Should You Make a PowerPoint for Your Therapist?

Dr. Olivier van Hauwermeiren, PsyD

This post is part of my Ask a Therapist series, where I take questions I've answered on r/askatherapist and go a little deeper than the comment section allows.

The Question

Would it be weird to make a PowerPoint for my therapist? I want to walk into the first session organized, with everything relevant laid out clearly, instead of rambling and wasting time. (The original post has since been deleted, but a related question captures the same instinct: "If I just went up to my therapist like 'here's a list of everything I think is wrong with me and why,' will they take me seriously?")

My Answer

One of the first questions I ask is "orient me to your life?"

The PowerPoint would absolutely cook for that question. I've never had a client do it, but I wouldn't be opposed if it helps provide context and keeps you organized.

Let's Go Deeper

I get why the instinct shows up, because it shows up constantly with the people I tend to work with, most of them high performers who run their own lives like a well-managed project. You walk into a first session not knowing the format, worried about burning an expensive hour rambling, so you reach for the move that's carried you everywhere else and you prepare, the way you'd prep for a review or a pitch. In a work context nobody would blink at that. Carrying the same instinct into a therapy room is about the most natural transfer there is, and honestly it already tells me something before you've said a word about what you do when you're nervous and out of your depth.

Which is part of why I open with something as loose as "orient me to your life." It isn't a form and it isn't a checklist, though plenty of checklists exist and get used later for the parts that need them. I lead with something open because the shape of what you volunteer first is already information: what you reach for, what you skip, where you slow down and where you hurry past. A well-built deck can answer the question of what's going on in your life. What it can't easily show me is how you hold that story together, and there's a long line of research on narrative identity (Dan McAdams has spent a career on this) suggesting that the way people structure their own life story, not just the facts inside it, tracks with how they're actually doing. Clean bullet points have a way of smoothing over the exact seam I'd have wanted to press on.

The companion question, the "here's a list of everything I think is wrong with me" version, is worth setting next to the PowerPoint one, because underneath they're the same move in different outfits: both hand over a finished analysis in place of the raw material. Clinicians have a slightly unkind word for that, intellectualization, one of the defenses Anna Freud catalogued back in the 1930s, where you manage something emotionally loaded by converting it into a tidy problem to think about instead of a thing to feel. I want to be careful here, because it isn't a flaw and I'm not diagnosing anybody for owning a laptop. For a lot of people it's a genuinely good skill, the one that got them through school and work and every hard conversation they've had to chair. A first session just happens to be one of the few rooms where arriving with the analysis already done can quietly work against you.

ACT, the approach I lean on most, has a cousin of this idea called experiential avoidance: the reflex to control or route around an uncomfortable inner experience rather than let yourself have it (Steven Hayes and his colleagues built the concept out). A meticulously organized deck can be a lovely instrument of avoidance, keeping the hour feeling handled instead of exposed, and I don't say that with any contempt, because feeling handled matters a great deal when you're sitting across from a stranger for the first time. The catch is just that the discomfort a deck is built to manage is usually made of the same material the session was supposed to reach.

None of this is an argument against preparing, and I want to be precise about that, because people hear "don't over-prepare" and overcorrect into showing up with nothing, white-knuckling the whole hour. Jotting down three things you don't want to forget, or a rough timeline of what's been going on, is a real kindness to yourself, especially if you're someone who blanks under pressure, and I've watched clients visibly exhale the second they unfold an index card. The version I'd keep an eye on is the one where the preparation's actual job is to keep you out of the session rather than help you through it. If you want a rough test, picture losing your notes on the way in. If you could still answer "orient me to your life" out loud, the notes were a backstop and you should bring them. If losing them would leave you with nothing to say, the organizing may be carrying some avoidance underneath the tidiness, and that is genuinely useful to know about yourself.

The impulse is worth sitting with apart from whether you act on it, too. Wanting to arrive polished, competent, visibly on top of your own problems, is very often the same pattern that runs through the rest of a person's life, the one that turns up at work and in friendships and in how you hand a partner a complaint. The perfectionism research draws a useful line here (Paul Hewitt and Gordon Flett's model is the one I reach for) between holding yourself to a high standard and needing everyone else to see a flawless version of you, and it's the second kind that tends to travel with the most distress. A first therapy session, where the stakes are genuinely low and the other person is paid specifically not to be impressed or let down, is one of the few places on offer to practice being seen a little unfinished.

So if you're the type already sketching slide titles, bring the outline if it steadies your hands. Just leave the session some room it didn't plan for: the tangent, the thing you'd decided wasn't relevant enough to include, the pause where you honestly don't know what comes next. Most of what turns out to matter early on lives in that unscripted margin rather than on the slides, and a good therapist is far less interested in how well the material is organized than in the person doing the organizing, and in what all that careful ordering has quietly been helping you avoid having to look at.

FAQ

Is it weird to prepare notes before a first therapy session?

No. Bringing a short list of things you want to cover, or a rough timeline of recent events, is a common and often helpful way to steady yourself, especially if you tend to go blank under pressure. It becomes worth examining only if the notes exist to keep the session feeling managed rather than to support you through an honest one.

Should I write a list of everything I think is wrong with me before therapy starts?

You can, but hold it loosely. A pre-written diagnosis of yourself can sometimes stand in for the more useful, messier process of describing your life out loud and seeing what surfaces. Therapists are generally more interested in how you tell your own story than in a finished summary of it.

What does "orient me to your life?" mean as a first-session question?

It's an intentionally open prompt some therapists use instead of a structured intake list. It lets the client decide what to lead with, what to skip, and how to organize their own story, and that shape often reveals as much clinically as the specific facts do.

What should I actually bring to my first therapy session?

Honesty about where things stand, and if it helps you, a short list of topics or a loose timeline as a backstop. You don't need a polished narrative or a complete diagnosis of yourself. A good therapist is equipped to work with whatever you bring, organized or not.

References

  • McAdams, D. P. (2001). The psychology of life stories. Review of General Psychology, 5(2), 100-122. https://doi.org/10.1037/1089-2680.5.2.100
  • Freud, A. (1936). The ego and the mechanisms of defense. International Universities Press.
  • Hayes, S. C., Wilson, K. G., Gifford, E. V., Follette, V. M., & Strosahl, K. (1996). Experiential avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment. Journal of Consulting and Clinical Psychology, 64(6), 1152-1168. https://doi.org/10.1037/0022-006X.64.6.1152
  • Hewitt, P. L., & Flett, G. L. (1991). Perfectionism in the self and social contexts: Conceptualization, assessment, and association with psychopathology. Journal of Personality and Social Psychology, 60(3), 456-470. https://doi.org/10.1037/0022-3514.60.3.456

If this resonates, it's the kind of work I do. You can book a free 15-minute intro call, or read more in the Ask a Therapist series.

Olivier van Hauwermeiren, PsyD, is a licensed clinical psychologist serving New York City via telehealth, licensed in New York and Wisconsin and PSYPACT-authorized to practice telepsychology in 40+ states. He specializes in anxiety, OCD, trauma, and performance challenges among high-achieving professionals.

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