The Orientation to Therapy Session

For my clients starting therapy: Here is the a structured format of our orientation session:

When beginning therapy with a clinician who follows a structured format with a consistent agenda and integrates Mindfulness-Based Stress Reduction (MBSR), Cognitive Behavioral Therapy (CBT), and Dialectical Behavior Therapy (DBT), the orientation session is designed to establish expectations, introduce key therapeutic concepts, and create a foundation for collaboration. This session ensures the client understands the therapy process, therapist’s approach, session structure, and their active role in treatment. Below is a breakdown of the orientation session and what a new client can expect.

Welcome and Establishing Rapport

At the start of the session, the therapist:

Welcomes the client, sets a warm and supportive tone, and acknowledges their decision to seek therapy.
Engages in a brief, informal discussion to help the client feel at ease.
Emphasizes therapy as a collaborative process where the client plays an active role in their growth.

Overview of Therapy Approach and Structure

The therapist provides a clear explanation of their approach, highlighting that therapy will primarily draw from:

MBSR – Developing mindfulness skills to reduce stress, increase awareness, and cultivate present-moment focus.
CBT – Identifying and challenging unhelpful thoughts and behaviors to improve emotional well-being.
DBT – Teaching practical skills in mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness.

The therapist explains that therapy will follow a structured session format to ensure consistency, progress, and skill-building.

Explanation of the Regular Session Format

The therapist describes how each session will typically be structured:

Check-in (5-10 minutes)
- Reviewing the client’s experiences since the last session.
- Assessing mood, emotions, thoughts, and any pressing concerns.
- Discussing any challenges or progress in applying previous session skills.
Review of Homework or Practice Assignments (10-15 minutes)
- Going over any CBT thought records, DBT skill practice, or mindfulness exercises from the last session.
- Identifying barriers to practicing skills and brainstorming solutions.
Psychoeducation and Skill Building (20-30 minutes)
- Introducing a new therapeutic concept or skill, which may involve:
  - CBT: Cognitive distortions, thought restructuring, problem-solving.
  - DBT: Mindfulness, distress tolerance, emotional regulation, or interpersonal effectiveness.
  - MBSR: Mindfulness meditation, body awareness, stress reduction strategies.
- Practicing the new skill in session through guided exercises.
Assigning Homework and Planning for the Week (5-10 minutes)
- Assigning a practical home practice related to session topics.
- Setting small, manageable goals for the upcoming week.
- Reviewing how the client will apply new skills in daily life.

Setting Expectations and Goals

The therapist discusses what the client hopes to gain from therapy and collaboratively sets treatment goals.
They explain the importance of active participation, practicing skills between sessions, and tracking progress.
The therapist clarifies that therapy will be structured, meaning clients should expect psychoeducation, practice exercises, and assigned homework to maximize effectiveness.

Psychoeducation: Understanding Therapy as a Learning Process

The therapist introduces the scientific basis of MBSR, CBT, and DBT, emphasizing that therapy is a skill-building process.
The client learns that therapy is like a mental health gym, where regular practice leads to improvement over time.
Common misconceptions about therapy are addressed, reinforcing that progress requires both in-session learning and between-session practice.

Introduction to Core Mindfulness Practices

Since MBSR and DBT emphasize mindfulness, the therapist introduces a short mindfulness exercise in the first session, such as:

Mindful Breathing Exercise: Focusing on breath to increase present-moment awareness.
Body Scan Meditation: Noticing physical sensations to cultivate mind-body awareness.
Observing Thoughts Exercise: Practicing non-judgmental awareness of thoughts.

The therapist explains that mindfulness is a core foundation of therapy and will be integrated into every session.

Homework Assignment for the Next Session

Before the session ends, the therapist provides a simple homework task to reinforce the first session’s concepts, such as:

Journaling about thoughts and emotions (CBT thought record).
Practicing a 3- to 5-minute mindfulness exercise daily (MBSR).
Observing emotions and urges without reacting (DBT mindfulness skill).

The therapist emphasizes that small, consistent steps lead to long-term change.

Q&A and Next Steps

The client is encouraged to ask any questions about therapy, structure, or expectations.
The therapist checks for any concerns and ensures the client feels comfortable moving forward.
The session ends with a brief reflection on what stood out for the client and affirmation of their commitment to the process.

Conclusion: A Clear and Structured Start

By the end of the orientation session, the client:

Understands how therapy will be structured and what to expect.
Gains insight into MBSR, CBT, and DBT and how these approaches will help.
Knows they will be actively engaged in learning, practicing skills, and applying therapy concepts.
Leaves with a clear first step to begin their therapeutic journey.

This structured format provides a predictable, skill-focused, and results-oriented approach that ensures clients feel supported and equipped for meaningful progress.