What You Should Expect from Your First Therapy Session

Starting therapy for the first time can feel both exciting and intimidating. Whether you’re seeking help for stress, anxiety, relationship issues, or personal growth, taking that first step toward seeking support is a powerful decision. But many people wonder: “What should I expect during my first therapy session?” Here’s a guide to help you prepare for your initial therapy experience, reduce any anxiety, and get the most out of your first session.

1. A Warm and Welcoming Environment: One of the first things you’ll notice when you walk into a therapy office (or sign into a virtual session) is that it should feel like a safe and welcoming space. Therapy is a place where you should feel comfortable expressing yourself without fear of judgment. A good therapist will create an environment where you feel heard, supported, and respected. In the first session, don’t expect to dive straight into heavy emotions. Your therapist will likely start by helping you settle in, and the conversation will be gentle, allowing you to get comfortable before delving into deeper topics.

2. Introduction to the Therapy Process: The therapist will typically begin by introducing themselves and explaining their role in your therapeutic journey. They may discuss their approach to therapy and how they work with clients. You might hear terms like “cognitive-behavioral therapy (CBT)”, “psychodynamic therapy” and “humanistic therapy” but don’t worry if you’re not familiar with them. The key here is that your therapist will make sure you understand what to expect from the therapy process. If you have any concerns or hesitations, feel free to ask about the therapist’s approach. It’s important to feel aligned with your therapist’s methods, and most therapists welcome questions about their treatment style.

3. Gathering Background Information: In most cases, your first session will involve some paperwork. This typically includes providing personal information like your contact details, insurance (if applicable), and medical history. The therapist might also ask you about your current concerns, background, and any mental health history that could be relevant to your treatment. This isn’t a quiz, but rather an opportunity to help your therapist understand where you’re coming from, your history, and the issues that are important to address. If you’re unsure how much to share, it’s okay. Your therapist will guide you through it, and you can go at your own pace.

4. Exploring Your Reasons for Seeking Therapy: During the session, your therapist will likely ask you about the main reason you’re seeking therapy. They might ask questions like:

- What brings you in today?

- What are your goals for therapy?

- What challenges or feelings have been bothering you lately?

- What would you like to get out of our sessions together?

These questions are designed to help the therapist understand the root of your concerns, and they serve as a way to begin forming a therapeutic plan. This part of the session can feel like the most vulnerable, but it’s important to be honest and open. However, remember: you can share only what you’re comfortable with. Therapy is your space, and you control the pace.

5. Setting Goals Together: The first session is often a time for goal-setting. You and your therapist will discuss what you want to achieve through therapy, whether it’s reducing anxiety, managing stress, improving relationships, or simply gaining a better understanding of yourself. Goals can be short-term (like reducing immediate anxiety symptoms) or long-term (such as improving self-esteem or making lifestyle changes). Your therapist will help you identify these goals and map out a plan to work toward them over time. This might include weekly check-ins on your progress.

6. Understanding Confidentiality: Your therapist will take a few moments to explain confidentiality. This is crucial because knowing that your conversations are private helps build trust. In general, anything you share in therapy remains confidential, with a few exceptions. For example, if there’s a risk of harm to yourself or others, your therapist is required by law to take action to ensure safety. Confidentiality creates a safe space where you can freely express your thoughts and feelings. If you’re unsure about any of the rules regarding confidentiality, don’t hesitate to ask questions therapists are happy to clarify.

7. No Pressure to Share Everything Right Away: A common misconception is that therapy requires you to reveal all of your deepest emotions and thoughts during the first session. While some people might feel comfortable doing so, it’s perfectly okay if you’re not ready to dive into the more challenging topics just yet. Therapists understand that trust takes time, and they will not push you to share more than you’re ready for. In fact, many therapists will take a gentle approach, letting you guide the pace of your disclosure. The first session is often more about laying the groundwork for future conversations.

8. An Opportunity to Ask Questions: Your first session is a two-way conversation. As much as your therapist will be learning about you, it’s also important that you learn about your therapist and the therapy process. Here are a few questions you might want to ask:

- What approach do you use in therapy?

- How do you typically work with clients who struggle with [anxiety, depression, etc.]?

- What should I expect from future sessions?

- How long does therapy usually take to see results?

These questions help you gain clarity and ensure you’re on the same page. If anything is unclear or if you have any concerns about the therapy process, now is the time to ask.

9. Your Therapist Might Give You Some Homework: Depending on the therapist’s approach, they might suggest an activity or a small task for you to complete between sessions. This could be as simple as journaling, practicing mindfulness, or using a specific coping skill. Don’t worry if you’re not asked to do anything right away some therapists prefer to take things slowly and wait until the second or third session before suggesting exercises.

10. Setting Up Future Sessions: By the end of the session, you and your therapist will likely discuss the frequency of future meetings. Depending on your needs, therapy sessions typically occur weekly, biweekly, or monthly. Regularity helps build momentum and creates a structure for your journey. The first session will be about establishing a rapport and beginning the therapeutic process. Subsequent sessions will be where deeper work happens. Your first therapy session is just the beginning of a transformative journey. While it may feel like a lot of information to absorb, know that it’s normal to feel a mix of emotions afterward. You might leave feeling hopeful, relieved, confused, or even overwhelmed. That’s okay these are all natural reactions when starting therapy.

References

Langs, R., & Langs, R. (2004). The first session. Fundamentals of Adaptive Psychotherapy and Counselling, 175-188.

Miller, R. (2011). The first session with a new client: five stages. The trainee handbook: A guide for counselling & psychotherapy trainees.