Why Can It Feel So Difficult to Return After a First Therapy Session?

I've been thinking recently about what happens after someone comes to see a psychotherapist for the first time. We tend to talk about how difficult it can be to make that first appointment, but perhaps less about what it can feel like afterwards. Particularly when someone has found themselves sharing things they have rarely, if ever, spoken about before.

Of course, it may not be their first experience of therapy at all. Some people have been in therapy before, perhaps more than once, and may have encountered quite different approaches along the way. They might have found therapy enormously helpful, or perhaps felt disappointed, misunderstood or that something was missing. Others may have fairly strong ideas about what therapy involves, shaped by conversations with friends, things they've read, or the often simplified and sometimes misleading portrayals of therapy on social media.

So we don't necessarily arrive at a first session with a new therapist without expectations. We bring hopes, doubts and previous experiences with us (whether we're particularly aware of them or not). And whatever our experience of therapy, meeting someone new and beginning to talk about ourselves can still feel like a significant step.

Yet I wonder whether, for some people, the greater difficulty comes afterwards: in deciding to return.

The feeling of having said too much

An initial therapy session can be a rather unusual experience. We don't often find ourselves sitting with someone whose attention is entirely on us, with an invitation to talk about whatever is troubling us.

There may be things we've kept to ourselves for a long time, perhaps because they feel too personal, too painful or simply too difficult to explain. And then, sometimes quite unexpectedly, we find ourselves talking about them to someone we've only just met.

In the moment, this can feel like a relief. But I wonder how often that relief gives way to something rather different once the session is over.

Perhaps there's a sense of having revealed too much. Of having been more emotional than intended. Or of wondering what this person, who was a stranger an hour ago, must now think of us.

Shame can creep in, even when there is nothing objectively shameful about what has been shared.

And with that shame may come a wish to withdraw, to put some distance between ourselves and the person who has seen something of us that we usually keep hidden.

Why being listened to can feel uncomfortable

We all have ways of protecting ourselves emotionally, often without being particularly aware of them. Some of us are used to being the capable one, the person who manages, who doesn't make a fuss or ask for help. Others have learnt to keep difficult feelings to themselves, perhaps because expressing them earlier in life didn't lead to the comfort or understanding they needed. These ways of managing can become so familiar that we hardly notice them.

Therapy can unsettle them, even in a first meeting.

To sit with another person and acknowledge that things aren't quite as we'd like them to be can leave us feeling exposed. And being listened to with interest and attention, although it might sound like something we would all welcome, isn't necessarily comfortable either.

There can be something surprisingly difficult about allowing another person to take us seriously, particularly if we struggle to take our own needs and feelings seriously.

What we bring to the relationship

I think it's worth remembering that we don't necessarily leave a therapy session feeling the way we did while we were there.

Something said in passing may stay with us. We may find ourselves replaying parts of the conversation or wondering whether we were understood. Perhaps we begin to worry that the therapist was judging us, or that we came across as needy, foolish or somehow inadequate. These thoughts may have little to do with what actually happened in the room. Equally, there may have been something about the therapist or the encounter that genuinely didn't feel right.

One of the foundations of psychodynamic psychotherapy is an acknowledgement of the way our past experiences can shape what we expect from other people, often without our realising it. We don't arrive at new relationships as blank slates. We bring with us a lifetime of experiences of being listened to, ignored, criticised, understood or misunderstood.

Our previous experiences of therapy can become part of this too. Someone who felt particularly understood by a former therapist may find it difficult to imagine developing that kind of relationship with someone new. Someone who felt let down might understandably be reluctant to trust another therapist. And someone accustomed to a more structured or practical approach may find the relative openness of psychodynamic therapy unfamiliar, perhaps even unsettling.

Some of these expectations can begin to emerge surprisingly early in a therapeutic relationship.

Of course, not every uncomfortable feeling needs to be understood in this way. Sometimes we simply don't feel at ease with someone. Sometimes the therapist isn't the right fit. And sometimes we may not feel ready to begin. But I do wonder whether, on occasion, the very feelings that make someone reluctant to return are the ones worth exploring: if these dynamics surface within the therapeutic relationship, it is highly likely they are quietly playing out in other areas of life as well.

Giving ourselves time

I sometimes think there's an unspoken expectation that we should know, after one meeting, whether therapy is right for us. But fifty minutes is not a great deal of time in which to meet someone, begin talking about difficult things and decide whether we can imagine trusting them. Nor is there any need to tell our whole story in that first session, although I suspect many people feel they ought to.

Trust tends to develop gradually. We may need time to become familiar with the experience of therapy, to discover what it feels like to speak openly, and to find out whether the person sitting opposite us feels like someone with whom we might be able to do this work. For this reason, I often think of the beginning of therapy as a process rather than a single consultation. There is no obligation to continue, of course. But if the thought of returning feels unexpectedly difficult, it might be worth wondering why.

Perhaps something about the meeting didn't feel right. Or perhaps it did, and that in itself has left us feeling a little more vulnerable than we anticipated. Either way, these feelings don’t have to be figured out alone before returning. They can be brought into the room too. And sometimes that is where the work begins.