How to Prepare for Your First Therapy Session

Finding the Right Therapist

Since the therapeutic relationship is such an important indicator of success in therapy, it’s best to do some research and choose a therapist who has direct experiences with your specific concerns. While a trusted friend or family member may know of someone or suggest a therapist to you, make sure that they specialize in what you’re looking for.

“The therapist/client relationship is very important because it is what allows people to be vulnerable in therapy which is essential to get the help you need. I want my clients to look forward to therapy and the discomfort involved in growth.” – Nicole Kleiman-Reck, MA, LMHC

How to Prepare for Your First Therapy Session

Here are 18 tips for how to prepare for your first therapy session:

1. Congratulate Yourself for Wanting Help

Looking to get help for yourself is an act of bravery. Therapy can sound scary and intimidating and there are many stigmas associated with the word, however there are so many more positive and beneficial aspects of therapy and getting help that you will uncover as you work through issues. You should congratulate yourself for wanting to get the help.

2. Ask for a Phone Consultation First

If you hate the phone and the thought of talking to a therapist you’ve never met in person causes anxiety, just jump ahead to the next section. Having a phone consultation before you begin therapy is an option, not a requirement. If it’s helpful to you, you have the right to do so. If it isn’t, you can confidently forgo this option and wait until your first session to ask questions.

While it’s not mandatory, many therapists expect you to want a brief phone consultation because they understand that choosing a therapist is a big decision and you might even feel some anticipatory anxiety before your session. You might have many questions that your therapist can answer to alleviate anxiety before you have your first session.

Here are some helpful questions to ask during a phone consultation with a potential new therapist:^3,4,5

• How do you approach helping people?
• Do you have experience working with people who have concerns like mine?
• Do you make treatment plans? If you do, will I be involved in creating and monitoring mine?
• What can I expect during the first session and subsequent sessions?
• What will you expect of me? Will I have homework?

Your initial phone consultation may help you prepare for your first counseling session by removing some of the mystery from the vague and often-intimidating idea of therapy.

3. Know Your “Why” for Therapy

A common question mental health professionals ask when they meet a client is what brought them to therapy, because the client’s purpose helps the therapist create a helpful plan for how the therapy sessions will go.² Make a list of your symptoms, including bothersome thoughts, emotions, behaviors, past experiences, and current situations and stressors. While you don’t have to articulate a detailed list of your concerns and goals, knowing the general reason you are seeking therapy will help you feel ready for going to a therapist for the first time.

To determine and express your “why,” your reason for seeking therapy and what you want out of it, actively engage in reflection rather than just letting vague ideas roll around in your mind.

Your process might look like this:

• Set aside some time, perhaps 10 or 15 minutes, to ponder your purpose for therapy.
• Choose a quiet, comfortable spot where you won’t be interrupted.
• Create a notebook dedicated exclusively to therapy.1 Select one that appeals to you and even choose a special pen. Use them now to record what you want out of therapy.
• Make the process positive and reduce stress by sipping a cup of tea or other favorite, healthy beverage. Play music or write in silence, whichever helps you think.
• Focus first on your end goal: How do you want to feel, think, and act after your work with a therapist? You might try brainstorming by free writing anything that comes to mind and later organizing your ideas.
• Then, write down a few notes about what is preventing you from feeling this way now.

Taking time to decide what is important to you will give both you and your therapist a solid starting point for you to get the most out of your therapy sessions. From there, you’ll build on your ideas as you work together to achieve your goals.

4. Tell a Friend or Loved One

Talking about going to therapy is completely optional, but it can be really helpful to have a support system that you know will check in with you about your first session and subsequent visits. You’ll want to continue processing what you’re learning in sessions outside of the therapy office.

5. Make a List of Topics to Cover

The first visit with any therapist can feel a bit awkward. After all, you are meeting with a stranger to discuss things you might be uncomfortable talking about. Where do you even begin? Rest assured, a therapist is an educated and skilled helper who will gently put you at ease and guide the first session. Still, arriving prepared with what you want to talk about during therapy can reduce anxiety.

Writing a list ahead of time of what you want to discuss during the first session (and bringing it with you) can help.⁶ Create a list of topics in your journal that you might want to discuss at your first session. Having it with you when you meet with your therapist can help keep you centered and focused.

Consider including topics such as:

• Challenges you are currently facing that you’d like to explore in later sessions (mentioning topics upfront will help the therapist guide future sessions)
• Recent changes in yourself or life circumstances that prompted you to seek therapy
• Things you have already tried in order to feel better
• Observations from family or friends (have they expressed concern about certain behaviors or moods, for example?)³
• Information about your personal background (your family situation, significant events, etc.)⁷
• How long you’ve been experiencing your current difficulties (if you’re bothered by social anxiety, for instance, has this plagued you for years or is it new?)

It might feel intimidating at first to talk about some of these topics. As you prepare your list, consider what you want to say and jot down some notes to guide you during the session.

