The First Therapy Session: What to expect

By Michaela Choy, AMFT

You have decided to begin therapy. And with this decision comes a variety of emotions. You may feel nervous about beginning the process; the idea of sharing the most intimate parts of your life with someone new can be scary. On the other hand, you may feel relief that someone with expertise can provide the guidance and support you need. Perhaps you feel both. These reactions among many others are expected. It’s normal to be scared, relieved, anxious, hopeful, optimistic, etc. Whatever you are feeling, it’s normal.

During a first session, many clients have reflected to me that they are not sure how to do this or what to expect. As someone who has sat in the therapist chair and on the couch, I am familiar with the anxieties and uncertainties that accompany a first session. The following entails a basic structure of an initial session and some words of advice. I hope this provides comfort and clarity into what to expect during your first session.

A Basic Structure

During the first 5 to 10 minutes, a therapist is likely to go over paperwork. This includes consent to treatment, payment policies, and an overview of confidentiality. Additionally, the therapist may discuss ways to contact them outside of appointments.

Next, the therapist will be curious to understand what brings you to therapy and will listen to your story and ask questions to better understand your situation. It is also possible that you’re unsure exactly what has brought you to this moment in time. Perhaps there is so much going on you need help sorting it out. If this is the case, it may take a few sessions to identify what’s brought you here.

After discussing the challenges you face, the therapist may ask what goals you have for therapy. Goals keep the therapy grounded and help both the clients and therapist measure success and progress. They can change throughout the work, and as one goal is met, another goal may surface. It is okay if you are unable to name a goal in the initial session. The therapist will help you make sense of what is important to you.

Once these initial tasks are completed, the course of therapy diverges. Your particular challenge, stage of life, past attempts at solving the problem, and numerous other factors will shape your path. A therapist will continue to gather information to paint a picture of your situation. Together, you will collaboratively find solutions with some trial and error along the way.

Words of Advice

You are most likely in a state of vulnerability and perhaps pain. Be gentle with yourself and your expectations from the start. We all have varying levels of readiness when it comes to sharing the private details of our lives. Yes, in the first session you will be talking a lot about yourself, but there is no pressure to put it all out there unless you are ready and able to do so. I have seen clients so desperate to manhandle change that they come into therapy sharing too much too fast, and we haven’t yet established a relationship. Honor the speed that feels comfortable to you.

Speaking of the therapeutic relationship, this is a key ingredient in the process. Feeling a sense of safety and trust with the therapist will further allow you to explore the hard parts of yourself or your life that you haven’t yet examined. This relationship will take time to grow. Gauging how you feel in your therapist’s presence after a few sessions will be a good indicator of fit. If things are feeling off, I encourage you to say something directly to your therapist. Therapists are trained to receive and gather feedback. It can be uncomfortable to give your therapist feedback, but could result in an adjustment that makes the therapy process what you need. A great response to feedback from a therapist is curiosity instead of defensiveness. If you are experiencing the latter, reevaluate whether you wish to continue.

Final Comments

As therapists, we know this can be uncomfortable, we know you are stuck, and we know you’d rather be anywhere else. It is impressive and respect worthy that you wish to look at parts of your life you’d like to change. It is my greatest hope that you find comfort, enlightenment, and growth in this new process. Please know we are honored to sit with you and be a part of your life in this way.