In preparation for Mental Health Awareness Month, Marvin asked members of its clinical team to answer a simple but revealing set of questions about what healthcare workers can expect from a first counseling session. What emerged was strikingly consistent. Across responses from Jacinta Harman, LCSW, Marvin’s VP of Clinical Services, Dr. Heidi Schrumpf, Director of Clinical Services, and Pamela Mongrandi LPC, CAADC, PhD, the same themes surfaced again and again: privacy matters, fit matters, and the first session is just the beginning of support.
The first few minutes are usually simpler than people expect
People often imagine a first counseling session as something formal, clinical, or intimidating. The clinicians described something much more human.
“The first few minutes are almost always about orientation and consent,” Harman writes. The therapist introduces themselves, explains confidentiality and its limits, and gives the member a chance to ask logistical questions before anything deeply personal comes up. “It is less clinical than people expect,” she adds. “There is often some version of ‘tell me what brought you here’ or ‘what made today the day you reached out’ it’s best to think of counseling as an open door, not an interrogation.”
Dr. Schrumpf describes a similar opening, though in more personal terms. “Asking for help can be stressful, so I always try to set a warm tone right from the start,” she says. She explains what the session will include, gives the member space to share, and makes clear that the conversation is also about whether the relationship feels like a good fit. “I’m not everyone’s cup of tea, and that’s perfectly okay. This is largely about fit. If I’m not the right one, I’ll help connect you with someone who might be better.”
Dr. Pamela also emphasizes that those early moments are often about clarity and reassurance. After a brief explanation of confidentiality and mandated reporting, she says, “the focus will shift to you sharing as much or as little as you want regarding what brought you to therapy.”
A first session doesn’t have to accomplish everything
One of the clearest messages in these responses is that people often expect far too much from a first session.
Harman puts it plainly: “It does not need to solve anything, diagnose anything, or go deep into history.” Instead, she says, “A first session is not supposed to be a breakthrough. It is supposed to be a beginning.” The therapist is “listening for themes, not conclusions.”
Dr. Schrumpf makes the same point in a slightly different register. Some of the questions, she notes, may not feel immediately relevant, but they help lay the groundwork for future care. What the first session does not need to do is “cover your entire life story or nail down every detail of a care plan.” Those things “unfold over time and can be adjusted as we go.”
Mongrandi describes the first conversation as an intake that helps a clinician understand stressors, coping patterns, support systems, and goals. The point is not to compress someone’s whole life into a single sitting. It is to begin building a picture of what support might actually help.
Privacy is not a side issue. It is central
Across all three responses, privacy came up repeatedly, and with good reason.
Harman says confidentiality concerns are “the biggest” issue, especially fears about whether support could somehow “get back to their employer or licensing board.” She also notes a second, related concern: whether the clinician will really understand the culture and texture of healthcare work without needing everything translated.
Dr. Schrumpf addresses that fear directly. “The most common question I hear is whether an employer can see their records or knows they’re seeking services,” she says. Her answer is unambiguous: “Employers have no access to records of any kind and don’t even know a person is seeing someone at Marvin unless that person chooses to tell them and signs a release.”
Dr. Mongrandi adds that people in higher-status roles often worry about professional reputation and standing. That fear, too, walks into the room with them.
Nervousness, skepticism, and uncertainty are part of the process
If someone feels unsure how to begin, none of these clinicians treat that as a problem to overcome, but rather a normal part of the process.
Harman says that the best approach is often simply to name that discomfort directly. “Sometimes people feel a little strange getting started,” she notes, and that is “completely normal.” More than that, she adds, “Ambivalence deserves to be welcomed, not managed.” It is an unusually humane line, especially for healthcare workers who are used to moving quickly through discomfort rather than sitting with it.
Dr. Schrumpf says she tries to “meet people exactly where they are.” Sometimes that means talking about her own approach before moving deeper into the member’s concerns. Sometimes it means “a little humor,” and sometimes “we simply take a breath together.”
Dr. Mongrandi reaches for solution-focused questions that can make the conversation feel less daunting. She asks things like, “What is your best hope for our talk today?” or “What would it look like to no longer have” the fear, anxiety, depression, or shame someone is carrying.
You don’t need a crisis to deserve support
Healthcare workers are trained to triage, and over time, many start doing that to themselves. You may compare your own distress to the suffering around you, then decide you should wait longer, tough it out, or be grateful it is not worse.
