Nervous About Therapy? What Actually Happens in the First Session
So you’ve made the decision to start therapy and chosen a therapist. I admire you getting to this point, as it takes a lot of courage to reach out for help. It’s normal to feel anxious about your first appointment. One part of this can be that, for many people, they don’t know what actually happens in therapy. This can act as a barrier to making the decision to get help. In this post, I will walk you through step-by-step what you can generally expect surrounding your first counseling session. While every therapist is different, I hope this will give you a general sense of what you can expect and help with some of the unknowns.
Why is the First Therapy Session Different?
Intake session versus standard therapy session:
This means that this session will look different than future sessions, in that the therapist will likely be asking you a number of questions to better understand you.
Establishing the “Therapeutic Alliance”:
You are meeting a new person. You are checking them out and they are working to better understand you and the reasons you reached out for therapy.
What Should I Do to Prepare for the First Therapy Session?
Some therapists will ask you to complete paperwork or questionnaires prior to the first session. Some therapists do it in the first session. It is helpful for you to complete any requested paperwork so that they can get a better sense of you and what you will be discussing. In addition, for many people this process helps them to gather their thoughts and feelings prior to the first session.
Send the therapist your insurance information and/or bring it along to your first session depending on what they have requested. It’s important for the therapist to be able to verify your benefits prior to your first session so there are no surprises.
Think about your main goals for therapy. You could even jot them down if you feel this could be helpful to you.
Consider what your day looks like after the session. It can be helpful to give yourself a little time to decompress after this session.
During the First Session: The Logistics
The session will likely begin by reviewing informed consent for treatment, as well as confidentiality and limits to confidentiality. It’s important for you to feel comfortable with all of this, so make sure you ask questions to help you clarify and feel more comfortable.
There might be additional discussions to clarify issues related to insurance and billing.
Some therapists will have you complete questionnaires at the beginning of the session rather than prior to the session.
During the First Session: What Questions Will the Therapist Ask Me?
For some therapists this might involve following-up on or reviewing the paperwork you completed prior to the first session. For others it might involve them asking these questions for the first time. Things that you are likely to discuss/review include:
What is the main reason you reached out for therapy?
Have you been in therapy before? Did it help? What was most helpful? Least helpful?
Questions about your history, including family, school, work, and medical.
Questions about various symptoms you might have (e.g., sleep, eating) and how these symptoms impact your functioning.
What are your main goals for therapy?
During the Session: What Questions Should You Ask the Therapist?
While a lot of questions will be asked of you, it is very important that you get the opportunity to ask questions. After all, you are a partner with your new therapist in this process. Questions you might want to ask include:
Have you worked with someone with my concerns before?
How would you approach our work together? What types of therapies might we use to address my issues? (e.g., CBT, IFS, EMDR)
What will future sessions look like?
After the Therapy Session: How to Know if it was a “Good Fit”?
The most important thing to consider after the session is whether it felt like a good fit for you. Do you feel you could partner with this person to address your struggles and reach your goals? Something things to consider:
Green flags: Feeling heard, respected, validated, and like you can trust the person
Red flags: Feeling rushed, not heard, dismissed or like the therapist shared too much about themselves (and didn’t keep the focus on you)
Final Thoughts About the First Therapy Session
Given that this is such a unique experience, it can sometimes be helpful to give a new therapist a couple of sessions to see if it feels like a good fit. Of course, you need to trust your gut and how you felt in that first session. However, if you are feeling uncertain about it, sometimes giving it a couple of sessions can be helpful. To read more about choosing a new therapist, check out my blog post titled, “How to Choose a Therapist: A Psychologist’s Guide to the Right Fit?”
The first session won’t solve all your problems. However, I have found that just the act of reaching out for help and starting the process can sometimes help people feel a sense of hope.
Congratulations on taking such an important and healthy step for yourself!
For further questions or to explore virtual therapy options in New York, reach out to me through my Contact Page to schedule a consultation.
Author Bio:
As a background, Dr. Amy Rodrigues is a licensed clinical psychologist located in Rochester, NY offering virtual therapy throughout all of New York State. She has 15 years of specializing in issues such as anxiety, depression, PTSD/trauma, life stress, and relationship struggles. She earned her doctorate in psychology from the University of Rochester and focuses in combining evidence-based approaches with compassionate, person-centered care.
View more about her or her professional credentials.
Disclaimer: The information provided on this blog is for educational purposes only and should not be treated as medical, psychiatric, or psychological advice. This content does not establish a therapist-client relationship. If you are experiencing a mental health crisis or emergency, please call or text 988 (in the US/Canada) or go to the nearest emergency room.
