I remember how it felt for me the first time I went to therapy—how many thoughts ran through my mind and how tense I felt during that initial session. I experienced a mix of curiosity and anticipation, but also a tinge of shame about my problems or who I was.
You might feel that deciding to go to therapy is a big step, and in part, that’s true. It is an important decision. However, going to therapy is as normal as going to the dentist or your GP. Your mind needs to be healthy just like your body does. Both physical and mental health need to be built and maintained with care and responsibility throughout your life. Seeking the right therapist to help care for yourself is completely normal and a sign of self-awareness and maturity.
Whether you need help with anxiety, depression, relationship problems, or another challenge, knowing what to expect from your first session might help ease some of your tension. This article will guide you through the process so you know what lies ahead and how to make the most of your first meeting with a therapist.
Preparing for Your First Therapy Session
Before your first psychotherapy session, you might experience a mix of emotions—nervousness, fear, mistrust, shame, curiosity, or even excitement. These emotions are entirely normal. The key is to approach the session with an open mind. Remember that the purpose of psychotherapy is to provide a safe space where you can express yourself freely and explore your thoughts and feelings without judgment.
Psychotherapists are usually warm and empathetic, partly because of their natural disposition and partly due to their training. They’ve also undergone at least 250 hours of their own therapy (EAP regulations and COPSI), so they come into the room with a neutral but empathetic attitude, focusing entirely on you.
It’s helpful to think about what you want to achieve from therapy before your first session. Are there specific issues you’d like to address? Do you have clear goals or changes you’d like to see in your life? Having a relatively clear idea of what you hope to get out of therapy can make your sessions more effective.
The First Meeting: Building a Foundation
In your first psychotherapy session, the primary therapeutic goal is to get to know you and establish a connection. This initial session is often referred to as an “assessment session.” Most therapists will ask you questions about your life history, current life situation, and the issues that brought you to therapy. You can expect to discuss your mental and physical health history, your family history (up to three generations back), any previous therapy experiences, and your current emotional state.
These initial questions may cover various aspects of your life, including:
- Personal and family history: your childhood, your family and social relationships, and any mental health issues within your family, your current life context.
- Current concerns: this is your opportunity to share what’s troubling you, whether it’s specific symptoms, stressful events, general feelings of dissatisfaction, or something from your life history.
- Medical history: understanding your physical health is important in therapy, especially if there are circumstances that could impact your mental health, or vice versa.
- Lifestyle factors: explore topics like work, social life, and habits (sleep, diet, exercise, alcohol, tobacco, or other substances) to provide context for your current situation.
Establishing a Connection
A crucial part of the first session is establishing a connection with your therapist. The relationship you build with your therapist is one of the most important factors in the success of therapy. Pay attention to how you feel during the session. Do you feel comfortable, understood, and respected? Trust your instincts. If you feel uncomfortable or unsafe, it’s okay to discuss this or consider trying a different professional.
Setting Expectations and Goals
After discussing your story, you’ll likely talk about how future sessions will proceed. After that, you’ll work together ona sketch to set goals and create a treatment plan. This is a collaborative process—your input is vital. Together, you’ll decide how to approach your goals, set a timeline, and reevaluate the plan as therapy progresses. What I ask all may new clients to understand right from the beginning is that therapy takes place in the real, often messy context of life, not in a sterile environment, so we will be working in a less neat fashion.
You’ll also discuss organizational aspects like the frequency and duration of sessions and any potential homework or exercises between sessions. If you’re clear on these details, you’ll know what to expect moving forward and can decide if you’re ready to commit to the therapeutic process.
Misconceptions About the First Therapy Session
Some people expect immediate results after their first psychotherapy session, but therapy is a process. It’s normal not to feel a change right away or to not have all your questions answered immediately.
Others believe that the symptom bringing them to therapy is the only problem. For instance, a panic attack, infidelity in a relationship, work stress, or smoking are often consequences of a belief system or unhealthy coping mechanisms. Usually, the symptom is just the tip of the iceberg, and sustainable healing will require deeper work.
It’s also possible that you and your therapist may have different opinions on what the actual problem is and how best to address it. Depending on how you negotiate the definition of the issue and the best approach, you will determine if you can work together effectively in the therapeutic process.
What Shouldn’t Happen in the First Therapy Session
You should never leave the session feeling worse than when you arrived. If you feel unheard, misunderstood, judged, blamed, shamed, ridiculed, labeled, scolded, or accused, something is definitely wrong. There is no reason for a psychotherapist not to maintain neutrality or to give an assessment after just one session. Exceptions include standardized evaluations, but even then, the evaluation should be discussed with neutrality and kindness.
Embrace the Process
Your first psychotherapy session is an opportunity to take the first step toward healing and self-discovery. Knowing what to expect can help you enter the session with confidence and a clearer understanding of the process. Remember, therapy is a partnership—one built on trust, communication, and commitment. Over time, this journey will lead you toward deep personal growth and a more fulfilling life.
