Blunt but honest opinion: Starting therapy can be a daunting step in your healing journey. I mean you’ve paged through all of the therapist profiles from your city, you’ve figured out how to fit 60 minutes into your weekly work and life schedule, and you’ve even mapped out that your insurance covers some of the costs (yeehaw!). You might have even met your therapist for a pre-consult and felt a super good connection with them. 

But you just can’t seem to shake that sense of anxiety that still sits in your chest when you think about your upcoming, first-ever session with this person. Where do you start? What do you even talk about? What do you do with any awkward silences that show up? You literally don’t know what to expect, and that is a recipe for anxiety for the planner in you.

Well, first and foremost, I hope you understand that you’re not alone in this trepidation or package of nerves you’re wrestling with. These questions (and all of the questions that follow in this post) are pretty dang common for folks who are just starting to seek out therapy, or are even coming back after a lengthy break. My goal in this post is to walk you through what typically happens in your first therapy session, answer some common questions, and help you feel as comfy as you can be as you take this exciting step.

What to Expect in Your First Therapy Session

Step 1: Setting the Stage: The Welcome and Introduction

In your first session, our main focus is creating comfort and building trust that we can base our therapeutic relationship on. Whether you’re meeting in person or online, you’ll be able to spend time building up a sense of who your therapist is and how they approach therapy.

Most of the time, we’ll review any questions you might have about the intake paperwork you completed before your first session. We’ll also go over confidentiality practices—what you can expect from us in terms of privacy, and how we ensure your safety and comfort throughout the process.

This is also the space to ask any logistical questions you have:

• Wondering about billing or payment details? We’ll clarify that.
• Curious about the space you’re in (whether it’s in person or virtual)? We’ll walk through it.
• Have questions about what’s next or what the therapy process will look like? We’ll answer those too.

Think of this first session as the foundation where we clear up any practical concerns, so you can feel confident moving forward.

Step 2: Getting to Know Each Other, Your Story and Your Goals

You and your therapist will then spend some time getting to know and understanding what brought you to therapy. They’ll ask questions about your life and what it looks like right now, current challenges or ‘stuck’ spots you’re finding, and what you’re hoping therapy can help with. This is your space to share as openly as you want, but we pinky promise that you’ll never be pressured to talk about anything you’re not ready to. 

Questions that might show up in the part of the session:

          -> How much should I share about my personal life in the first session?

As much, or little, as what feels right for you. And if you don’t know the answer to that, rest assured, your therapist will ask questions along the way to help them explore, understand, and connect with what you’re saying and feeling. 

          -> What kind of questions will the therapist ask me? Will I have to talk about everything right away?

This depends on who your therapist is, but generally speaking they’ll be most interested in exploring what brought you in to see them. They might ask you where you’re feeling stuck in your life, if you know what it is that’s keeping you stuck or if that’s something we still need to explore, and maybe they’ll ask a bit more about the context of your life (think: what your relationships look like right now, what your family life was like while you were a kid, satisfaction levels with work/school, those kinds of things.)

          -> What if I don’t know exactly what my goals are for therapy?

That’s the beauty of it all, you don’t need to have exacts when you choose to step into the therapy space. Your willingness to explore and work towards what you want your life to look like is what fuels your progress, not your ability to have it all mapped out immediately (or ever, if we’re being honest). If you’re not sure what your goals are, starting with explaining where you’re feeling stuck in your life, relationships, work, etc., is a great place to launch from. Your therapist will ask questions to better understand what you’re experiencing and help develop goals that fit like a glove. 

Step 3: Building Trust: Your Therapist’s Approach

While talking about what brought you to the office, your therapist might weave in info on how they’ll approach the barriers you’re facing with you. This might look like talking you through what theories inform the work they do, explaining how their work has helped others that have gone through similar things, or some example exercises that could help progress you towards your goals. You two might also start drafting an idea of how therapy will unfold over time for you. This  is a chance for you to ask questions about how they work and to flag any concerns/worries/hesitations that pop up around starting to move forward. 

Questions that might show up in the part of the session:

          -> What if I don’t like the therapist’s approach or style?

Did you know that the fit between you and your therapist is the strongest predictor of your success? This means that if you’re recognizing an ill-fit with your therapist’s personality or approach, it’s imperative that you find a therapist that you do feel you connect with. If you feel uncomfortable sharing this with your current therapist, you’re welcome to reach out directly so we can help you make the switch feel seamless.

          -> Can I ask my therapist about the tools they use in therapy?

Please do! Some questions that you could ask are: ‘What have you seen to be helpful for others that you’ve treated facing similar situations?’, ‘How are we going to be able to work with the problems that I’ve outlined thus far?’, ‘What tools can you hand me that would be helpful, given what you know so far about my stuck spots?’.

Step 4: Setting Expectations: Frequency, Duration, and Homework

How often you’ll meet with your therapist is an important topic of conversation within this first session. You two will want to strike a balance of having ample time to work with what you’ve uncovered together, but meeting frequently enough to avoid losing steam and momentum. As a rule of thumb, it’s common to meet for therapy somewhere between once every week or once every two weeks. 

Some of our therapists like to suggest “homework” or things to do between sessions that help you bring what you’ve learned into everyday life. This can be helpful to keep momentum up between your appointments and make sure that what you’re covering in therapy is practical and useful. 

Questions that might show up in the part of the session:

          -> How often will I need to come to therapy? Is weekly the norm?

This depends on what feels helpful for you, what is financially feasible, and what goals you’re hoping to tackle. Most commonly we are seeing folks somewhere between weekly and every other week.

          -> What happens if I don’t do the homework we talked about, in between my sessions? 

Any tasks suggested for between sessions are just that, suggestions. The goal of offering you something to work on between your appointments is to help further the work you’re doing by applying it to your daily life. If you forgot about it, didn’t find the time, or simply didn’t think it fit what you need, no sweat. Your therapist might explore how to overcome some of the barriers you faced or how to make sure that anything suggested is more fitting for what you’re needing. 

Step 5: Ending the Session: Wrap-Up and Next Steps

As the time together comes to a close, your therapist will probably want to know how you’re feeling about the conversation and if questions have bubbled up along the way. You’ll work to create a plan for your next session, and set up a time and date for your next meet up.

Questions that might show up in the part of the session:

          -> Will I feel “better” after the first session?

If the fit feels solid and you’ve started to build a connection with your therapist, you might leave your first therapy session feeling hopeful or excited about the potential your healing journey holds. It is pretty dang exciting to finally feel heard & seen, especially if you’ve spent a long time not feeling that. It could also be that sharing parts of your story with someone new brings up some feelings that you hadn’t expected. There’s no right or wrong way to feel after your first therapy appointment, but if something unexpected or troublesome shows up it would be important to bring this up to your therapist next time you meet. 

          -> What if I don’t feel ready to dive into certain topics yet?

My best advice: dive into what you do feel ready for, and leave the rest for later. There’s no reward for pushing you through things you don’t feel ready for, especially in a therapy office. If your therapist asks about things you’re not ready to talk about, just say “I’m not ready for that yet” and they’ll help you move into talking through what you are. 

Final Thoughts: Let’s Get This Show on the Road

Your first therapy session is not going to be a magical fix-all moment (we’ll leave that to the movies), but it most definitely is the start of something real. A real space that you’ll feel heard, seen, and above all, respected. We’re here to get to know you, answer your questions, and make sure you’re diving in a pace that feels right for you. 

Ready to dive in? Let’s get started.

With so so so much peace and light, 

Jakkie DeCorsey, MSW LICSW