non-judgmental way in working through their challenges as a couple. I also hope that couples walk away from the first session with the idea that they are a team in this and that instead of feeling like they are working against each other, they will be working together to solve their problems and to create a stronger relationship. If you are seeking to make changes in your relationship please contact our office and we can talk about if couples therapy might be a good fit.

Emily Short Steiner is a licensed marriage and family therapist in the state of Pennsylvania. She has extensive experience working with couples and families and a specialization in sex therapy.