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Key points
- Take time before the first session to reflect on your goals and what you hope to gain from therapy.
- Calibrate your expectations around the time frame for treatment, therapy modality, and potential fears of judgment or vulnerability.
- Choose a time strategic time for the appointment if possible and find a location that is quiet and private.
Beginning therapy can feel a little intimidating. Those new to the process may have questions—and sometimes misconceptions—about what it will look like, so it can help to understand what the first session entails and how to make the most of your time. Here’s how to get started.
1. Think about your goals.
“I would hope my clients come in with an idea of what they’re hoping to get out of therapy,” says Shani Turner, Ph.D, a therapist and assistant professor of clinical psychology at William James College. Take a few moments to reflect on what brought you to therapy. What have you been struggling with lately? What changes would you like to make? Take time to think through these questions. If it would be helpful, you can write down thoughts and questions to bring to the appointment.
You’ve already done the hard work of committing to therapy and finding a therapist. So don’t worry about identifying and articulating your goals perfectly. Some patients may arrive with specific concerns, such as “I had a really difficult childhood and I think that it’s influencing my ability to develop healthy relationships.” Others may be more amorphous: “I’ve started feeling really anxious and I don’t know why. I’d like to understand what’s happening.” Any way you choose to share your goals is valid.
2. Know how the first session is structured.
First, try to arrive or log on a few minutes early to make sure that you're ready. You may fill out some paperwork, so you may want to have your insurance on hand.
Therapy sessions are typically 45 to 50 minutes. The therapist may begin with a question such as, “What brings you here today?” The therapist will ask questions throughout the session to learn about you, both your past and present, and they may take notes as you answer. They may ask about your clinical history, family history, and current stressors and symptoms, explains psychologist Pamela Garcy, Ph.D. They may also ask about your goals and discuss expectations around therapy, such as confidentiality, which may apply in family contexts or to conditions such as child abuse and suicidality.
When the session draws to a close, it may feel like you’ve only scratched the surface, or that you just got to the heart of the problem but have to stop. That’s ok—you will pick up the conversation next session.
3. Calibrate your expectations.
It can be helpful to set realistic expectations for your first session and confront any misconceptions or fears.
Time Frame: Some people have the misconception that they’ll walk in, divulge their entire history, and be healed in one or two sessions. Unfortunately, this is completely unrealistic. The process takes time, and the goal of the first session is to begin building a relationship. “The expectation should be that the therapist is attempting to understand you,” Garcy says. “If you leave thinking that the therapist has begun to understand you, and they seem curious, that may be as good as it gets in the first session.”
Therapeutic Approach: There are many different approaches to therapy. Some patients may have visions of lying on a couch and speaking in a stream of consciousness to a silent therapist. Select therapists use this approach, but many use other approaches, such as cognitive behavioral therapy, which involves more dialogue, guidance, and skill development. (If you haven’t discussed modality ahead of time, the first session can be an opportunity to ask how the therapist’s approach aligns with your goals.)
Fear of Judgment: Another misconception is that the therapist will judge you for certain choices or experiences. Some patients may begin sentences with “you’re going to think I’m crazy…” or “you’re going to judge me…,” Turner says. But the therapist is not judging you for your choices—they want to understand you. This fear of judgment may be due to the stigma around therapy and mental health, particularly in certain communities and cultures. “You have to be respectful of someone’s culture and upbringing. You have to be educated in those topics. But you also want to offer a space where there may be additional approaches,” Turner says. (In the rare case that your therapist does judge or shame you, that’s a red flag that you should find a new therapist.)
Honesty: Recognize that being truthful is essential for therapy to be effective. If honesty and vulnerability feel scary, Turner says, think about it as trying something new: If other approaches haven’t worked, what do you have to lose? Give it a chance for a few sessions. If you still don’t feel comfortable opening up after three or four sessions, think about whether a different therapist may be a better fit.
4. Pick a strategic time.
For many people, squeezing a therapy session into a busy schedule is already hard enough. But if you have the flexibility, choose a strategic time for the appointment, when you have a few moments to clear your mind before the session and time afterwards to process it. For example, you may want to avoid scheduling the session, which may be emotional, right before an important meeting.
5. Find a private place.
If your therapy session is virtual, decide where you will have it ahead of time. Find a quiet space so you’ll be able to hear the therapist and you won’t be distracted. Find a private space as well, so you’ll feel comfortable sharing your true feelings, even if they’re about people in your household. If you don’t have a private space in your home, Turner suggests, you could sign out a room at your local library or drive to a quiet location and have your session in the car.
To find a therapist, visit the Psychology Today Therapy Directory.
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