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Entering a therapy session for the very first time requires a lot of courage. You may experience a little bit of fear, not knowing what to explain, or even be concerned about being judged. These emotions are absolutely normal - in fact, they're the very reason why familiarizing yourself with what a first therapy session entails can come as a huge help.
In this blog, you are going to find a comprehensive overview of what the therapy room looks like, the type of questions the therapist will be asking, and how to utilize that starting hour effectively.
Why the First Therapy Session Matters
Research published in Frontiers in Psychology (2022) showed that the therapeutic alliance - the attitude you and your therapist have towards working with each other, made during the first session is among the most powerful predictors of therapy outcomes. In simple words: the bond you start to create in the first session is very important.
A systematic review in Clinical Psychology & Psychotherapy (Wiley, 2023) backed the view that people coming to therapy for the first time sometimes feel frightened, secluded, or ashamed of their need for help. Being aware that this is nothing to be ashamed of - in fact, it's quite normal - can help you arrive more confidently.
What Is a Therapy Intake Session?
The initial therapy session is sometimes referred to as an intake session - which, by definition, is the first meeting with the therapist where the therapist attempts to learn about the client's history, comprehend the client's goals, and decide how they might be able to help the client. In fact, you should not think of it as diving right into deep work but rather as a well-organized first chat.
Typically, intake sessions take about 50–60 minutes. The therapist is going to take notes, ask you questions, describe their method of working, among other things. You don't have to have all the answers before going to the session.
What Happens in Therapy - Session One
Here is a realistic overview of what the first therapy session typically involves:
Paperwork and consent
Before the session or during the session, you will fill out forms related to confidentiality, your rights as a client, and payment or insurance. Your therapist will tell you about the limits of confidentiality for example, if there's a risk of harm to yourself or others, they are obligated by law to intervene.
Background and history
Your therapist will inquire about your present circumstances, your mental health history, therapy and medication you may have had in the past, and also your general life history, etc. This isn't an interrogation - rather your therapist is trying to form an understanding of you as a person.
Your goals
They will inquire about what brought you to therapy and what you want to achieve through therapy. There's no need for a well-prepared reply. "I just feel stuck" or "I keep doing the same things and it doesn't work" would be enough.
Their approach
A good therapist will tell you about their way of working and the kind of therapy that they use - whether it is CBT, psychodynamic therapy, IFS, or something else - so that you get an idea of what is involved in working together.
A chance for your questions
Effective therapists really encourage you to ask questions. Don't hesitate in doing this. Matching is very important in therapy.
Questions Your Therapist Will Ask
It can be very helpful to stuff the list in your brain so you can rehearse the answers and not panic when you start the therapy sessions.
|
Question |
Why They Ask It |
|
"What brings you in today?" |
To understand your primary concern |
|
"Have you been in therapy before?" |
To understand your history and expectations |
|
"Are you currently taking any medication?" |
To understand the full clinical picture |
|
"Do you have any thoughts of harming yourself?" |
A standard safety assessment, not an accusation |
|
“What does a good outcome look like for you?" |
To align on goals from the start |
|
"Is there anything you're nervous about telling me?" |
To open the door to trust early |
What to Talk About in Therapy - First Session Tips
Many people just can't think of what to say at their very first session in therapy. Here are some simple ways to kick off the conversation:
-
Why you decide to come here now - not only your entire life story, but what was it that made you finally schedule the session
-
Your biggest, most desired change - in your feelings, thoughts, or behaviors/lifestyle
-
Your deepest fears - it could be the fear of being judged, not being understood, or having to confront painful memories
-
Any previous therapy sessions - what worked, what didn't, what felt wrong
You don’t have to come here with a great plan of action. The therapist's role is to guide you in finding the main point.
Preparing for Therapy: What to Do Before You Go
One of the best ways to lower anxiety about your first therapy session is to prepare what you want to say beforehand:
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Write down your biggest worries - a few bullet points are enough to help you when you feel lost and don’t know what to say
-
Jot down any important history - mental health diagnoses, medications, major events in your life, etc.
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Consider your aims - even vaguely: "I want to be less anxious" or "I want to improve my relationships."
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Show up a little bit ahead of time - allowing yourself a moment to get comfortable lowers cortisol (the hormone of stress) even before you have your session
If you want a tool to help you systematize what you want to say before your session, August, an AI health assistant ranked 100% on medical licensing exams, can help you better understand your symptoms, decide what you want to talk about, and lead your first session with a feeling of readiness instead of being overwhelmed.
What If It Doesn't Feel Right?
It's quite normal not to find every therapist suitable for you because everyone is different. According to a World Psychiatry (Wampold, 2023) article, the research shows that quality of the therapeutic relationship, rather than just therapy type, is a strong factor determining the results. Therefore, it would be perfectly acceptable to switch to a different therapist if you don't feel heard, respected or understood after two or three sessions.
Getting the right fit is certainly not a defeat. It is merely one of the steps.
Key Takeaways
First of all, understanding what your initial session with a therapist will be like can really help eliminate your anxiety about it. Your initial visit to a therapist should simply be a dialogue, not a show. You will be recounting your background, identifying your objectives, questioning the therapist, and taking the opportunity to start at your own rhythm during the session.
The professional relationship which you initiate during that first session is one of the key determinants of the effectiveness of therapy. Simply be there, as open and truthful as you can, and have faith in the process.
If you want, you can even come in much better prepared with the help of August. It can assist you in getting ready - from sorting out your thoughts to figuring out what kind of help will fit you best.
Frequently Asked Questions
Do‍‌‍‍‌‍‌‍‍‌ I have to discuss my childhood during the first session?
Do‍‌‍‍‌‍‌‍‍‌ I have to discuss my childhood during the first session?
No, not at all. The decision of sharing your childhood with a therapist is totally yours and you can always decide to share only as much as you are comfortable with. A professional clinician would not force you to reveal anything beyond your (mental) readiness.
What if I start crying?
What if I start crying?
It's perfectly normal, actually, you could say it is a good sign. Therapists are fully aware of that possibility. Crying doesn't show you're weak; most of the time, it's just an indicator that you have hit upon something meaningful.
How long is the initial therapy session?
How long is the initial therapy session?
Normally, the intake session takes somewhere between 50 and 60 minutes whereas in some practices it is a little longer than the normal sessions to give therapists time for paperwork and checking your background.
What if I am not aware of what my goals are?
What if I am not aware of what my goals are?
No worries. Quite a few people come to therapy without having any tangible goals yet. Your therapist will be there to support you in figuring those goals out through your interactions and dialogues in the first couple of sessions.
Is it okay if I want to change my therapist because it doesn't feel right to me?
Is it okay if I want to change my therapist because it doesn't feel right to me?
Of course, you can. Actually, the alignment of the therapeutic relationship is an important factor. If even after a few sessions you do not feel safe, heard, or understood, it is perfectly fine, and even recommended, to be looking for a different change.
Is what I say absolutely confidential?
Is what I say absolutely confidential?
Nearly everything that you say is confidential. Your therapist will talk you through the boundaries of confidentiality, being very clear that they are legally obligated to disclose if there is a serious and imminent risk of harm to you or somebody else, or if there is a legal request. Something they will also make clear during the first session.
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