By deciding to start therapy, you’ve taken a gigantic step toward increased mental health and wellbeing. Acknowledge the strength required to take action like this, and be proud. Acknowledge, too, that you might be feeling extra stress and anxiety at the notion of starting therapy. That’s normal and a sign that you care about your mental health.
Choosing a therapist which you can build an open and trusting relationship with is a major factor in the success of therapy. The therapeutic relationship is as important, if not more important than the treatment method. If you have not found the right therapist, Choosing Therapy can help. We offer a directory of therapists, as well as free consultations to help match you with the right therapist.
The American Psychological Association (APA) recommends preparing for your first appointment ahead of time to help reduce anxiety and position yourself to get the most out of therapy from the very first session.1
Decide What’s Important to You
It’s natural for your thoughts and emotions to be jumbled before you begin therapy. After all, one of the reasons for working with a therapist is to identify and clarify problematic internal experiences that are interfering in your life. 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 your first conversation with your therapist.
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.2 WebMD suggests making a list of your symptoms, including bothersome thoughts, emotions, behaviors, past experiences, and current situations and stressors.3
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.
- The APA suggests creating 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. From there, you’ll build on your ideas as you work together to achieve your goals.
Once you’ve solidified what’s important to you as you engage in therapy, you can talk to your therapist ahead of time to make sure they’re a good fit.
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.
It is acceptable to request a phone consultation with your therapist before officially beginning sessions. In fact, therapists expect (but don’t require) it because they understand that choosing a therapist is a big decision and that anticipating your first session can be nerve-racking. You might have many questions that your therapist can answer to alleviate anxiety before you begin in earnest.
The APA, National Institute of Mental Health (NIMH), and WebMD suggest similar helpful questions to ask before therapy begins:4,5,3
- 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 mine?
- What can I expect during our sessions?
- What will you expect of me? Will I have homework?
Your initial phone consultation may help you prepare for your first in-person session by removing some of the mystery from the vague and often-intimidating idea of therapy. There are other things you can do to prepare for your appointment to further put yourself at ease.
Make a List of Topics to Cover Right Away
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 can reduce anxiety.
The National Institute of Mental Health advises that writing a list ahead of time of what you want to discuss during the first session (and bringing it with you) can help.6 In the dedicated mental health notebook discussed above, create a list of topics 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.
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.
Practical Questions You Might Ask at Your First Session
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.
Some logistical things you need to know:
- Billing information such as fees, insurance accepted, 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.
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.
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.
Adding some extra time to your schedule after the therapy session can allow you to reflect on what you and your therapist discussed. Devoting part of your notebook to post-session journaling can lead to deeper insights or new goals.
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.
Manage Your Expectations
Your first appointment will probably be a bit different from subsequent sessions.
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 extremely helpful).
Your therapist doesn’t know much, if anything, about you yet; therefore, 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.
An initial session often is 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.
Why the First Therapy Session Can Sometimes Be Frustrating
You’ve decided to seek therapy, selected the professional you want to work with, and you’re ready to dive in. In addition to feeling a bit anxious, you might also feel excited. After all, you’re eager to feel better and improve your wellbeing. This is a great attitude that will keep you motivated even when therapy might be difficult; however, it can also set you up for disappointment in your first session.
It’s important to have realistic expectations for the therapeutic process in general and the first session specifically. Therapy isn’t a quick-fix. Quite likely, you 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.
Perhaps the most important and most helpful aspects of therapy is the relationship between you and your therapist.8 This relationship, though, takes some time to develop. The two of you might begin to develop a strong rapport from the very first handshake, but the deep connection and trust won’t develop instantly.
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, in time and with work, therapy will help your mental health and quality of life.
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 advisable to be patient and try a few sessions with a therapist before deciding whether to continue working with them. According to the APA, “By the end of the first few sessions, you should have a new understanding of your problem, a game plan and a new sense of hope.”1
If, after three or four sessions you feel frustrated, it’s okay to find a new therapist to work with.
Signs that this therapist isn’t for you include:
- You feel disconnected from the therapist
- You don’t notice any progress toward change
- Each session has ended with you feeling confused or discouraged
Mental health 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.
