What to Expect in Your First Therapy Session

Taking the step to begin therapy is a courageous decision that opens the door to personal growth and healing. If you’ve scheduled your first appointment, you might be wondering what actually happens during an initial therapy session. Understanding what to expect can help ease anxiety and prepare you for a productive start to your therapeutic journey.

Before You Arrive

Most therapists will have you complete intake paperwork prior to your first session. This typically includes your personal information, medical history, insurance details, and questions about what brings you to therapy. Some therapists send these forms electronically beforehand, while others may ask you to arrive early to complete them in the waiting room.

The Initial Meeting

Getting Comfortable

Your therapist will likely begin by welcoming you into their office and inviting you to sit where you feel comfortable. Therapy spaces are designed to feel safe and private, with comfortable seating and a calm atmosphere. This first interaction sets the tone for your therapeutic relationship.

Introductions and Orientation

The therapist will introduce themselves and explain their approach to therapy. They’ll outline important practical matters such as:

Session length (typically 45-50 minutes)
Frequency of sessions
Cancellation policies
Confidentiality and its limits
How payments and insurance work

Discussing Confidentiality

Confidentiality is the cornerstone of therapy. Your therapist will explain that what you discuss remains private, with a few important exceptions that they are legally required to report

If you pose an imminent danger to yourself or others
Suspected child, elder, or dependent adult abuse
If required by court order

The Assessment Phase

The bulk of your first session focuses on you sharing what brought you to therapy. Your therapist may ask:

What specific concerns prompted you to seek help now
How long you’ve been experiencing these difficulties
What you’ve tried previously to address these issues
Your personal and family mental health history
Your current living situation and support system
Your goals for therapy

Remember, you control how much you share and at what pace. Some people feel comfortable opening up immediately, while others need more time to build trust.

Establishing Goals

These might be specific (like reducing panic attacks) or more general (like improving relationship communication). Goals help provide direction and a way to measure progress.

Treatment Planning

The therapeutic modality they think would be most helpful (CBT, psychodynamic, etc.)
An estimated timeline for treatment
Any homework or practices to try between sessions
Additional resources that might complement your therapy

Questions and Next Steps

Your Turn to Ask Questions

The first session is also your opportunity to ask questions and determine if this therapist is the right fit for you. You might want to ask about:

Their experience treating your specific concerns
Their theoretical orientation or treatment approach
What a typical session will look like going forward
How progress will be measured

Scheduling Your Next Appointment

If you feel comfortable continuing with this therapist, you’ll typically schedule your next appointment before leaving. Many therapists try to establish a regular weekly or bi-weekly time slot for consistency.

After Your First Session

It’s normal to experience a range of emotions after your first therapy session. You might feel:

Relief from finally sharing your concerns
Emotionally drained from discussing difficult topics
Hopeful about the possibility of change
Uncertain about whether therapy will help

Give yourself time to process these feelings. The first session is just the beginning of your therapeutic journey.

What Therapy Is Not

To set realistic expectations, it’s important to understand what therapy is not:

It’s not a quick fix or instant solution
Your therapist won’t tell you exactly what to do or make decisions for you
It’s not just venting or casual conversation
Your therapist isn’t your friend (though they are friendly and supportive)
It’s not a one-size-fits-all process

Finding the Right Therapist

If after your first session you don’t feel comfortable with your therapist, that’s completely normal and okay. Therapeutic relationships, like any relationship, require good chemistry. It may take meeting with a few different therapists before finding someone who feels right for you.

Final Thoughts

Your first therapy session marks the beginning of a journey toward better mental health and well-being. By approaching it with openness and honesty, you’re taking an important step in caring for yourself. Remember that therapy is a collaborative process that unfolds over time, and the initial session is just laying the groundwork for the meaningful work ahead.

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