Your First Therapy Session: What to Expect

Starting therapy, especially if it's the first time, can feel unfamiliar and maybe even intimidating. Common questions many people are asking themselves before their first session include ‘’What will they ask me? Do I need to prepare? What if I get emotional?’’

To answer some of those questions and ease the apprehension, we will provide a rough overview of what the first session entails and what it aims to accomplish.

Rest assured that the first session is primarily about getting to know each other and for the therapist to gain an understanding of what brings you in.

The first session is different from later sessions. Being more assessment-focused is what differentiates it from later sessions. Therefore, the first session is usually referred to as the intake session.

The therapist gathers background information about you, including your family background and upbringing, relationships, work or study life, previous therapy experiences, significant life events or trauma, and current symptoms or difficulties. Likely questions you might be asked can include ‘’What prompted you to seek therapy now?, What has been difficult lately? What would you like help with?’’

Rather than trying to ‘’analyse’’ you, the intake serves as a tool for creating a full picture of you as a person.

It is perfectly okay to come in feeling confused and overwhelmed and not have clear answers to all the questions. Moreover, the intake is a good trust-building point, as you can get a sense of whether this particular therapist feels like a good fit. Thus, therapy is collaborative, and the client is also assessing the therapist.

Setting Goals Together

Another important part of the intake process includes setting goals together. Your therapist might ask you what you would like to change or what feeling better would look like for you. Again, it is absolutely fine not to have perfect answers. Examples of therapy goals might be wanting to reduce anxiety, improve relationships, or understand your patterns.

Practical and Confidentiality Information

While the point in time for discussing matters of confidentiality might vary from practice to practice, your therapist will inform you about certain practical matters.

Therapists are bound to strict confidentiality rules prohibiting them from disclosing sensitive information about you to third parties. However, it is important to be aware of the limits of confidentiality.

Some example scenarios in which therapists can or must even break confidentiality include:

• Imminent danger to self or others

• Suspected abuse or neglect

• Court orders / legal proceedings

Your therapist will likely provide you with a detailed document outlining these matters. You will also be informed about session length and frequency, cancellation policies, and the therapeutic approach applied by your therapist.

It’s Normal to Feel Nervous or Emotional

Because you will likely be discussing emotionally loaded topics, it is more than normal to feel apprehensive. It is not uncommon for some people to cry, struggle to talk, or feel emotionally tired after a session. Some people might also feel a sense of relief after sessions. Whatever you might be experiencing, rest assured that it is okay. There is a reason that a therapist's office is equipped with tissue boxes.

It is also important to realise that there is no pressure to disclose everything, including potential trauma, right away in the first session. Trust develops over time, and therapy should move at a manageable pace.

What Happens After the First Session?

After the first session, it might be wise to take some time to reflect on whether you felt heard and safe, and whether the therapist’s style suits you.

If so, possible next steps will likely include the continuation of regular sessions, agreeing on goals and deciding on a treatment approach. Sometimes during or after the first session, it might become apparent that a different specialist could be a better fit, in which case the therapist might issue a referral.

Remember, the intake is not about having all the perfect answers and disclosing everything at once. It’s about getting to know each other and making a start. Showing up is already the first step.