What to Expect in Your First Therapy Session: A Step-by-Step Guide

Starting therapy can feel like a big step, especially if you’re unsure what to expect. Whether you're seeking support for anxiety, trauma, stress, or personal growth, the first session is an opportunity to explore how therapy can help and begin building a foundation for meaningful change. This guide explains what happens in a first therapy session, how to prepare, and what you can gain from the experience.

The Purpose of the First Session

The first therapy session, often called an intake session, is designed to help your therapist get to know you and your concerns. It’s also a chance for you to learn more about your therapist’s approach and decide if their style feels like a good fit. Research highlights the importance of the therapeutic alliance—the bond between therapist and client—as a key factor in successful therapy outcomes (Horvath et al., 2011).

During this session, your therapist will likely:

• Ask about your reasons for seeking therapy.

• Gather information about your personal history, current challenges, and goals.

• Explain their therapeutic approach and how they can support you.

  
  

Remember, this is a collaborative process. You don’t have to have everything figured out—therapy is about exploring and clarifying your thoughts and feelings over time.

What Happens During the Session

Here’s a step-by-step overview of what you can expect:

1. Introductions and Setting the Tone

Your therapist will begin by introducing themselves and explaining their approach to therapy. They’ll review important information, such as confidentiality and its limits (e.g., situations involving harm to self or others). This conversation sets the stage for a safe and supportive environment.

2. Discussing Your Reasons for Seeking Therapy

Your therapist will ask about what brought you to therapy. You might discuss specific challenges, such as anxiety, relationship difficulties, or life transitions, or more general feelings of unease. This is your opportunity to share as much—or as little—as you feel comfortable.

3. Exploring Your History

To gain a better understanding of your experiences, your therapist may ask about:

• Your family and upbringing.

• Past mental health experiences.

• Medical history or current health concerns.

• Your social and professional life.

This background helps your therapist understand patterns and influences that may shape your current challenges.

4. Establishing Goals

Together, you and your therapist will discuss what you hope to achieve in therapy. Goals can be specific (e.g., “I want to manage my anxiety better”) or open-ended (e.g., “I want to feel more confident in myself”). Setting clear goals provides direction for your sessions.

5. Outlining the Process

Your therapist will explain how they plan to work with you, including the therapeutic methods they use (e.g., CBT, ACT, or Schema Therapy). They might also discuss session frequency, what progress looks like, and how you’ll work together to measure it.

Preparing for Your First Session

To make the most of your first therapy session, consider the following:

1. Reflect on Your Goals

Take some time to think about why you’re seeking therapy and what you’d like to achieve. You don’t need to have all the answers, but having a general idea can help guide the conversation.

2. Gather Relevant Information

Your therapist may ask about your medical history, mental health background, or current medications. Having this information ready can streamline the session.

3. Bring Questions

Therapy is a collaborative relationship, so don’t hesitate to ask questions. Examples include:

• “What is your approach to therapy?”

• “How do you typically work with people facing challenges like mine?”

• “What should I expect from future sessions?”

  
  

Addressing Common Concerns

1. “What if I don’t know what to say?”

It’s completely normal to feel unsure or nervous about what to share. A good therapist will guide the conversation and create a space where you feel comfortable opening up.

2. “What if I don’t feel a connection with my therapist?”

The therapeutic relationship is crucial, and it’s okay if you don’t feel an immediate connection. If you’re unsure, give it a few sessions to see if the relationship develops. If not, it’s perfectly acceptable to seek a better fit.

3. “Is what I’m sharing confidential?”

Therapists are bound by confidentiality, with some legal exceptions (e.g., threats of harm). Your therapist will explain these limits during your first session.

The Role of the Therapist

Your therapist’s role in the first session is to:

• Listen without judgment.

• Provide clarity about the therapeutic process.

• Begin to build a trusting and collaborative relationship.

  
  

Effective therapy is rooted in mutual respect and understanding. Your therapist should convey empathy, warmth, and professionalism while creating a space where you feel heard.

What You’ll Gain from the First Session

The first session is just the beginning of your therapy journey, but it can offer immediate benefits:

• Validation: Sharing your concerns with a non-judgmental professional can be a relief.

• Clarity: Discussing your challenges and goals can help you better understand what you’re facing.

• Direction: You’ll leave with a clearer sense of how therapy will help and what the next steps are.

Research shows that even a single session of therapy can provide noticeable benefits, particularly when the therapist and client align on goals and approach (Swift et al., 2011).

Moving Forward

After your first session, you’ll likely feel a mix of emotions—relief, hope, and maybe even some uncertainty. Therapy is a process, and it takes time to build trust and see lasting change. Future sessions will delve deeper into your concerns, helping you uncover insights, develop coping strategies, and achieve your goals.

If you’re considering therapy, know that taking this first step is an act of courage. It’s a commitment to yourself and your well-being, and it sets the stage for growth and healing.

References

Horvath, A. O., Del Re, A. C., Flückiger, C., & Symonds, D. (2011). Alliance in individual psychotherapy. Psychotherapy, 48(1), 9–16.https://doi.org/10.1037/a0022186

Swift, J. K., Greenberg, R. P., Whipple, J. L., & Kominiak, N. (2011). Practice recommendations for reducing premature termination in therapy. Professional Psychology: Research and Practice, 43(4), 379–387.https://doi.org/10.1037/a0028291