Starting therapy can feel overwhelming, but the more you know, the better prepared you will be. Here’s what to expect at your first therapy session.
So you've decided to make your first therapy appointment and I'm guessing you may be feeling nervous, apprehensive, or possibly even frightened about starting. Most people have a natural fear of the unknown, which may be contributing to your feelings. This is very common. Remember that taking the first step to reaching out and finding help can be challenging, so try to show yourself compassion and patience.
Psychotherapy can be a powerful tool to help you navigate the challenges of daily life, work on stress management, and develop effective coping strategies. To help you manage any stress or fear you might be experiencing, here’s a rundown of what to expect in the first session.
Before The First Session
Assuming you've already identified a therapist and scheduled an appointment, your therapist will likely have some paperwork for you to complete before the first session. This may include informed consent forms, fee agreements, privacy policies and a patient questionnaire. I encourage prospective clients to provide as much relevant information as you feel comfortable sharing on the questionnaire. This is a chance for you to say, in your own words, why you are seeking therapy and gives your therapist a chance to get familiar with your goals and concerns.
A common question a therapist may ask in the first session is what brought you to therapy, because the client’s purpose helps the therapist create a plan for how the therapy sessions will go. Prior to the first session, I encourage prospective clients to make a list of your symptoms, including bothersome thoughts, emotions, behaviors, past experiences, and current situations and stressors. While you don’t have to articulate a detailed list of your concerns and goals, knowing the general reason you are seeking therapy will help you feel ready for going to a therapist for the first time.
The First Session
The first session is often called the "intake session" and the goal of this appointment is for you and your therapist to get acquainted with one another. Your therapist will go over the paperwork you completed and answer any questions or concerns you have. They will cover topics such as insurance/billing, confidentiality, and the therapy process. This session may last anywhere from an hour to two hours depending on the provider. Generally, most therapy sessions are about 53-60 minutes long.
Next, your therapist will turn the focus toward you and likely want to collect the following information:
what prompted you to seek treatment
your background
your life circumstances
any past treatment you’ve sought
your goals for therapy
There may be some topics you’re not comfortable sharing yet. If so, it’s absolutely okay to set boundaries and communicate your limits to your therapist. Especially if you are living with trauma, it's important to remember that you get to determine the pace. Therapy is a safe space and is designed to work for you and it can take time to build the trust and rapport needed to open up more deeply.
As important as it is for your therapist to get to know, it's equally as important for you to get to know your therapist. This mutuality is essential to building trust and rapport. Feel free to ask your therapist about their therapy style and their experience. Some therapists may offer additional self-disclosure, but this varies from provider to provider.
Toward the end of this session, your therapist may inquire if you want to make another appointment. Know that you don't have to if you need time to think about it. I offer my clients the option to either schedule our next session or to take a day or two to think about it and get back to me. You and your therapist will determine the frequency of appointments based on factors like medical necessity and scheduling preferences. I generally encourage clients to meet with me weekly until we've established a good foundation, but this can vary based on a client's needs and preferences.
I encourage new clients to email me if they think of any questions or have concerns they need addressed after the first session. Have you ever left a doctor's appointment and by the time you get to your car you think, "Darn it! I forgot to tell them...." or "I forgot to ask about..."? That happens to me all the time and it's reassuring to know you can contact your provider after-the-fact, so don't be afraid to reach out if needed.
And that's pretty much what you can expect in the first session. You won't have time to get in to everything in your first session, so don't worry if you feel like you were rambling or missed important aspects of your history. Your therapist will continue to gather background information and get to know you over the course of the next few sessions. Therapists are skilled at taking what you're saying and organizing it and this gives them an opportunity to ask questions and provide insights.
If you're still feeling nervous or apprehensive about your first session, it's okay! It can be scary to open up to a complete stranger and it's important to listen to your gut while remaining open minded to the process. So much of therapy is about your participation in the process and it can take time to find a rhythm with a provider that feels right for you.
Therapy is a gradual but steady process of developing insights, overcoming obstacles, setting and achieving goals, and enhancing wellbeing and the quality of your life. The first session is just the beginning of what can be a rewarding experience. With preparation and realistic expectations, you and your therapist can start to develop rapport, trust, and an important sense of hope for healing.
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