Starting therapy can feel like stepping into the unknown. You may feel nervous, curious, or even a little skeptical about what to expect. That’s completely natural. Understanding the structure and purpose of a first session can help ease these uncertainties. Here’s a guide to what usually happens in a first psychotherapy session and how you can make the most of it.

1. Preparing for Your Session

Before your first meeting, your therapist will ask you to fill out some paperwork. This includes consent forms, insurance and billing details, and a brief history of your concerns. It’s a good idea to take a few moments before the session to jot down any thoughts, symptoms, or goals you want to bring up.

Consider reflecting on what led you to seek therapy. Are there specific problems you want to address, or are you looking for a space to talk through feelings or behaviors you don’t fully understand? If you’re not sure, that’s okay. Your therapist will help guide you through this exploration.

2. The Setting and Initial Introductions

When you arrive, you’ll be welcomed into a comfortable and confidential space. The session usually begins with a warm introduction. Your therapist might briefly talk about their approach and background. This is an opportunity to ask any questions about their qualifications, therapeutic style, and experience. If you’re unsure about anything, don’t hesitate to ask! Knowing you’re in competent hands can help build trust.

3. Talking About the Practicalities: Confidentiality and Boundaries

One of the first things your therapist will cover is confidentiality. They’ll explain that what you share stays private, with a few legal exceptions (such as risks of harm to yourself or others). Understanding this will help you feel safe to open up, knowing that your information won’t leave the room.

Your therapist may also set some basic boundaries about session length (usually 45-53 minutes), frequency, and communication outside of sessions. This is the time to clarify logistics like scheduling, and cancellations.

4. Exploring the “Why”: Understanding Your Reasons for Coming to Therapy

Once the groundwork is set, the therapist will start by asking some broad questions about what brought you to therapy. Common starting points include:

• “What made you decide to seek therapy now?”
• “What are you hoping to achieve from our work together?”
• “Can you tell me a little about what’s been on your mind lately?”

This part isn’t about getting everything out at once. You don’t have to know all the answers or provide a perfectly linear story. The therapist’s job is to help guide the conversation and make sense of your narrative as you go. It’s okay if emotions come up unexpectedly or if you feel a bit scattered in your thoughts. Your therapist will help create a safe space for you to explore these without judgment.

5. Discussing Your History: Past and Present

Many therapists will spend part of the first session gathering background information. This might involve asking about your family, your relationships, work or school life, and any past experiences with mental health concerns. If there are specific topics you’re not ready to dive into, let your therapist know. You can always choose to revisit those later when you feel more comfortable.

If your therapist asks something that feels intrusive, you’re not obliged to answer. A good therapist will respect your boundaries and follow your lead. Remember, this is a relationship built over time, and you get to decide how much to share and when.

6. Setting Goals Together

The first session typically ends with a discussion of your goals for therapy. These don’t have to be concrete or perfectly articulated. They can be as simple as wanting to “feel better,” “understand myself more,” or “manage anxiety.” Collaborating on goals gives you and your therapist a shared direction for your work together and helps set expectations.

Your therapist might offer some preliminary impressions or suggest areas to explore. This is a good opportunity to see if their ideas resonate with you. It’s not unusual for goals to shift and evolve over time, so treat this as a starting point rather than a definitive plan.

7. Your Reactions: Take Note of How You Feel

After your first session, take a moment to reflect on how you felt. Did you feel heard and understood? Did the therapist’s style match what you were looking for? It’s normal to feel a mix of emotions, but feeling relatively comfortable and safe is important.

Therapy is a partnership. While it’s okay to feel a bit uncertain in the beginning, you should feel some sense of connection with your therapist. If not, it’s worth discussing in future sessions or exploring other options. Finding the right fit can make a significant difference in your therapy experience.

8. The Takeaway: Building Trust Takes Time

The first session is just the beginning. Building a trusting relationship with your therapist takes time and patience. Don’t be discouraged if you don’t experience an immediate sense of relief or clarity. Therapy is a process, and each session contributes to a larger journey of self-understanding and healing.

Approach it with curiosity and compassion for yourself. You’ve already taken the first step by seeking help—acknowledge that as a significant achievement. At Birchwood Clinic, our team of psychologists and mental health counselors are here to help guide you through your first session and identify your needs and goals for future sessions.