What to Expect at Your First Therapy Session

If you’re thinking about going to therapy for the first time, you might feel a mix of emotions: excitement to get a professional’s take on issues that are bothering you, anxiety and awkwardness about opening up.

All of those feelings are valid (which is something you’re about to start hearing a lot). “It’s natural to feel nervous—you’re challenging societal norms that encourage you to stay quiet, endure, and push through,” says Amie Grant, the owner of Take Up Space Therapy Services in Cleveland. But in therapy you can reject those expectations and honor your voice, your needs, and your truth, she says.

Krista Jordan, a clinical psychologist in Austin, reiterates that going to therapy for the first time can feel even more stressful if you don’t know what to expect. To quell your nerves, it can be helpful to keep in mind that therapists are just people, and that as a part of their training, most have been in therapy themselves, “so we know what it’s like to sit on the couch side of the room.”

Here’s exactly what to expect at your first therapy appointment, and how to set yourself up for success.

What happens before your first appointment

Many therapists offer a 10-20 minute complimentary consultation call to see if you feel it’s a good fit before booking a formal session. If you decide to move forward, they will likely have you fill out paperwork covering insurance information, basic medical history, what you hope to achieve in therapy, and any medications you take. Some practitioners try to screen for certain conditions like depression or anxiety in advance of your first session, so you may fill out one or more of these mental-health questionnaires before your appointment, then review the results in your first session, says Jordan.

Therapy has started. Now what?

“When I’m as prepared as possible in any situation, I’m less nervous,” says Sheri Langston, a licensed professional counselor and director of Rocky Mountain Therapy Group in Denver. Therapy is no exception.

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Most appointments are between 45 and 55 minutes, though some forms of therapy may last up to two hours. All therapists conduct their sessions differently depending on factors like what kind of therapy they practice, their personality, and how they prefer to structure meetings.

But all therapy modalities share one commonality: You’ll be talking about your feelings. (No getting around that part.)

Body talk

You’ll likely sit facing your therapist, says Jordan, since therapists are trained to read facial expressions and body language. Seeing your therapist’s face and body while you talk to them can also assuage some of your fears, says Jordan. “For example, if you are worried that you are saying something that makes you look like a loser, but you see that your therapist has a warm look of compassion on their face, it can help you to believe that maybe people don’t see you as a loser,” she says. “Seeing your therapist’s reactions to what you say can actually be part of the growth process.”

However, lots of people are uncomfortable with prolonged eye contact, so know that it’s OK not to stare at the therapist every second. If your session is in-person, the therapist will often deliberately have art or knickknacks around the room that you can look at when you need a break from looking directly at them, she says.

Similarly, if you’re in a virtual therapy session, feel free to look away from the screen periodically to give yourself a break.

The one exception to these face-to-face set-ups is for psychoanalysis, which is conducted with the client lying down and looking away from the analyst, but “most therapies no longer do that arrangement,” says Jordan.

Settle in

Not sure where to sit? “If there is a sofa or cushy chair, that is for you,” Langston says. “The biggest clue is: look for the box of tissues and sit there.”

So once the session begins, should you break out a pen and notepad? Grab the tissues? Start talking or let the therapist steer the show?

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The truth is, most new therapy patients are anxious before their first session, and therapists know this and will do their best to put you at ease. “Walking into your first session—whether virtually or in person—can feel like stepping into unfamiliar territory, but know this: you belong here,” says Grant. 

She always starts sessions for new patients by explaining her approach to therapy. She also urges patients to release their pressure to perform: “You don’t need a detailed life story or perfect answers. The fact that you showed up is enough,” Grant says. And remember: “You’re in control of how much you share.”

What to talk about

Many people don’t realize that the first therapy session—often called an “intake”—isn’t about going deep, Jordan says. A good therapist will take time to get to know you, she says, and doesn’t need you to divulge all the most painful things you’ve experienced on day one. 

“Therapists are actually trained not to let you talk about all the gory details of trauma in the first session,” says Jordan. “Even if you eventually get around to talking about really difficult memories, we are trained to do it in small pieces so that you don’t fall apart and can’t function the rest of the day.”

