What to Expect in Your First Therapy Session
Deciding to start therapy is a significant step, and it's completely normal to feel nervous about your first session. You might be wondering what you're supposed to talk about, whether you'll be judged, if you'll have to share your entire life story, or whether therapy will even help.
The uncertainty about what actually happens in that first appointment can create enough anxiety to prevent people from showing up at all. But here's the truth: first therapy sessions are designed to be low-pressure opportunities for you and your therapist to get to know each other and begin understanding what brings you to therapy.
Knowing what to expect can significantly reduce that first-session anxiety and help you get the most out of your initial appointment. Let's walk through what typically happens so you can arrive feeling informed and prepared.
Before Your First Session
Your therapy experience actually begins before you walk through the door (or log into your first video session). Most practices, including Alba Wellness Group, handle several administrative tasks ahead of time to make your first session focused on you rather than paperwork.
Intake paperwork is usually completed online before your appointment. These forms collect basic information about your demographics, contact details, insurance, emergency contacts, and sometimes preliminary questions about what brings you to therapy. While filling out forms might feel tedious, this information helps your therapist prepare for your session and ensures they have the necessary background before you meet.
Insurance verification happens before your appointment if you're using insurance. The administrative team will confirm your coverage, explain your copay or coinsurance, and help you understand what your out-of-pocket costs will be. If you have questions about fees and insurance, this is the time to get clarity so finances don't become a source of stress during therapy itself.
Choosing your therapist matters. If you completed a consultation call with an admissions coordinator, they likely matched you with a therapist whose specialties and approach align with your needs. At Alba Wellness Group, we take time to understand what you're looking for so we can connect you with someone who's genuinely a good fit.
What Happens During the First Session
First sessions typically last 50 to 60 minutes for individual therapy, or longer for couples or family sessions. Here's a general flow of what usually happens, though every therapist has their own style:
1. Introductions
Introductions and building initial rapport start the session. Your therapist will likely introduce themselves, share a bit about their background and approach, and help you feel comfortable. They might explain how therapy works, what confidentiality means, and answer any questions you have about the process. This isn't just small talk; it's the beginning of building trust that makes therapy effective.
2. What Brings You to Therapy
Understanding what brings you to therapy forms the core of most first sessions. Your therapist will ask about what's happening in your life that led you to seek support. This might include current stressors, specific symptoms you're experiencing, relationship challenges, life transitions, or longer-standing patterns you want to change.
You don't have to have everything figured out or articulate your problems perfectly. "I just feel overwhelmed," or "My anxiety is getting worse," or "I don't know exactly, I just know something needs to change" are all completely valid starting points.
3. Background Info
Gathering relevant background helps your therapist understand the context. They might ask about your family history, past therapy experiences, medical history, substance use, current medications, or previous trauma. These questions aren't meant to be invasive or judgmental; they help your therapist understand factors that might be contributing to your current difficulties.
You don't have to share everything in the first session. If questions feel too personal or you're not ready to discuss certain topics, it's okay to say, "I'm not comfortable talking about that yet" or "Can we come back to that question later?"
4. Goals and Expectations
Discussing goals and expectations helps establish where you want therapy to go. Your therapist might ask what you hope to gain from therapy, what success would look like for you, or how you'll know therapy is helping. Goals don't have to be perfectly defined, and they can absolutely evolve as therapy progresses.
5. Therapeutic Approach
Explaining the therapeutic approach gives you insight into how your therapist works. They might explain their theoretical orientation (like CBT, psychodynamic therapy, or EMDR), what a typical session looks like, or how they conceptualize problems and change. This transparency helps you understand what you're signing up for.
6. Logistical Details
Logistical details get covered at some point, including scheduling frequency (usually weekly initially), appointment policies, how to reach your therapist between sessions if needed, and what happens if you need to cancel. Understanding these practical matters helps avoid confusion later.
Common First Session Questions You Might Be Asked
While every therapist has their own style, certain questions come up frequently in first sessions. Knowing some of these ahead of time might help you feel more prepared:
What brings you to therapy right now?
Have you been in therapy before? If so, what was that experience like?
What are you hoping to get out of therapy?
Can you tell me about your current life situation (work, relationships, living situation)?
Are you currently experiencing any thoughts of harming yourself or others?
How have you been sleeping and eating?
Are you taking any medications or receiving other medical treatment?
Is there anything important you want me to know about you?
Do you have questions about therapy or how we'll work together?
