Your First Therapy Session

After you’ve chosen a therapist, the next step is your first session. Even if you feel confident about starting therapy, it’s completely normal to feel nervous, especially if this is your first experience and you’re unsure what to expect.

Keep in mind, though, that the purpose of the first session is to help you and your therapist get to know each other and to help you decide if you think the relationship will be a good fit.

1. Preparing for your session

Set goals

Prior to your first session, reflect for a few moments on what brought you to therapy. What have you been struggling with lately? What changes would you like to make? Take time to think through these questions. If it would be helpful, you can write down thoughts and questions to bring to the appointment. It may also help you feel more comfortable to think about what relevant information you think the therapist should know about you, and what you hope to get out of your first session.

Manage logistics

For many people, squeezing a therapy session into a busy schedule is already hard enough. But if you have the flexibility, choose a strategic time for the appointment, when you have a few moments to clear your mind before the session and time afterwards to process it.

If the office is somewhere you’ve never been before, it can be useful to plan out your route beforehand and calculate when you should start your trip. Make sure you bring your insurance information and any other relevant documents, and plan to get there a few minutes early so you can go over any necessary paperwork. If you arrive very early, therapists typically have a waiting room where you are welcome to look at your phone, read a book, or flip through a magazine until it is time for your session.

If your therapy session is virtual, decide where you will have it ahead of time. Find a quiet space so you’ll be able to hear the therapist and you won’t be distracted. If you don’t have a private space in your home, you could sign out a room at your local library or drive to a quiet location and have your session in the car.

Handle payment and insurance

Therapists differ on when and how they prefer to be paid; if your therapist doesn’t bring up the payment process prior to the first session, you should feel free to ask when you arrive. Many therapists prefer to take care of payment up front, or to have clients pay for several sessions in advance; that way, both therapist and client avoid the awkward experience of having to discuss payment after a particularly difficult session.

2. What Happens During the First Session

What the session will cover

Therapy sessions are typically 45 to 50 minutes. First sessions cover the basics: what brings you to therapy, your personal history, and how the therapist plans to treat you. Expect the therapist to ask about the specific problem that inspired you to seek therapy, what you hope to achieve over the course of treatment, a brief overview of your life story, and any experience you’ve had with therapy in the past. Many, if not most, clinicians will also explore your family’s mental health history, either directly or indirectly, though not necessarily in the first session. They may also discuss their own therapeutic orientation.

Set expectations

Some people have the misconception that they’ll walk in, divulge their entire history, and be healed in one or two sessions. Unfortunately, this is completely unrealistic. The process takes time, and the goal of the first session is to begin building a relationship. When the session draws to a close, it may feel like you’ve only scratched the surface, or that you just got to the heart of the problem but have to stop. That’s ok – you will pick up the conversation next session.

Setting expectations also includes understanding the therapist’s therapeutic approach. Therapy is not a one-size-fits-all process, and different clinicians use different modalities. While some people imagine a largely unstructured, reflective style, many therapists use more interactive approaches, such as cognitive behavioral therapy, that involve more active dialogue and skill-building. If you have not already discussed modality, the first session is a great time to ask how the therapist works and how their approach aligns with your goals. If you have discussed modality in advance, having a clearer sense of what the sessions will look like can help you feel more prepared and comfortable going into your first session.

Fear of judgment

Another misconception is that the therapist will judge you for certain choices or experiences. This fear of judgment may be due to the stigma around therapy and mental health, particularly in certain communities and cultures. In the rare case that your therapist does judge or shame you, that’s a red flag that you should find a new therapist.

Recognize that being truthful is essential for therapy to be effective. If honesty and vulnerability feel scary due to concerns about judgment, think about it as trying something new: If other approaches haven’t worked, what do you have to lose? Give it a chance for a few sessions. If you still don’t feel comfortable opening up after three or four sessions, think about whether a different therapist may be a better fit.

3. Reflect on the session

There’s no sure-fire way to determine whether a therapist is a good fit, but most clients sense a strong alliance in their first session.

If you’re unsure after the session, ask yourself:

• Do you feel comfortable speaking with the therapist?
• Do you have a good rapport with the therapist?
• Did you feel that the therapist was trustworthy, likable, and respectful?
• Do they seem attentive to your concerns and focused on what you were saying?
• Do they have experience working with clients with similar issues?

If the answer to these questions tends to be yes, it may indicate that you and the therapist have a strong therapeutic alliance, which is a great predictor of successful outcomes. If you primarily answered no, it may be best to keep looking.