Instead, focus on things like what’s been bothering you in the past week, stress about an upcoming event, or a work incident that rubbed you the wrong way. Jordan says you can also discuss goals that you would like to pursue, like learning to be more assertive or better at identifying your emotions.

Share your goals

It can also reduce your pre-session anxiety to have a short version of what you hope to accomplish in therapy ready, such as “I’d like to work on self-esteem” or “I want to stop repeating negative partner choices,” says Jordan. If the conversation stalls or you’re not sure what to say next, it’s OK to ask the therapist, “Can you help me understand what would be useful to talk about?” she adds.

It’s the therapist’s job to be flexible. “I’ve had clients who prefer to share as little as possible until they get to know me better,” Langston says. “Sometimes a client will say, ‘I’d rather talk about that in a later session’ or ‘I’m not ready to talk about this yet.’ Any compassionate, person-centered therapist not only understands, but will appreciate your honesty and will honor your words.”

Give yourself time

As you build a foundation with your therapist, remember that the first session (or even the first few sessions) are just as much about them getting to know you as you getting to know them and determine if they are a good fit for you.

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Things might feel a little awkward during those early sessions, and that’s normal, says Grant. After introductions in an intake meeting, Grant asks about the person’s goals, challenges they’re facing, and what support looks like to them.

People shouldn’t expect to “feel better” after the initial session, Langston adds. Initial sessions are about information gathering, so expect a lot of questions as your therapist gets to know you and your needs. “All of this is to build a treatment plan that’s personalized for you,” says Langston. 

Remember to ask questions

Some therapists may devote the last few minutes of an intake session for you to ask questions, recap what you’ve discussed, and determine action plans; they may even give you a “homework” assignment to try before your next meeting. Before your session ends, Langston recommends patients ask two questions:

1. “What are my treatment goals?” You and your therapist will together decide on the goals for therapy.
2. “How often should we meet?” Therapists typically like to see clients at a regular cadence such as weekly or once every two weeks in order to meet treatment goals.

As for actually remembering—and putting into practice—key takeaways from your session? During therapy, some people might find it useful to jot down important advice and next steps by hand or on their phone, while others prefer to partake in the session without any note-taking (you could also ask your therapist to share their personal notes with you after your meeting).

Another option is to write down notes immediately after a session while your thoughts are fresh. Some people also like to record their therapy sessions to review later; just ask your therapist if this is okay with them.

What to do after your first session

Take a deep breath and give yourself some time to reflect after a therapy session. For those conducting their session virtually, you may want to take a walk around your block to clear your head and mark a transition between activities, rather than hopping right back into your inbox, checking the stock market, or cooking dinner.

“You don’t need to decide right away whether this therapist is ‘the one,’” says Grant. She suggests asking yourself questions like “Did I feel comfortable?” and “Could I see myself opening up to this person over time?” Still, she says, if the answer is uncertain, that’s normal, so you may have to give yourself more time or more sessions to decide.

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If you realize a therapist isn’t the right fit right away, however, Grant says you should have no qualms about not scheduling any further sessions with them. “If you feel comfortable, you can let them know directly. A simple statement like, ‘I don’t feel this is the right match for me, but I appreciate your time,’ can help you close that chapter,” she says.  

In some situations, you may feel a therapist is a good match but have feedback for them. This kind of constructive feedback can take several forms, Grant says:

• “Can we slow down a bit next time? I need time to process.”
• “I’d like more structure or specific tools to take away from our sessions.”
• “I feel like we’ve been focusing on [X topic], but I want to shift toward [Y topic].”

Since your therapist is there to support you, a negative or dismissive response to you voicing your opinion may be a sign to part ways with a practitioner, says Grant.

In general, therapists have thicker skin than you might think, and all good therapists want what’s best for the patient, so they won’t take things personally if you decide to part ways.

“It’s OK to shop around for a therapist that meets your needs. Try to determine the criteria that are important to you,” says Langston. She often ends initial sessions by telling clients that if she’s not a good fit for them, they shouldn’t feel obligated to continue. “I want my clients to feel comfortable—it’s their time and their therapy,” she says. “If you are with a therapist that isn’t a good fit, it will hinder the therapeutic process.”

“There have been 50 years of research on what makes therapy work,” Jordan says. “The only thing all of these studies agree on is that you have to feel that you have a good fit with your therapist.”