What to expect in your first therapy session?

A complete guide for anyone considering starting therapy

Starting therapy is not always an easy decision. It can be accompanied by feelings of anxiety and uncertainty about the journey ahead. Not knowing what will happen can create anxiety long before you ever sit down with a therapist. This guide walks you through the entire process so you can feel more prepared, informed, and at ease.

The first session is all about getting to know each other

The first session is often called ‘an assessment’. This can sound a bit unnerving, but in reality, it’s about you and the therapist getting to know each other. You can expect your therapist to introduce themselves, explain how therapy works, and what you can expect from the process. They will ask you some questions to understand the problem you’re facing, but they probably won’t delve too deeply into difficult or uncomfortable topics. The purpose of this session is to build rapport and emotional safety within the therapeutic space.

The practicalities

Your therapist will likely go over some of the more practical parts of therapy such as confidentiality and its legal limits, session length and frequency, note taking, fees, payments and cancellations. Transparency here sets the foundation for trust.

Why now?

Most first sessions begin with some variation of the question: “What made you decide to start therapy now?” Your therapist might also ask you if you’ve had therapy before and whether it was helpful or not. There are no right or wrong answers. It’s all about thinking about what’s happened to you and what’s led to this moment.

Beginning to unravel the problem

Your therapist might start to explore some of the events and triggers that have led to the current problem. You might also go with a list of problems and the therapist might help you decide which difficulty to focus on first. They might ask about your thoughts, feelings, and behaviours, any important relationships, and other important parts of your life such as your physical health. You only share what you feel ready to share.

A tentative formulation

If your therapist thinks they have gathered enough information during your first session, they might share a first formulation of the problem. This could explain what the problem is, what drives it, and what maintains it. It is the blueprint from which the treatment follows. At other times, the therapist might ask to see you again to continue the assessment before sharing their formulation.

Clients are encouraged to ask questions

Many people don’t know that one of the most important parts of therapy is the therapeutic relationship itself, not a service you passively receive. It’s important that you become an active participant in your own treatment. This can start by asking questions about the process or voicing any worries you have about starting treatment.

You don’t need to decide immediately

There’s no pressure to continue to seeing the therapist after the first session. Take a moment to notice how you felt, whether they understood you, and how you experienced the session overall.

Final Thoughts

Therapy is not easy or quick. Often there might not be big breakthroughs, but a good therapist should be able to plant the right seeds, which will continue to positively impact you even after the therapy is over.