What Actually Happens in a First Session of Therapy?

I know a first session can feel intimidating and awkward, especially when you don't know what to expect. My goal in this post is to break it down and offer some insight into what a first session with me might actually be like. I can only speak from my own perspective, but I hope this is also useful if you are thinking about starting therapy with another psychologist.

Even if you've never been to therapy before, you might have a pretty good idea of what you think is supposed to happen. You sit down, the therapist asks why you are there, and then somehow you are expected to start talking about your deepest thoughts and feelings.

Which can leave you wondering… What am I actually supposed to say?

The short answer is: you don't need to have it all figured out before you come in.

The first session is mostly about getting to know each other, beginning to build trust, and getting a general sense of where we might be heading. We'll talk about what has been going on, what brought you in, and what you are hoping might be different. We don't need to have everything figured out by the end of the first session.

The first session is mostly about getting to know each other

Before we can do much therapeutic work together, we need to have a relationship that feels comfortable enough for you to be honest. The first session gives us a chance to start building that relationship.

I'll ask questions and listen to what brings you in, but I'm also getting to know you as a person. You are getting to know me too. You are figuring out whether you feel comfortable talking with me, whether my approach makes sense to you, and whether you can see yourself working with me.

I don't expect trust to be established in one session. That's something we build over time. But creating that foundation is an important part of where we start.

You aren’t expected to tell your whole life story

One of the things people sometimes worry about is where to even begin. Do you start with what happened last week? Your childhood? Your relationship? The thing that happened five years ago that you still think about?

There isn't one right place to start, and you don't need to have everything prepared.

My initial sessions are structured to help guide us through different areas of your life. This helps me get a clearer picture of you, your environment, and the context in which the “problem” is presenting. I ask questions to help us understand what brought you in, what has been happening recently, and anything else that might be important for us to know. We may talk about your current circumstances, relationships, past experiences, patterns you have noticed, and what you have already tried.

You don't need to remember every detail or tell your story in chronological order. We can fill things in as we go.

We'll talk about what's bringing you in now

Sometimes there is a clear reason someone decides to start therapy. Maybe you have been feeling anxious, you're struggling in your relationship, you're overwhelmed at work, or something happened that you are having a hard time moving through.

Sometimes it is less clear.

You might simply know that you haven't been feeling like yourself. Or that something keeps happening in your relationships. Or that you are functioning, but you are exhausted by how much effort it takes.

Whichever describes you, I'll meet you there. I don't expect you to come into therapy already knowing exactly what you need, how to talk about it, or what therapy is supposed to look like. Part of my role is to help us figure that out together.

Part of our work together is figuring out what might be underneath what brought you through the door. Sometimes what initially looks like the problem is only one part of a bigger pattern.

We'll start figuring out where we're headed

You might already know exactly what you want to work on. You might have a few things in mind. Or you might have no idea.

All of those are okay.

The first session is not about coming up with a perfectly specific treatment plan. We will talk about what you are hoping to get from therapy and what you would like to be different, but those things can change as we get to know each other and understand what is really going on.

I want us to leave the first session with a general sense of where we're heading, rather than a list of things we need to accomplish. As we build trust and learn more about you, we can become more specific about what we want to work on and how we'll get there.

Some of the questions we might explore are:

• What is happening that you don't want to keep happening?

• What would you like to feel differently?

• What would you like to understand about yourself?

• What would be different in your life if therapy were actually helpful?

You don't need to have answers to these questions before your first session. Sometimes figuring out what you want is part of the therapy itself.

You don't have to tell me everything right away

Starting therapy can involve talking about things that are difficult, uncomfortable, or painful. But that does not mean you have to tell a stranger everything about yourself in the first hour.

There may be things you are not ready to talk about yet. There may be things you aren't even sure how to put into words. We can work with that too.

You get to have a say in what you share and when. My job is not to push you into talking about something before you are ready. It is to help create a space where, over time, you can feel safe enough to explore the things that brought you in.

You may become emotional. You might not.

Some people worry that they will cry in their first session. Others worry that they won't be emotional enough.

There isn't a particular way you are supposed to react.

You might cry. You might laugh. You might feel uncomfortable. You might feel relieved. You might talk a lot. You might have trouble finding the words.

You might leave thinking, “I don't even know what I just talked about.”

Therapy can feel a little strange at first. You are having a very personal conversation with someone you have just met, and it can take some time to get used to that.

So, do I need to prepare?

Not really.

If it helps, you might spend some time thinking about what made you decide to reach out now. You could write down a few things you have been struggling with or questions you have about therapy.

But you do not need to prepare a presentation.

You don't need to figure out the right words.

And you definitely don't need to make yourself sound like you have everything together.

Just come as you are.

The first session isn't about fixing everything

You’re probably not going to walk out of your first therapy session with everything resolved. That's not the point.

The first session is the beginning of understanding what is going on, getting to know each other, and starting to figure out where we might go from there.

You may leave feeling relieved. You may feel tired. You may have a lot to think about. You may even feel a little unsure.

Finding the right therapist is also part of the process. Therapy works best when you feel comfortable enough to be honest, challenged in ways that are helpful, and understood without feeling judged.

Most importantly, you don't have to know how to do therapy before you start therapy.

We can figure out where to start together.

If you're curious about the practical or administrative things you need to know before your first session, check out [The Practical Details of a First Therapy Session].