Starting therapy can feel intimidating, especially if you've never been before. It's completely normal to feel nervous, uncertain, or even skeptical about what to expect. Many people wonder: "What will we talk about?" "Will I be judged?" "How do I know if this therapist is right for me?"
"The first therapy session is like a first date with yourself—it's about getting to know your needs, exploring possibilities, and deciding if this relationship feels right for your healing journey."
— Common therapeutic wisdom
This comprehensive guide will walk you through exactly what happens during that initial session, how to prepare, what questions to ask, and how to get the most out of this important first step in your mental health journey.
Common Fears & Myths About First Sessions
Let's address some common concerns people have about starting therapy:
Myth
"I have to lie on a couch and talk about my childhood for 50 minutes"
VS
Truth
Modern therapy is collaborative and conversational. You sit facing your therapist and discuss what's relevant to your current concerns.
Myth
"The therapist will analyze me and tell me what's wrong with me"
VS
Truth
Therapy is a collaborative process. Your therapist will work with you to understand your experiences, not make judgments or pronouncements.
Myth
"I need to know exactly what to say and have my 'story' perfectly prepared"
VS
Truth
It's okay to not know where to start. Your therapist is trained to help guide the conversation based on your comfort level.
Before Your Session: How to Prepare
A little preparation can help reduce anxiety and make your first session more productive:
1
Clarify Your Goals
Think about what you hope to achieve in therapy. What brought you here? What changes would you like to see in your life?
2
Complete Paperwork
Fill out any intake forms beforehand. This helps your therapist understand your background and saves session time.
3
Technical Setup
For telehealth sessions, test your technology 10 minutes before. Ensure good internet, audio, and video quality.
4
Create Space
Find a private, comfortable space where you won't be interrupted. Consider having water and tissues nearby.
What If I'm Too Anxious to Prepare?
That's completely okay! The most important preparation is simply showing up. Your therapist understands that starting therapy can be anxiety-provoking and will meet you where you are. You don't need to have everything figured out before you begin.
What Happens During the First Session: A Timeline
First 5-10 Minutes: Welcome & Logistics
Your therapist will welcome you, review confidentiality and informed consent, discuss session structure (length, frequency), and answer any logistical questions.
Minutes 10-20: Getting to Know You
They'll ask open-ended questions about what brought you to therapy. Common starter questions include: "What brings you here today?" or "What would you like to work on in therapy?"
Minutes 20-40: Exploring Your Story
This is where you'll discuss your current concerns, relevant history, and how these issues impact your daily life. Your therapist listens and asks clarifying questions.
Minutes 40-50: Setting Goals & Next Steps
Together, you'll begin to identify goals for therapy and discuss what approach might work best. Your therapist will outline what to expect moving forward.
Final 5-10 Minutes: Wrap-up & Questions
Your therapist will summarize key points, check in on how you're feeling, and give you space to ask questions. You'll schedule your next session if you decide to continue.
Common Questions Your Therapist Might Ask
Knowing what kinds of questions to expect can help you feel more prepared:
"What brings you to therapy at this time?"
This helps identify your primary concerns and motivations.
"How have you been coping with these challenges?"
This explores your current strategies and resilience.
"What would you like to be different in your life?"
This helps establish goals for therapy.
"Have you been in therapy before?"
This informs what has or hasn't worked for you in the past.
"What does a typical day look like for you?"
This provides context about your daily life and routines.
"How would you describe your support system?"
This assesses your social connections and resources.
Remember:
You don't need to answer every question perfectly or completely. It's okay to say "I don't know" or "I'm not ready to talk about that yet." Your therapist will respect your boundaries and pace.
Questions You Should Ask Your Therapist
The first session is also your opportunity to assess if this therapist is a good fit for you. Consider asking:
About Their Approach
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"What therapeutic approaches do you typically use?"
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"How do you typically work with clients like me?"
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"What does a typical session look like with you?"
Practical Questions
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"What is your cancellation policy?"
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"How do you handle emergencies between sessions?"
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"What can I expect in terms of progress timeline?"
After Your First Session: What's Next?
The work doesn't end when the session does. Here's what to consider afterward:
Check In With Yourself
Notice how you feel after the session. Did you feel heard? Understood? Comfortable? Trust your instincts about the therapeutic relationship.
Journal Your Thoughts
Write down any insights, questions, or topics you want to explore next time. This can help you track your progress and prepare for future sessions.
Give It Time
The therapeutic relationship takes time to develop. Consider committing to 3-4 sessions before deciding if this therapist is the right fit for you.
Signs of a Good Therapeutic Match
Potential Red Flags
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Therapist talks more than listens or interrupts frequently
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Makes you feel judged, shamed, or invalidated
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Has poor boundaries (shares too much personal information)
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Promises quick fixes or guarantees specific outcomes
Green Flags
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You feel heard, understood, and respected
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Therapist explains their approach clearly
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Collaborates with you on treatment goals
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Maintains professional boundaries while being empathetic
Finding the Right Fit Takes Time
Remember that finding the right therapist is like any other relationship—it needs to click. If you don't feel comfortable after a few sessions, it's perfectly acceptable (and encouraged!) to seek another therapist. Your comfort and trust in the therapeutic relationship are essential for progress.
You've Taken the Brave First Step
Simply considering therapy and reading this guide shows your commitment to your wellbeing. Whatever worries or questions you have, your therapist has heard them before and is ready to support you.
Ready to Begin Your Journey?
At Lakesyde Behavioral Health, we understand that starting therapy can feel daunting. Our compassionate providers are here to make your first session as comfortable and productive as possible.
Most insurance plans accepted • Flexible scheduling • Virtual and in-person options
