What to Expect at Your First Therapy Session

What Happens at a First Therapy Session?

Most people seek therapy because they want something in their lives to change, but often, they have misconceptions about the process, so it’s important to know what to expect. In most cases, during your first counseling session, you’ll be filling out paperwork and answering basic questions, primarily about your medical and family history, your reasons for going to therapy, and discussing confidentiality, among others.

Paperwork & Waiting

Before your first session begins, you may need to complete several forms. Some professionals will send this to you ahead of time, while others ask clients to fill out paperwork while waiting for their appointment to start. For in-person appointments, make sure you know where the building and specific therapy office are located. Plan to leave early to accommodate for traffic or other potential hold-ups. If you’re doing online therapy, check your Internet connection and log in to the secure portal a few minutes early.

Some of the paperwork you may be asked to review, fill out, and sign includes a release of authorization if using health insurance to pay for treatment, a consent form outlining your therapist’s specific policies and procedures for treatment, and medical history checklists.

Introductions

Most therapists begin their first session by obtaining informed consent, which refers to the process of informing the client about the risks, benefits, and potential treatment outcomes of psychotherapy.¹ Even if you already signed this form prior to the session, your therapist will likely review it again to ensure that you fully understand the treatment process.

Your therapist will also likely use this time to review their own approach to treatment. For example, they might share their past experience, schooling, or other relevant clinical details about their work. Some therapists will also use this opportunity to share some personal details–whether they have pets, children, what their hobbies are–to build a better connection.

Talking About Why You’re in Therapy

When preparing to start therapy, it’s important to have an idea of what you want to address. It’s okay if you don’t have an overly specific goal, but you should have some general insight into what you might want to work on. This can be as general as “I want to be more organized” and “I want to be more responsible” or get more specific, like “I want to get help while I grieve the loss of a parent” or “I want to get help for my depression.”

Your Therapist Will Ask You Several Questions

Your therapist will need information about your personal background, family history, and medical details to understand you better. Some questions may feel overly general, while others may feel somewhat invasive or private. Keep in mind that you don’t need to divulge anything that makes you feel uncomfortable, but your answers will help your therapist best support you.

Some potential questions your therapist might ask you at a first session include

• What made you decide to enter therapy right now?
• What’s causing you the most stress in life?
• Have you ever tried therapy in the past? What was your experience like?
• Do you have any concerns about therapy?
• What do you hope to achieve in our work together?

You Should Ask Your Therapist Questions, Too

You have every right to ask your therapist questions about their work or experience. Keep in mind that they may not answer every question, particularly if the questions are personal.

Here are some of the questions you might want to ask your therapist at your first appointment:

• What kind of experience do you have treating my particular issue?
• How long have you been working in the field?
• What kind of certifications or specialties do you have?
• How long do you expect my treatment to take?
• How often do you recommend we meet?
• How do you measure a client’s progress?
• What is your policy for contacting you in-between sessions or during emergencies?
• What should I do if I disagree with your opinion or approach?

You Might Be Given a Treatment Plan

After your therapist reviews your goals and intentions, they may use that information to formulate a treatment plan. While your treatment plan may be updated as you get to know each other, your health insurance may require it to authorize your care.

Treatment plans consist of various time-based interventions, goals, and objectives. It’s meant to increase your likelihood of you achieving your intended treatment outcomes. Treatment plans are generally collaborative, so you should have a full say in this process.

Ending Your First Session

You will generally end your first session by scheduling the next meeting and providing payment. Some therapists automatically place a credit card on file to avoid dealing with payment at the end of each appointment. Your therapist may also assign homework for you to work on during the week. Even if they don’t assign something for you to do, you can always request homework by saying something like, What would you like me to focus on this week? Conversely, your therapist may ask you what you would like to focus on during the next session.

How Long Do Therapy Sessions Last?

Therapy sessions generally last 45-60 minutes. Fifty minutes tends to be the most popular length of time, but your therapist will explain their policy during the first session.

Couples, family, and group sessions may last up to two hours. Furthermore, your initial intake may be longer than your regular sessions, as your therapist may need more time to complete required questionnaires or forms.

3 Common Myths About Therapy

Unfortunately, our society perpetuates many damaging myths about therapy that can prevent people from getting the help they need. These stereotypes can be about the approaches to therapy, when to get therapy, and what therapy can help with.

