It can be really helpful to prepare for your first appointment ahead of time to help reduce anxiety and position yourself to get the most out of therapy from the start.1 By deciding to start therapy, you’ve taken a gigantic step toward better mental health. Acknowledge the strength required to take action like this, and be proud.
Here are 13 tips for how to prepare for your first therapy session:
1. Don’t Just Go Off Referrals
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.
“It is important to feel comfortable with the therapist/client relationship in order to want to be open and express yourself. It will feel like a good fit when you feel you can trust the space you are in and feel like you can be vulnerable.” – Jaclyn Gulotta, PhD, LMHC
“The therapeutic relationship is like a dance. We need to choose our partners carefully so it is ok to ask your therapist questions about the process and come to the table with specific goals. If something is not working, the client should feel comfortable voicing their concerns. Therapists should also invite feedback. Clients should feel safe being vulnerable with their therapist.” – Adria Hagg, LCSW
“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
2. 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.
3. 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 our 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.
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. Get the Practical Questions 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.
7. 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.
Is It Normal to Cry During a First Therapy Session?
“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
8. 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.
9. Manage Your Expectations
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.
10. 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
“Here are three things to remember about your therapist to make you feel comfortable:
Therapists are just regular people with degrees to help people.
Be open to creating a regular conversation. You are the leader of the session.
It’s ok to be nervous, however, this is just like meeting a new friend.” – Shawndrika Cook, LPC
“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
11. Understand That It’s Not a Quick Fix
In addition to feeling a bit anxious about your first therapy session, 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, 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.
Perhaps the most important and most helpful aspect 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, with time and work, therapy will help your mental health and quality of life.
12. 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.
13. 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.
For Further Reading
Infographics: Preparing for Your First Therapy Session