6. Review Your Life History & How That May Be Impacting You Now

Having an idea of how your family, life experiences, and personal history has impacted you is a good place to start. Think about what comes to mind when you think about different areas of your life.

Ask yourself:

• Are there people you avoid?
• Emotions you avoid?
• Situations you avoid?
• Past circumstances you try not to think about?

Knowing the answers to these questions can give you some insight into areas that may need some special attention.

7. Dress for Comfort

Therapy is designed for you, so there is no need to feel pressure to dress a certain way. It is important that you are comfortable in your session, so dress in layers if it is too cold or hot. If you aren’t able to sit for a long period of time in certain jeans, wear sweat pants instead. No matter what you choose, choose comfort first.

8. Get the Practical Business & Paperwork Out of the Way First

In some cases, you might have talked with your therapist or their office staff ahead of time to learn about the logistics of therapy. If you didn’t receive basic information about their policies, the first session is the time to ask questions.

Practical questions during your first therapy session might include:

• Billing information such as the cost of therapy, if they accept mental health insurance, and whether they offer a sliding scale or payment plans
• How many sessions you can expect to have
• How frequently you’ll meet with this therapist
• The length of each session

Understanding your therapist’s procedures will allow you to plan accordingly and integrate therapy into your life.

9. Don’t Be Too Worried About Knowing What to Say

You can’t really say anything “wrong” in therapy, and your therapist should be skilled at steering the conversation in helpful ways. It is a space and time for you to explore your own thoughts and emotions and the guidance from a therapist is the entire point of going. You are the person who knows you best, and if you don’t know something, eventually those things work themselves out.

10. Be Open & Honest With Your Therapist

Keep in mind that honesty is paramount to successful therapy. In order for your therapist to help, they need to know what you’re experiencing. Therapists aren’t there to judge you. They chose their profession so they can help people improve mental health and wellbeing—not to make things worse.

Your therapist will likely emphasize confidentiality. All therapists are ethically bound to safeguard the information you share with them. Other than a few rare circumstances, such as if they believe you may harm yourself or others, they can’t talk about you to anyone else without your permission. During your very first meeting, your therapist will clearly explain confidentiality and its limits. If they don’t mention it, you can ask them about it.

11. Don’t Be Afraid to Ask Your Therapist Questions

Asking your therapist questions is a great way to build rapport if you are feeling anxious. Sharing that you feel that way is also helpful as your therapist can also help you work through any discomfort you’re having about being in therapy. It could be helpful to let your therapist know about these insecurities as these may also be issues related to why you are in therapy in the first place.

First Therapy Session Questions to Ask

There can be many questions you may want to ask your therapist, but in the first session you may find yourself wondering where to start. Some questions you can start with include:

• How long have you been a therapist?
• Do you give people advice?
• Do your clients get better?
• How will I know if I’m getting better?
• Will I have homework?
• Do you have training on the issue I am bringing to you?
• Can I bring a friend or family member to a session sometime?
• What if I can’t come to a session?
• Will you recommend that I take medications?
• Will you judge me if I share certain things?
• When will I know my diagnosis?

12. Understand That You May Cry or Get Emotional

“It is absolutely normal to cry during the first session. Crying is a great release for the body and should not be seen as a weakness. We are all on a unique emotional journey that requires various emotions. Crying should be normalized in therapy and in life in general.” – Adria Hagg, LCSW

“Crying is a normal emotion when we express our feelings and it helps to let it out. People usually feel overwhelmed about therapy that when they finally have the chance to release those guarded emotions, they become more emotional in the moment and leave feeling lighter.” – Jaclyn Gulotta, PhD, LMHC

“Safety and trust are necessary components of a therapeutic relationship. If you find yourself crying during a first session, especially if you are NOT typically a crier, it means that these two elements have been established. It is a great sign that this particular relationship may be right for you.” – Carissa Hodgson, LCSW, OSW-C

13. Clear Some Space on Either Side of Your Appointment

Whether it’s your first appointment or any other session, blocking out extra time before and after your session can relieve unnecessary stress and allow time for you to process the work you and your therapist accomplished during the session. You might want to ask your boss for a mental health day off to have an appropriate amount of time to prepare beforehand and process after your first session.

Often, anticipating a therapy session can cause stress and anxiety, and feeling rushed before a session can cause you to feel frazzled. Arriving early and practicing slow, deep breathing turns off your body’s stress response, decreasing the stress hormones like cortisol and adrenaline and easing physical symptoms such as muscle tension, dizziness, or digestive discomfort.²

It can also give you time to review homework you might have been asked to complete between sessions, look back through your notebook to see if you have new questions, or simply enjoy a bit of relaxed downtime. However you decide to use your time before and after each session, giving yourself even 10 extra minutes on both sides of the appointment might give your sense of wellbeing an extra boost.