Below are three common myths about therapy–and why they’re wrong:

1. You Won’t Necessarily Lie on a Couch

Although the media often depicts clients dramatically lying on a couch in therapy, that type of setup isn’t all that common. In fact, many therapy offices don’t even have couches (and this is especially true if you’re meeting with an online therapist). Often, you will be sitting across from your therapist in an office-like setting, or via a video call if meeting online.

2. You Don’t Have to Be in a Crisis

Unfortunately, many people assume you need to be in crisis mode to reach out for support. But that isn’t true. In fact, many therapists recommend seeking support even before you really start struggling. Preventative mental health treatment can give you coping skills to avoid certain symptoms from developing and lower the likelihood of them escalating.

3. Not All Therapists Are the Same

Every therapist brings their own unique background, expertise, and personality into their work. Likewise, there are numerous therapeutic approaches and interventions. Therefore, what one therapist does with a client can be significantly different from what someone else does.

Some common therapy approaches that you might encounter include: 

• Cognitive-Behavioral (CBT): One of the most common methods out there, CBT teaches you to change negative thought patterns, which in turn helps you influence how you feel and react to situations.

• Narrative: Narrative therapy helps clients re-author their stories to reevaluate how they perceive themselves. It’s a client-driven modality that focuses on your unique experiences.

• Psychodynamic: Psychodynamic therapy explores past interactions and experiences to understand current needs. The work focuses on moving subconscious material to the conscious mind.

• Solution-focused (SFT): SFT is a goal-oriented therapy that focuses on direct goal achievement. This therapy is brief and helps clients identify and meet their needs.

• Experiential: Experiential therapy is an overarching definition for using various modes of immersive expression to facilitate processing. Therapists may use art, nature, music, psychodrama, dance, or animals in experiential therapy.

• Humanistic: Humanistic therapy focuses on client-centered work. Therapists focus on treating “whole people” and believe their clients are inherently motivated and capable of solving their own problems.²

• Acceptance and Commitment (ACT): ACT blends behavioral and mindfulness strategies to increase meaning in a client’s life. Instead of focusing on direct symptom reduction, ACT embraces the idea of making room for psychological flexibility.

• Eclectic: Eclectic therapy refers to the common practice of blending together several different treatment approaches based on the client’s needs.

How to Get the Most Out of Your First Therapy Session

Therapy is a significant investment of time, money, and energy, so you want to make sure you get the most out of your sessions. Fortunately, research shows that about 75% of people who seek therapy benefit from it, so it is fairly common to reap its positive effects.³

Even if you feel nervous about going to therapy, it’s important to be proactive when going into your first session. Therapists are skilled in interpreting human behavior, but nobody can read your mind. Nobody can advocate for your needs better than you can! One study found that a staggering 84% of clients report lying in therapy.⁴ It’s normal to feel embarrassed or afraid, but your therapist will not judge your experiences. Aim to be as honest as possible—remember, your therapist is there to help you, and the more information they have, the easier it is.

What to Consider After Your First Therapy Session

Ideally, you should leave your first session feeling somewhat inspired and challenged. You should want to continue working with your therapist! However, it is also common to experience mixed emotions after your first session with a provider, which are important to address so they do not hinder your progress in therapy. Therapy is a process, and you can’t expect to have everything figured out after just one session.

Moreover, it’s also a relationship. Trusting and feeling safe with your therapist takes time–this is known as building rapport. Research shows having good rapport is one of the most essential predictors in determining a client’s treatment success.⁵ While rapport often happens over several sessions, you don’t owe your therapist your time. If you strongly feel like you might not be a good fit, it’s perfectly reasonable to switch providers.

When to Find a New Therapist

Not every therapist will be the best fit for you, but keep in mind that the therapeutic relationship is crucial to your success in therapy. Likewise, you need to feel like you’re making progress towards your goals. You may be able to resolve certain issues or misunderstandings with your therapist directly, but they can be indicative of larger incompatibilities in the therapist-client relationship.

Signs that you need to find a new therapist include:

• They don’t have any experience treating your presenting issue
• The fee is too high
• You felt shamed or judged
• You felt like they were disorganized
• You don’t sense you have a plan for your treatment
• They acted inappropriately or unethically
• They spent most of the time talking about themselves
• They didn’t ask you enough questions or didn’t talk enough
• You believe you need a higher level of care

Final Thoughts

Even if you feel uncertain or afraid, therapy can be a great, valuable investment for your emotional well-being and functioning. Remember that the first session will mostly focus on initial paperwork and introductions, which can help you ease into the process. Most people find their anxieties about therapy dissipate after the first few sessions, and once you really dive into the work, you’ll feel incredibly proud of yourself for taking that first step!