Your First Therapy Session

Absolutely. The decision to start therapy is rarely made lightly, and the prospect of sharing your innermost thoughts and feelings with a stranger can induce feelings of skepticism, apprehension, anxiety, or outright fear. You’re welcome to share these feelings with your therapist during your first session, if you like, but you are not obligated to. Typically, pre-session anxiety will ebb as you get to know your therapist, see how the process works, and start to see results as the weeks go by. If you continue to feel anxious about therapy even several sessions in, it may be wise to bridge it with your therapist and see if you can address the feelings directly.

Most therapists offer free phone consultations; some offer free in-person introductory sessions to determine if the therapist and client are a good fit. This is because finding the right therapist is often a process of trial and error, and paying for a single session with a therapist who ultimately won’t work out can feel unfair to clients. But therapists debate about the ethical and financial drawbacks of offering their services for free, and many have decided that they will charge for any in-person session, even the first one. Check with your prospective therapist before making an appointment.

It may help you feel more comfortable to think about what issues you want to discuss, what relevant information you think the therapist should know, and what you hope to get out of your first session. If the office is somewhere you’ve never been before, it can be useful to plan out your route beforehand and calculate when you should start your trip. Before you go, make sure you bring your insurance information and any other relevant documents, and plan to get there a few minutes early so you can go over any necessary paperwork.

If you would like to bring a friend or family member to sit in the waiting room for moral support, you are free to do so. When it comes to having someone else sit in on your session, however, the question becomes more complex. In couples therapy or family therapy, it’s common (indeed, expected) to bring others to the session. For more traditional one-on-one psychotherapy, it is significantly less common, but not entirely unheard of. Some therapists view therapy as a private interaction between them and the client, and would hesitate to allow someone else to join; others, however, may be open to the idea. If you really would like someone else to sit in on your session, ask your prospective therapist beforehand; they will let you know if they are amenable to it and what to expect.

First sessions focus on broad strokes: what brings you to therapy, your general autobiography, and how the therapist plans to treat you. Expect the therapist to ask about the specific problem that inspired you to seek therapy, what you hope to achieve over the course of treatment, a brief sketch of your life story, and any experience you’ve had with therapy in the past. He may also discuss his own therapeutic orientation, summarize what you shared, and provide feedback on the issues you shared.

Many, if not most, clinicians will explore your family’s mental health history, either directly or indirectly, though not necessarily in the first session. Since many mental health disorders have genetic components, learning a client’s family history of depression, addiction, anxiety, or otherwise may offer clues to their current issues. While some therapists prefer to get this information in the first session, others prefer to dive into the issue that brought the client to therapy and leave historical questions for another time. How your therapist addresses this may depend on their theoretical approach or their personal preference.

There’s no surefire way to determine whether a therapist is a good fit, but most clients sense a strong alliance. If you’re unsure after the session, ask yourself: Do you feel comfortable speaking with the therapist? Do you have a good rapport with the therapist? Did you feel that the therapist was trustworthy, likable, and respectful? Did she seem attentive to your concerns and focused on what you were saying? Does she have experience working with clients with similar issues? If the answer to these questions tends to be yes, it may indicate that you and the therapist have a strong therapeutic alliance, which is a great predictor of successful outcomes. If you primarily answered no, it may be best to keep looking.

Yes, it is perfectly okay to cry during therapy. Therapists are trained to deal with difficult emotions on a daily basis; if you start crying, any competent therapist will respond in an empathetic, non-judgmental way. If you feel embarrassed about crying, it’s also okay to bring this up with your therapist; he can help you explore why crying evokes shameful feelings. On the other end of the spectrum, many clients wish to cry in therapy but feel they’re unable to do so. Exploring this “emotional blockage” with your therapist, too, can be a productive way to make progress.

Like any other medical waiting room, it’s best to be quiet and to respect the privacy of others. You are welcome to look at your phone, read a book, or flip through a magazine. If you see someone you know, it’s up to you if you want to say hello; if you do, it’s best to keep it brief and avoid asking any therapy-related questions.

Therapists differ on when and how they prefer to be paid; if your therapist doesn’t bring up the payment process in the first session, you should feel free to ask. Many therapists prefer to take care of payment up front, or to have clients pay for several sessions in advance; that way, both therapist and client avoid the awkward experience of having to discuss payment after a particularly difficult session.

You should confirm that your therapist accepts your insurance before going in for your first appointment. (Psychology Today’s therapy directory allows prospective clients to sort therapists by the insurance they accept.) If you have specific questions about co-pays, payment schedules, or seeking reimbursement, you should ask those at the beginning of your first session to get them out of the way.

You should expect to have at least a sense of whether you and your therapist are a good fit, whether you’d like to continue seeing her, and what working with this particular therapist might be like. You should feel as if your biggest questions were answered and that you have at least a basic grasp of what approach your therapist will be using. You should not expect to feel totally better or to have your problems resolved immediately.

Having your first session over online video or over the phone is largely similar to having a session in person; your therapist will likely ask you general questions to get a sense of your concerns and help you determine whether or not the relationship is a good fit. There are, however, some differences that clients should keep in mind. For starters, you should find a private, quiet space in which to have the session; this can be your bedroom, your car, or even a closet. If conducting the session over a video-chatting platform, it may be useful to test it beforehand to make sure that video and audio both function properly. Be prepared for your therapist to ask for consent to hold the sessions remotely; they may also ask for your location, in order to contact local resources in case of an emergency.