14. Manage Your Expectations & Keep an Open Mind

Your first counseling session will probably be a bit different from the following sessions. Your therapist doesn’t know much about you yet, so they will likely ask you many questions as they start to understand you and what you’re experiencing. Depending on the therapist and their approach to therapy, you might be asked questions about your childhood, education, job, relationships, thoughts, feelings, or actions. Your responses help your therapist understand you and know how best to help you.

The first meeting may involve housekeeping tasks such as:

• Taking care of insurance and billing information
• Completing initial paperwork (your address, contact information, emergency contacts, authorizations to obtain information from or provide information to others, if applicable)
• Explaining the process of therapy
• Discussing confidentiality

Each meeting will build on previous ones, but this first one is a blank slate. You may feel nervous and unsure of what to say (which is why having a prepared list of topics and knowing your reason for seeking therapy can be helpful).

An initial session is often more helpful to the therapist than the client. For this and other reasons, the session can be disappointing or frustrating if you don’t know what to expect.

15. Remember That Your Therapist Is There to Help You

A first session can feel intimidating, but remember that your therapist is trying to learn all they can so that they can set you up for success with the work you’ll do together in later sessions.

“I think it is helpful to remember that anxiety before your first therapy session is totally normal. Remember to be open and write down personal goals that may help your anxiety (which is totally normal prior to starting therapy, so it doesn’t mean you should not attend). Remember that anxiety lives in your mind before an actual event occurs and usually eases with experience.” – Nicole Kleiman-Reck, MA, LMHC

“Remember that this is for you and therapists are there to be a support system. It is normal to be nervous about something that is new. Remind yourself that this will help you to feel better long term.” – Jaclyn Gulotta, PhD, LMHC

16. Understand That It’s Not a Quick Fix

It’s important to have realistic expectations for the therapeutic process in general and the first session specifically. Therapy isn’t a quick fix, and you probably won’t discover solutions at your first session because mental health is complex. Just as it takes time for problems to develop and begin interfering in your life, it takes time to work through and unravel those challenges.

Further, while you’ll begin to express yourself during the session, it won’t be until later sessions that the therapist knows you well enough to know what to ask and how to interpret your words and nonverbal communication, and you feel comfortable enough to go deeper in what you express.

Therefore, it will be unlikely that you emerge from session one feeling transformed. It is, however, realistic to expect that after your first meeting you will feel a sense of hope that, with time and work, therapy will help your mental health and quality of life.

17. Ask Your Therapist What Progress Might Look Like

While there’s a lot that happens in a first session and you won’t come up with every answer, a therapist can help you understand that progress is possible—and hopefully give you a feel for what you can expect as you continue to attend sessions.

18. Know That It’s Okay to Switch Therapists

Because it does take time to develop a relationship with your therapist and begin to feel positive movement toward your goals, it’s a good idea to be patient and try a few sessions with a therapist before deciding whether to continue working with them. After the first few sessions, you should have a better understanding of the problems you’re experiencing, a game plan for how to feel better, and a new sense of hope.¹

If you feel frustrated after three or four sessions, it’s okay to find a new therapist to work with.

Here are a few signs that this therapist isn’t for you:

• You feel disconnected from the therapist
• You don’t notice any progress toward change
• Each session has ended with you feeling confused or discouraged

Therapy is a gradual but steady process of developing insights, overcoming obstacles, setting and achieving goals, and enhancing wellbeing and the quality of your life. The first session is just the beginning of what can be a rewarding journey. With preparation and realistic expectations, you and your therapist can start to develop rapport, trust, and an important sense of hope for healing.

What to Expect in Your First Therapy Session

Your first session is about getting to know one another and learn about your history and give you some time to get used to being in a therapy room and talking about your life and history. It gives you time to get used to your therapist and see how you feel around them.

How Long Is a Therapy Session?

Therapy sessions are usually 45-60 minutes long. It depends a lot on the provider and/or the issues you bring to them. For example, some couples therapists offer sessions that are more like 90 minutes.

How Much Is a Therapy Session?

Therapy costs can vary. Some variables include insurance benefits and networks. Some sessions that are in network can be anywhere from $20-$60 copay, while out of network can be $120+. Online therapy platforms can offer a weekly or monthly charge but not take insurance. Some providers can take insurance for online platforms.

If You Need Medication

If you need medication, you may be referred to a psychiatrist and/or your primary care provider for follow-up with blood work and assessment for medication.

What to Do After Your First Therapy Session

After your first session, it can be a good practice to begin journaling how you feel, how you think therapy went, and what you think changed for you in that session. Taking time to reflect is a good way to stay present with therapy after your session is over and think about how to apply any breakthroughs you may have had.

How to Know If Your Therapist Is a Good Match

If you are feeling positive about therapy, feeling that you are safe and being heard, that is a good sign that your therapist is a good match. If you find them challenging you while still supporting you and hearing your concerns, that is another sign of a good fit. Trust your intuition with that and you will reap the benefits of attending therapy!