Navigating Your First Therapy Session: What to Expect and How to Prepare

Taking the first step to therapy can feel scary and overwhelming, but the benefits are worth it, if your goal is become the best version of yourself. You were placed on this Earth because you deserve it!

The First Session: What to Expect

Many of my patients arrive nervous for their first session, but by the end, they’ve often let their guard down and can talk for hours. Most of them express feeling a sense of relief after finally releasing so much they’ve kept bottled up inside. I can relate—I had the same experience the first time I saw a therapist. Opening up to someone and being truly listened to was incredibly liberating.

Intake Forms and Getting Started

Before your first session, you’ll likely be asked to complete intake forms, which may include consent for treatment and a few questionnaires. These forms help the therapist understand your background and what you’re looking to work on. Don’t stress about it—you can write as little or as much as you’re comfortable sharing. The goal is not to overwhelm you but to give the therapist a starting point to guide your treatment.

Take some deep breaths and imagine you are entering a safe, welcoming space. There’s no need to overprepare for your first session; remember, you’re paying the therapist to guide you through the process!

What Happens in the Waiting Area?

If you’re attending an in-person session, the therapist will likely direct you to the waiting area, which is typically quiet and calm. You may see other patients or therapists coming and going, but it’s generally a peaceful environment. Feel free to read, scroll on your phone, or simply relax while you wait. Once your therapist is ready, they will greet you, invite you into their office, and show you where to sit and put your belongings. Some therapists might offer a cup of water or tea—remember, this time is all about you.

If your session is virtual, the therapist will let you into the virtual waiting area and likely ask if both video and audio are working properly. Just make sure you're in a comfortable, private space at home.

The Ice Breaker and First Conversation

Every therapist has their own approach to beginning a session. Some may ask an ice-breaker question or start by discussing your day. Others might dive right into the classic, "So, what brings you here today?" (Yes, I know, it's the question we always see in movies!) If you’re working with a therapist like me, we might “shoot the sh#t” casually for a few minutes about the weather or your commute to the office. In virtual sessions, I might ask to meet any pets that happen to make an appearance—my own cat often makes a cameo!

Once we’re comfortable, I will explain the process of conducting a “psychosocial evaluation.” I often joke that it sounds intimidating, but I’ll just be asking a lot of questions and “get all in your business”. This is an information-gathering session where I learn about your background, family, and anything relevant to how you became the perfectly unique individual you’ve become. It’s important to note that there is no judgment in therapy. (And if you feel like there is, this is not a good therapist for you.) I reassure my patients that they can share whatever they feel comfortable with, and everything discussed is confidential— except for the following two things: If you mention you are going to harm yourself or someone else, we are mandated reporters, and this warrants a confidentiality breach. Other than that, I’m happy to hear it all!

What to Expect During the Evaluation

Some therapists may follow a structured set of questions during the initial evaluation, while I tend to let my patients share their "life story" starting from the beginning. I usually say “so tell me about growing up as _____ (insert your name). The goal is to learn more about you, your upbringing, your family dynamics, and anything that might be relevant to your mental health. I’ll take notes during the session since it's hard to remember everything on the first day. Feel free to jump in with your own questions at any point. You don’t need to take notes the first day unless something resonates with you that you’d like to revisit later, although some of my patients will jot down certain quotes from later sessions or notes of some good advice they’d to take home.

This first session is not technically "therapy," and you are not expected to dive into deep trauma or emotions unless you feel ready. Crying is completely okay if it happens—I mean, what better place to cry but on a therapist’s couch right? But it’s also okay if you don’t cry. The first session is about gathering information and starting the relationship.

How Long Will This All Take?

At the end of the evaluation (which typically lasts between 50-70 minutes), we will discuss a “treatment plan” moving forward. I’ll ask you to share your own goals for therapy. Common goals include  "learning to manage my anxiety," "becoming a happier person," or "Not letting my trauma define me anymore”.  I once had a patient answer this question with a simple “I have no idea” and that’s okay too! We’ll work together to figure it out.

You can ask any questions you have, like “What can I do between sessions?” or “Will there be homework?” It’s best to avoid asking overly personal questions, like about the therapist’s family, but asking about their experience with certain types of patients (e.g., LGBTQIA or people of color) is completely appropriate. I once had a patient ask me if I minded sharing my own journey to becoming a therapist and I found that quite insightful, as it gave the patient a glimpse into my authenticity as a therapist. I am more open with my patients then some therapists are, but please don’t be offended if the therapist is resistant to answering personal questions as we are trained to not self-disclose.

You will want to discuss a schedule moving forward with this therapist, that is if you decide to… I always advise my patients to journal any thoughts or questions they have outside of sessions and to email me with any urgent ones.

What If You Don’t Click With Your Therapist?

If, after your first session, you don’t feel comfortable with them, that is perfectly okay. Not every therapist will be the right match, and you are absolutely entitled to seek a better fit. While I never encourage ghosting, you can either not schedule a follow-up or have an open conversation with your therapist about how you’re feeling. You may want more reassurance or a different approach. Do not worry about offending us. It is our job to leave our egos at the door. I once had a patient tell me that she needed someone to be more direct with her and challenge her since no one else in her life does. Other patients request a more structured session with goal setting and homework assignments. Therapy is like dating—it’s important to find someone who matches your needs and makes you feel comfortable. If the therapist can’t meet your needs, it might be time to look elsewhere.

Taking the Next Step

Starting therapy is a brave and significant step toward self-improvement and healing. By understanding what to expect, you can ease any anxiety or uncertainty and make the most of your sessions. Therapy is about finding the right fit, and it’s okay to take your time and explore what works best for you.

Remember, you deserve to heal, grow, and become the best version of yourself. The journey might not always be easy, but it will absolutely be worth it. You don’t have to face it alone—your therapist is there to guide and support you every step of the way.