18 Things to Expect From Your First Therapy Session

Knowing what might happen at your first appointment may make it easier to take that first step.

Published October 20, 2022
Smiling woman with therapist at community center

Have you ever thought about going to therapy? If you never went, what roadblocks stood in your way? Maybe you didn't have access to a therapist. Or, maybe you were nervous about sharing your most vulnerable thoughts. For some people, the greatest barrier is simply not knowing what to expect when they dive into the unknown.

Opening up about your personal struggles is a big ask. However, it shouldn't hold you back from getting the help you need. We talked to mental health professionals to create a guide that gives you an inside look at a first therapy session to help break down the process and ease your mind.

What to Expect From Your First Therapy Session

People often have misconceptions about therapy. For example, some might think that therapy is only for those who are in an emotional crisis. Or that therapy is only for people who already have a mental health diagnosis. However, neither of these common beliefs is true.

Therapy can support almost anyone. It is a tool that can help a wide range of people heal emotional wounds, find balance, or tend to their mental health.

If you think that therapy will help you achieve one of these goals, use this guide to educate yourself about the psychotherapy process. The more you know, the less scary it might seem.

You (May) Start With a Short Consult

Therapy requires you to be open and honest with someone who is, initially, a stranger. So it's important to do some research beforehand and find a therapist that fits your needs and preferences. You can use online resources to find a professional or get a referral from your healthcare provider.

"Ideally, you (will be) able to have a free, quick consult with your new therapist prior to the first appointment to get an idea if the therapist is a fit," says Lindsey Ferris, a licensed marriage and family therapist associate (LMFTA). A short video or phone chat with your potential therapist can help you decide if you want to commit to a full session.

During the consultation, you can learn a little bit about each other and get a sense of whether you would like to move forward. If you aren't sure if a therapist offers consultations, send them an email or call their offices.

There Is a Lot of Paperwork

Before you can actually get to the therapy itself, there is some paperwork you will have to fill out. Your therapist will help you with it at the start of the first session, or they may send it to you beforehand.

"Paperwork can be completed prior to a session, but therapists need to get a client's agreement to fees, billing insurance, privacy and HIPAA policies, cancellation policies, and a disclosure agreement consenting to therapy," says Gabrielle Juliano-Villani, licensed clinical social worker (LCSW).

You will get copies of all of the information, and you can ask questions at any time. Your therapist might provide an online patient portal where you can access the information digitally.

You and Your Therapist Will Get To Know Each Other

The first therapy session is where you and your provider will break the ice. "It's a mix of getting to know you and setting the agenda for the rest of the therapeutic process," notes Jeremy Schumacher, marriage and family therapist (MFT).

There's no right or wrong way to introduce yourself. Just say whatever feels right. You can share your hobbies, what you do for work, talk about any pets, or even about where you live.

Then, your therapist should say a little bit about themselves. For example, they might talk about their job title, specialties, or approach to therapy.

Your Therapist Will Ask Background Questions

Your first session might feel a bit like an interview. But don't worry, you're not being interrogated. Your therapist is just trying to get a holistic view of you and your life.

"You'll likely be asked questions about your mental health history, previous experiences with therapy, as well as information about your childhood and family history," notes Halle M. Thomas, LMFTA. Just do your best to be as honest as possible."

According to Dr. Elizabeth McMahon, Ph.D., some topics you cover during a first therapy session include:

  • Any biological relatives who have mental health conditions (to understand possible genetic factors)
  • Childhood and relevant past experiences
  • Medical issues and use of alcohol and other chemicals
  • Relationships
  • What was helpful or not helpful from any past experiences you have had in therapy
  • What you want to gain from therapy
  • Your education and work experiences

You'll Discuss Your Motivation for Therapy

"I typically ask a client what brings them to therapy," says Juliano-Villani. Maybe your motivation for seeking therapy can't be summed up in one sentence. Or, maybe you aren't exactly sure, but you just felt like it was a step you needed to take.

It's okay if you don't have the exact words, just try to give as many details as possible. You can talk about your thoughts, where you're at in life, or where you want to be. If you have the time, it can be helpful to reflect on this question before your session.

You'll Do Most of the Talking

The first therapy session is all about gathering information. In fact, it's known as an "intake session" because your therapist is trying to take in as much information about you as possible. Your therapist might ask most of the questions, but you'll be doing the majority of the talking.

"Therapists want to be able to get a clear picture of what you're dealing with, so going through your story in detail is important," says Kali Wolken, licensed mental health counselor (LMHC). In addition, Wolken says, they may ask questions that don't feel relevant or that you don't know the answer to. It is okay to say, "I don't know."

You don't have to do a deep dive into vulnerability just yet if you don't feel ready. Share whatever you can that may help your therapist create a clear picture of how they can help.

You Will Set Goals

During your first session, you may be asked to set some goals. What do you want to accomplish through therapy?

"This is an incredibly hard question to answer on the spot. So if you have time, try to picture what you hope your life will look like at the other end of the tunnel," says Wolken. Don't worry if you can't answer this question by the end of the session. Take whatever time you need to really think about what changes you would like to make.

You and Your Therapist Will Build Rapport

"You will begin forming a connection with your therapist to establish a safe working relationship," says Danielle Tucci, a licensed professional counselor (LPC). Creating a rapport with your therapist allows you to build the trust that is needed to create change in your life.

Tucci adds that a solid therapist/client match is key to treatment success. So it is important that you feel some level of comfort during your first session.

You May Experience a Lot of Emotions

For some people, going to therapy feels like running an emotional marathon. You're likely to experience a range of exhausting emotions. If you feel comfortable, you can express them to your therapist.