These questions help your therapist understand both your immediate concerns and the relevant context. Remember, you're in control of how much you share and what you discuss.
What You Can Ask Your Therapist
Therapy is a collaborative relationship, and you should feel comfortable asking questions. In fact, asking questions demonstrates engagement and helps ensure therapy meets your needs. Don't hesitate to ask things like:
What's your experience working with [specific issue]?
What approach or therapy style do you use?
How long does therapy typically last?
How will we know if therapy is working?
What should I do if I'm struggling between sessions?
Do you give homework or exercises to practice?
How does confidentiality work, and are there exceptions?
What's your cancellation policy?
Can we switch to a different therapist if this doesn't feel like the right fit?
A good therapist welcomes questions and provides clear, honest answers. If your therapist seems defensive or dismissive about questions, that's information worth noting.
It's Okay If You Don't Click Right Away
Chemistry between therapist and client matters. While some people feel an immediate connection, others need a few sessions to determine whether the fit feels right. That's completely normal.
Give it a few sessions before deciding whether to continue with a particular therapist, unless something feels genuinely wrong or unsafe. Initial nervousness doesn't necessarily mean the therapist isn't right for you; it might just mean therapy feels vulnerable and unfamiliar.
However, trust your instincts. If after two or three sessions you don't feel heard, understood, or comfortable, it's okay to try a different therapist. Finding the right fit is important, and good therapists understand this isn't personal.
Common First Session Concerns
"I don't know what to say."
Your therapist will guide the conversation. You don't need to prepare a speech or know exactly what to discuss. They're trained to help you explore what matters.
"What if I cry?"
Crying in therapy is completely normal and okay. Therapists expect emotions and have tissues ready. You won't be judged for showing feelings.
"What if my problems aren't serious enough?"
If something is bothering you enough to seek therapy, it's worth addressing. You don't need to meet some threshold of suffering to deserve support.
"What if I'm too anxious to talk?"
Tell your therapist you're feeling anxious. They can adjust their approach to help you feel more comfortable. Anxiety about therapy is incredibly common and not a barrier to getting help.
"What if I don't like therapy?"
First sessions can feel awkward or uncomfortable. Give it a few tries before deciding. But if it genuinely isn't helping after several sessions, discuss this with your therapist or consider trying a different approach.
After Your First Session
After your initial appointment, take a moment to reflect on how it felt. Did you feel heard? Did the therapist seem competent and compassionate? Could you imagine opening up more to this person over time? Do you feel hopeful about continuing?
Schedule your next appointment before you leave (or during your session). Regular sessions are more effective than sporadic appointments, and having the next one scheduled increases the likelihood you'll follow through.
Be patient with the process. Therapy usually doesn't provide immediate relief or solutions in the first session. It's the beginning of a process that unfolds over time. Real change typically requires multiple sessions as you build trust, explore patterns, develop insights, and practice new skills.
Notice what comes up between sessions. You might find yourself thinking about things you discussed, noticing patterns you hadn't seen before, or feeling emotions more intensely. This is all part of the process.
Specialized First Sessions
First sessions for different types of therapy have some variations:
Couples therapy initial sessions are typically 90 minutes and involve both partners sharing their perspectives on relationship challenges. The therapist is working to understand both viewpoints without taking sides.
Teen therapy often includes a portion with parents to discuss concerns, then time alone with the teen to build rapport and hear their perspective.
Trauma-focused therapy might move more slowly in the first sessions, prioritizing safety and stabilization before addressing traumatic experiences directly.
Specialized approaches like ketamine-assisted therapy have unique first sessions that focus heavily on preparation, medical screening, and setting intentions for the work ahead.
You're Taking an Important Step
Starting therapy takes courage. Admitting you need support and actually showing up for that first appointment deserves recognition. Many people spend years thinking about therapy before finally making it happen.
That first session might feel vulnerable or awkward, and that's okay. Therapy gets easier and more comfortable as you build a relationship with your therapist and learn to trust the process. What matters is that you're taking steps to support your mental health and well-being.
At Alba Wellness Group, we understand that starting therapy can feel intimidating. Our therapists are trained to make first sessions as comfortable as possible while beginning the important work of understanding your needs and goals. We're here to support you every step of the way.
Ready to take that first step? Schedule your consultation today and begin your therapy journey with a team that truly cares about your wellbeing.
At Alba Wellness Group, we believe everyone deserves a space where they can heal, grow, and truly belong. If you're ready to take the next step in your journey, we're here to walk alongside you; contact us today for your free consultation.