What to expect during your first therapy session 

Making your first therapy appointment is something to be proud of. It takes a lot of strength and self-awareness to admit that you may need help or that you have challenges to work through. But if you’re new to therapy, it’s understandable if you’re a bit nervous. The unknown can be scary.

While every therapist is different, there are a few things you can expect. And that’s true whether you’re going for a virtual session or an in-person appointment. Getting a feel for how the session may be structured and what you’ll talk about not only helps curb first-time jitters, it helps you get the most out of your time together. 

So here’s a breakdown of what to expect during your first therapy appointment. (If you're still looking for the right therapist, we can help.)

Part 1: It’s ‘get to know you’ time

Whether you're meeting virtually or in person, the first few sessions focus on what’s called the assessment, says Nicole Bentley, LCSW. She’s a licensed therapist and senior director of intake services and clinical operations at Cityscape Counseling in Chicago.

“The therapist needs to get to know a lot about the client, their history and what brings them to therapy at this time,” she says.

That’s a lot of information, especially when you’re meeting someone for the first time. So let your therapist take the lead, and don’t worry about whether you’re revealing too much or too little. The questions might be similar to those you’re used to answering at the doctor’s office (such as if you drink alcohol), but they’ll also go deeper.

The exact questions will differ depending on your therapist and what’s bringing you in, Bentley says. To help you prepare, here are some topics they may cover:

• Is there a history of mental illness in your family?
• How would you describe your relationship with food?
• How do you feel about your body image?
• Do you drink alcohol? How much and how often?
• Do you do drugs? How much and how often?
• Any medical concerns or diagnoses?
• Do you ever think about hurting yourself or have thoughts of suicide or homicide?
• Do you ever feel depressed? Anxious?

This builds the foundation for your therapist to understand more about your life and ask the right follow-up questions. If this is your first therapy session, you may be completely open to talking about these things or feel a little awkward at first. You can be as open as what feels right for you. 

“I always let clients know they only have to share what they feel comfortable with during an intake or initial appointment,” says Michelle Hunt, MHC-LP. She’s a licensed mental health counselor with Empower Your Mind Therapy in New York City.

She cautions first-time clients that talking about your past or current experiences can feel a bit triggering. That can be true whether you’re talking about your relationship with your mom, your anxiety about driving a car, or how a traumatic event affects your everyday life.

If this happens, you can expect your therapist to talk about techniques you can use after the appointment to help process what was discussed. If they don’t, feel free to ask about helpful coping strategies.

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Part 2: Goal setting

Once you’ve gone into your backstory, you’ll set some goals with your therapist.

“People go to therapy for a variety of reasons,” says Caroline Brown, LMSW. She’s a senior associate therapist with Gateway to Solutions in New York City.

You likely have an idea of what you hope to achieve with therapy. Maybe you want to work on managing symptoms of anxiety or depression. Perhaps you want to break out of certain relationship patterns. Or maybe you hope to reduce social anxiety.

“At the end of the day, any goal that will make someone feel more authentic and genuine to who they are — even figuring out who they are — is a valid goal and can be worked on in therapy,” Brown says.

If you’re unsure or come in with multiple concerns, your therapist will help you focus your goal if needed.

They’ll also talk about how and how often your goals will be evaluated. Is it every 6 or 8 weeks? Every 6 months? How will you know when things are progressing? They’ll want to talk through all of this with you. (Learn more about why tracking your goals is so important.)

One thing that’s not up for discussion: Your therapist won’t tell you exactly what to do or how to fix things in your life. “The help comes by having someone who is not personally involved ask you questions that you might not be thinking about and/or propose perspectives that you may not have yet considered,” Brown says.

During the first session, you’ll learn about your therapist’s personality and style. The most important thing, Brown says, is that you feel listened to and not judged. If that’s not the case, try other therapists until you find someone who clicks with you.

Part 3: Finalize logistics

One of the final to-dos before your first appointment ends is to talk about the logistics of therapy, Hunt says. That includes discussing fees, billing cycles and statements as well as setting a therapy schedule (such as every Monday at 1 p.m. or every other Thursday at 6 p.m.).

If your therapist’s fee concerns you, don’t be afraid to ask about a reduced fee based on income or financial problems. You might be able to work something out that fits your budget, whether it’s a lower cost or starting with less frequent visits.

These logistical details are important for your success in therapy because they will help you build a consistent routine and set up therapy as a sacred space in your schedule. Let the healing begin.

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