Tucci says, "It is 100% normal to feel mixed emotions starting therapy!" She notes that people might feel anxious at the thought of having to connect to someone or even fearful about sharing particular thoughts or feelings.

Whatever you feel, just know that it's normal and that many people feel the exact same way during their first therapy session. Remember to take deep breaths and communicate as much as possible.

Your First Session Will Probably Last Less Than an Hour

Talking about your emotions for long periods of time can be stressful and even triggering for some individuals. If this is a barrier for you, know that your first therapy session will most likely be under an hour.

"Generally, therapy appointments run 45 minutes to one hour based on individual client needs," notes Akos Antwi, a psychiatric mental health nurse practitioner (PMHNP). Many people find that the introductory session is even shorter than the standard session to help ease people into the new experience. You can ask your therapist at the start of your session for a time estimate.

You Can (and Should) Ask as Many Questions as You Want

Your therapist isn't the only one allowed to ask questions. In fact, the client-provider relationship is a two-way street. "It is important in this first session that you have a clear idea of what working together will look like, so ask any questions that you think of," says Elspeth Robertson, a registered clinical counselor (RCC) and art therapist.

If anything is unclear, you should feel empowered to get clarification. According to Amber Dee, therapist and founder of Black Female Therapists. Some questions to ask may include:

It Can Take Several Sessions to Feel Comfortable

Therapy takes a lot of work. It requires you to question your thoughts and behaviors and maybe even communicate feelings that you may have never shared with anyone else.

"Talking with a new person about personal and sensitive topics is difficult. It may take several sessions before you begin to feel comfortable," says Keyasia Downs, licensed independent social worker (LISW). So don't feel disheartened if you leave your first session still feeling a bit guarded.

It takes time to establish trust. The more therapy sessions you experience, the greater the bond you can form with your therapist. It's okay if it takes three, four, or even more sessions until you really open up.

You Get to Decide if Your Therapist Is a Good Fit

At the end of your first session, your therapist might ask if you want to schedule a second appointment. You don't have to respond right away if you aren't sure. You can tell them that you want to take some time to sort through your feelings and decide if it's a good match. Then, they should reach out to you within the week to get your decision.

How do you know if you and your therapist are a good match? According to Kevin Coleman, a marriage and family therapist (MFT), you should ask yourself the following questions:

  • Do I feel comfortable telling my therapist about myself and what I'm struggling with?
  • Do I trust that this therapist is both a caring person and a knowledgeable professional?

Coleman says that after answering these questions, you'll know how you feel about your new therapist, and hopefully, you'll be confident that they can help you improve your mental health, your relationships, and your life. You should be able to develop a close relationship with your therapist, but still feel as though you can set and maintain boundaries.

Your Therapist Also Gets a Vote

Your therapist also has a say in whether or not you are a good fit. According to Erin Pritchard, a licensed professional clinical counselor supervisor (LPCC-S), during the first session, the therapist is also determining if they're clinically appropriate for the client's needs and goals.

This is important because there are many different types of therapy. In addition, therapists are trained in various techniques, have different approaches, and have unique ways of facilitating sessions.

Your therapist might believe that there is a mental health professional that is better suited to your needs. For example, if you have experienced trauma in your life, your therapist might not have the background to give you the trauma-informed support you need. In this case, your therapist might be able to refer you to a therapist who is a better fit.

You Might Get Homework

You might get "homework" from your therapist that can help you address whatever issues you are facing. For example, you might get a handout to read, a writing assignment, or even a self-care activity.

These exercises serve as a simple tool or strategy for you to practice before the next session, says Amanda Craven, clinical hypnotherapist and life coach. If you don't complete the assignments, that's okay. What's important is that you explore the assignment and provide some feedback.

You May or May Not Be Given a Diagnosis

Do you hope to be given a diagnosis at the end of your session? Some people feel that a diagnosis helps them better understand and connect with whatever they are facing. But others might feel weighed down by a label.

"A diagnosis is required to bill the insurance company, so if you are using insurance, expect that there will be a diagnosis given," says Christina Meighen, LCPC and board-certified telemental health provider.

If you want to know your diagnosis, ask your therapist about it at the end of the session. You can also ask about the pros and cons of knowing and whether or not it would help you heal. It's important to note that it might take more than one session for a therapist to deliver a diagnosis.

Your Therapist Will Start a Treatment Plan

Your treatment plan is like your road map. "Assessing the patient's level of functioning in different areas of their life, such as work, relationships, and self-care, will help the therapist create a treatment plan tailored to the patient's individual needs," says Dr. Harold Hong, a board-certified psychiatrist.

A treatment plan will lay the framework for what you and your therapist might work on in the following sessions. The plan can also help you mentally and emotionally prepare for the steps ahead.

Therapy Takes More Than One Session to Work

Wouldn't it be wonderful if every negative thought or internal conflict could be resolved after talking to someone just once? Unfortunately, that's not usually the case. Therapy is a marathon, not a sprint.

"All problems cannot be addressed in one session. You need to sit with the feelings even if they are very uncomfortable," says Jordyn Mastrodomenico, licensed clinical alcohol and drug counselor (LCADC).

"You can keep a journal to write down how you feel, take a walk, go out with a friend for coffee and even sleep it off," she notes. Healing takes time, and it can cause a lot of emotions to bubble up to the surface. But don't let those feelings discourage you.

After your first session is complete, schedule a second appointment, or continue your search for a therapist that might be a better fit. Each step you take will bring you closer to improving your overall mental health and well-being.

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18 Things to Expect From Your First Therapy Session