Harman challenges that instinct directly: “You do not need a crisis to deserve support.” If something is affecting “your quality of life, your sleep, your relationships, how you feel at work,” she says, “that is enough.” She goes on to call the “big enough” threshold “a myth,” especially among healthcare workers who have internalized a system built around acute need. “The fact that you are questioning whether you belong here is itself a reason to be here.”
Dr. Schrumpf makes a similar point in even plainer language. “I’m not in the business of comparing people’s pain,” she says. When someone worries they do not have a serious enough reason to seek support, what she hears is that they “had the courage to reach out before things became a crisis,” and “that takes strength.”
Mongrandi’s version is simple and generous: “We are here to help people with whatever is burdening them. No problem is too big or too small.”
What is different about healthcare workers
None of our clinicians flatten healthcare workers into a stereotype, but all three acknowledge that people in this field often arrive carrying a specific set of concerns and habits.
Harman says many healthcare workers come into counseling with a “thoughtful, reflective mindset shaped by their professional experience,” which can be helpful, but can also keep them one step removed from their own emotions. “Part of the work becomes gently creating ways to connect with their emotions in a different way,” she writes. She also notes that stepping out of the role of caregiver and into the role of a person receiving support “can take time.”
Healthcare workers often feel they “should” have been able to fix things themselves, or “should” be able to handle more than they can. “That belief deserves to be gently challenged from the very start,” she says.
Mongrandi widens the lens to include the broader realities of healthcare work: long hours, emotionally demanding environments, patient loss, professional hierarchy, difficult coworkers, and systems that can feel “high on judgment and low on support.” She also notes that many healthcare workers struggle with self-care, boundaries, perfectionism, and negative self-talk.
The habits that help people survive at work often show up in the session too
One of the sharpest parts of Harman’s response is her description of the patterns healthcare workers tend to bring into the room.
“Three show up almost universally,” she writes. “The first is minimizing.” The second is intellectualizing, or “staying in their head, analyzing their feelings rather than having them.” The third is “caretaking the therapist,” which can look like checking whether they are making sense or being overly considerate. “All of these are ways of staying safe and in control.”
Dr. Schrumpf describes a related pattern as “minimizing their needs while simultaneously intellectualizing them,” which creates a distance between how they are functioning and what they are actually feeling. A key part of the work, she says, is helping people “bridge that gap in a way that feels safe.”
Mongrandi points to many of the same dynamics, including codependency, perfectionistic thinking, fluctuating self-esteem, and difficulty setting boundaries. Read together, the clinicians’ responses suggest that what looks like composure from the outside is often just a well-practiced form of self-protection.
What surprises people most once the session begins
For all the apprehension people may feel beforehand, the actual experience is often less frightening than expected.
Harman says people are often surprised by “how normal it feels,” by “how much they end up saying once someone is actually listening without an agenda,” and by “how much they have been holding that they did not realize was there.”
Dr. Schrumpf puts it more simply: it often “wasn’t nearly as scary or painful as they’d anticipated,” and Dr. Mongrandi highlights another quiet revelation. People realize “they are neither alone nor strange.”
The reassurance they keep giving, over and over
By the end of these reflections, the clinicians are not just describing the mechanics of a first session. They are also describing the message they hope healthcare workers hear when they enter one.
Harman says that there is no “right” way to begin. People do not need to articulate everything perfectly or make sense of it all right away. Support is collaborative, and trust develops over time. “Wherever someone is starting from is both valid and workable and we will meet them there.”
Dr. Schrumpf says the reassurance she offers most often is simple: “I’m not judging you, and no that wasn’t silly or stupid.” She reminds healthcare workers that “we all struggle at some point,” and that accepting help is part of caring for ourselves and, by extension, for others.
A first session is not a performance
What these clinicians describe, taken together, is not a dramatic breakthrough moment or a highly choreographed clinical ritual. It is something quieter and more credible than that.
At first counseling session is a conversation. It’s a place where privacy is taken seriously, where fit matters, where you don’t need a crisis to justify showing up, and where you are not expected to arrive with a polished explanation of your pain.
For healthcare workers, that may be the most important message of all this Mental Health Awareness Month. Awareness is rarely the problem. They already know what strain feels like. What they need is a place where they do not have to minimize it, justify it, or carry it alone.
Marvin connects healthcare workers with licensed counselors who understand the demands of the profession. Sessions are confidential, flexible, and covered through your employer. Learn more at meetmarvin.com.
