What to Expect From Your First Therapy Session

If you've never been to therapy before, your first session can feel a little like showing up to an interview for a job you don't remember applying for.

You might be wondering: What am I supposed to say? Am I going to have to talk about my childhood immediately? What if I cry? What if I don't cry? What if I don't know what's wrong with me? What if my therapist thinks I'm ridiculous?

Here is where I am going to have you take a really deep breath.

You don't have to walk into your first therapy session with everything figured out. You don't need a perfectly organized explanation of your life, a list of symptoms, or a dramatic opening monologue. You just need to show up. Here's what you can actually expect....

You'll Probably Do Some Paperwork (Before The Session or At The Beginning of Your First Session)

I know. Thrilling. Before you get to the actual therapy part, you'll probably complete some intake paperwork. This usually includes basic information about your history, current concerns, medications if applicable, relationships, and what brought you to therapy.

When you work with me, I actually have you do this through a secure portal before you even step foot in the door. By finishing the paperwork beforehand, you will be able to pop into my room, maybe make yourself a coffee (yes, I have a Keurig) & get comfy with a blanket.

Before jumping into all the fun stuff, your therapist may also review confidentiality, scheduling, cancellations, payment, and other practice policies. It's not exactly riveting, but it gives you and your therapist a starting point.

Then You'll Talk About Why You're There

Your therapist will probably ask some version of: "What brings you in?"

And here's where people sometimes panic. You do not need to have a specific answer.

You can say:

"I don't really know."

"I'm overwhelmed."

"My relationship is falling apart."

"I've been anxious for months."

"I feel like I'm functioning, but I'm exhausted."

"Someone told me I should come."

"I keep reacting to things and I don't understand why."

All of those are valid places to start.

Your therapist's job isn't to sit there waiting for you to produce the perfect explanation. They'll ask questions, help organize what you're experiencing, and start figuring out what might be most useful to focus on.

You Might Talk About Your History

Depending on your therapist and what brings you in, you may talk about your family, relationships, previous therapy, major life events, work, stress, mental health history, or other experiences that help provide context.

For me, I like to know everything and anything. Whatever you feel comfortable sharing, I am open to hearing it. Think of this as a getting to know you conversation, without the awkward icebreakers.

But this does not mean you have to tell your entire life story in 50 minutes. You are allowed to have boundaries.

You can say:

"I'm not ready to talk about that yet."

"I don't know if I'm comfortable going there today."

"I'd rather come back to that later."

That's okay. Therapy should involve honesty, but honesty doesn't mean handing over every piece of yourself on day one.

You Might Cry

Or you might not. Both are completely fine. Some people cry during their first session because they've finally gotten somewhere they can say things out loud. Other people don't cry at all. Some people laugh when they're nervous. Some people talk constantly.

Some people go completely blank. There is no correct way to have a first therapy session.

You May Not Feel an Instant Connection

This is an important one. You may walk out of your first session thinking: "I think I liked them." Great. You may walk out thinking: "I'm not sure yet." Also completely normal. Therapy is a relationship, and relationships take time to develop. You don't necessarily need to feel like you've found your therapist soulmate after 50 minutes. What matters is whether you generally feel respected, heard, comfortable enough to be honest, and like the therapist understands what you're looking for. Sometimes the fit becomes clearer after a few sessions. And sometimes you realize it's not the right fit. That's okay too.

Your Therapist May Ask Questions You Don't Love

Therapists have a mildly inconvenient habit of noticing patterns. You might mention that you're constantly overwhelmed, and your therapist asks how often you say no to other people. You might talk about a relationship problem, and suddenly you're discussing boundaries. You might say, "I don't care what people think," and then spend 20 minutes describing how much you care what one particular person thinks. We're curious creatures. The goal isn't to catch you doing something wrong. It's to help you notice things you may not be able to see when you're standing in the middle of them.

You Don't Have to Know What to Talk About

This deserves its own section because it's one of the most common worries people have. You can literally walk in and say: "I have no idea what I'm supposed to talk about." Congratulations. You have something to talk about. Your therapist can help you identify where to start. You don't need to bring a list of topics every week. Sometimes the most important thing that happens in therapy is the thing you almost didn't mention.

You Can Ask Your Therapist Questions

Therapy is not a one-way interrogation.

You can ask:

"What approach do you use?"

"How do you think therapy will help with this?"

"What should I expect from treatment?"

"How often do you recommend sessions?"

"Can I tell you if something isn't working?"

You can—and should—ask questions about the process.

You're allowed to understand what you're signing up for.

What Happens After the First Session?

Usually, you and your therapist will have a better idea of what you're working on and what the next few sessions might look like. You may begin identifying goals. You may talk about patterns that keep showing up. You may learn some practical tools. You may simply spend some time getting to know each other and understanding what's happening in your life. Therapy isn't always about immediately "fixing" something.

Sometimes the first step is figuring out what the actual problem is.

The Most Important Thing to Remember

You don't have to be good at therapy. You don't have to know the right things to say. You don't have to show up emotionally organized. You don't have to convince your therapist that your problems are serious enough. And you absolutely do not need to have your shit together before you walk through the door. That's part of why you're there. Your first therapy session isn't about fixing your entire life. It's about starting a conversation. And sometimes, that's more than enough for day one.