Deciding to start therapy can take a long time. For many people, the hardest part is not the decision itself but the unknown on the other side of it. What will they ask? Do I have to tell my whole story at once? What if I cry, or go blank, or say the wrong thing?
Those questions are completely understandable. Walking into something important without knowing the shape of it is unsettling for anyone.
So here is a plain description of what a first therapy session usually involves. Every therapist works a little differently, and the details will vary from practice to practice, but the main parts are remarkably consistent. Knowing them ahead of time can make that first hour feel far less like a test and far more like a conversation.
Before you arrive
Most therapists ask you to complete some paperwork before the first session. This often includes contact details, a brief questionnaire about what brings you in, some health history and a set of consent forms to read. It can be tempting to skim them. If you can, give them a real read, and note anything you want to ask about.
If your session is by telehealth, a little setup helps. Find a private space where you will not be overheard, use headphones if others are home, check your connection a few minutes early, and keep a glass of water nearby. Some people talk from a parked car when home is not private. That works well too. Because therapists are licensed state by state, you will generally need to be physically located in a state where your therapist is licensed during each telehealth session, so do not be surprised if you are asked where you are joining from.
It can also help to jot down a few lines for yourself beforehand: what made you decide to reach out now, what you most want to be different, and anything you are nervous about saying. You do not need to read from it. Having it close by simply means your nerves will not erase the things you came to say.
The beginning: consent and confidentiality
A first session usually starts with the practical foundation. Your therapist will walk you through what is called informed consent. Professional ethics codes, including the National Association of Social Workers Code of Ethics, ask therapists to explain the purpose of services, reasonable alternatives, your right to refuse or withdraw consent, and to give you an opportunity to ask questions.
This is also when your therapist will talk about confidentiality. What you say in therapy is private, and that privacy is one of the reasons therapy works. There are, however, a small number of legal and ethical limits, and a good therapist will name them clearly at the start. In general terms, they include:
- When there is a serious and imminent risk of harm to you or to someone else.
- When there is a reasonable suspicion that a child, or a dependent or older adult, is being abused or neglected.
- When a court orders records to be released.
Hearing this list can feel a little jarring. Most people find it reassuring once they understand it: the limits are narrow, and knowing them in advance means there are no surprises. If anything is unclear, ask. A therapist will be glad to explain how these limits work in practice.
You are allowed to ask questions in your first session too. It is a conversation, not an exam.
Molly Hinke-DeWild, LISW
The middle: getting to know you
After the practical part, the session turns toward you. This part is often called the intake or assessment, and its goal is for your therapist to understand what is happening in your life and what you hope will change. Expect questions along these lines:
- What brings you in now, and how long has it been going on?
- How is it affecting your sleep, work, relationships and daily routine?
- What have you already tried, and what has helped even a little?
- What is your health history, and are you seeing any other providers?
- Who are the important people in your life, and who do you lean on?
- Have you been in therapy before? What worked, and what did not?
Some questions may feel personal. You are always allowed to say “I am not ready to talk about that yet.” A first session is not the place to tell every hard thing. It is a place to give a broad outline, so the two of you can decide together where to begin.
Many therapists will also ask about safety, including whether you have had thoughts of harming yourself. This is a routine question asked of everyone, not a sign that your therapist is worried about you in particular. If you ever need support between sessions, you can call or text 988 to reach the Suicide and Crisis Lifeline, or call 911 in an emergency.
The end: goals and next steps
Toward the end of the session, your therapist will usually reflect back some of what they heard and talk with you about goals. These do not need to be polished. “I want to stop dreading Mondays” or “I want to feel less on edge with my kids” is a perfectly good starting place. Over the next few sessions, those broad hopes often become clearer and more specific.
Your therapist may also share how they tend to work, what approach might fit what you described, and how often they suggest meeting. You will usually leave with a sense of the plan for the next few weeks and a time for your next appointment.
Questions worth asking your therapist
The National Institute of Mental Health notes that rapport and trust are essential in therapy, and suggests asking a provider about their approach, experience and goals. A first session is the natural time. You might ask:
- What experience do you have with what I am dealing with?
- What approach do you usually use, and what might a typical session look like?
- How will we know if this is working?
- How long do people usually see you for something like this?
- What should I do if I need support between sessions?
- How do you handle it if I want to give feedback or something is not working for me?
You are allowed to ask questions in your first session too. It is a conversation, not an exam. There are no wrong questions. How a therapist responds to them will also tell you a great deal about whether you will feel comfortable working together.
After the session
It is very common to feel a mix of things afterward: lighter, tired, emotional, unsure, or all of the above. Talking about hard things out loud for the first time can stir feelings up before it settles them. If you can, give yourself a gentle half hour afterward rather than going straight back into a full schedule.
Later that day or the next, you might notice how it felt to be in the room or on the screen with this person. Did you feel listened to? Did you feel respected? You do not need to feel instantly at ease, since trust builds over time. Still, the fit between you and your therapist matters, and many people find that a strong working relationship is one of the most important parts of therapy. Giving it three or four sessions before deciding is usually fair to both of you. If it does not feel right after that, it is completely acceptable to say so and to look for someone who is a better match.
Starting therapy with Molly
At Integrated Functional Health, we believe mental, physical and spiritual wellbeing are connected, and that therapy is one of the most powerful ways to care for all three. I offer therapy for people located in Iowa, in person in Bettendorf or by telehealth, and I am always glad to work alongside your doctor and other care.
If you are a professional or leader looking for focused support with stress, performance or a transition, my online coaching for high functioning professionals is another option. If therapy would serve you better, I will say so. Whichever you choose, you are welcome to reach out with any questions before you begin.
Sources
- Psychotherapies, National Institute of Mental Health
- Code of Ethics: Ethical Responsibilities to Clients (Informed Consent; Privacy and Confidentiality), National Association of Social Workers
