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  • Writer's pictureDr. Kathleen Tallent

What to Expect at a First Therapy Session

You’ve made the call and gotten your first therapy appointment scheduled. Now what? First of all, congratulations. You have taken an important step in what will hopefully be a life-changing experience that can improve your mental, emotional, and physical health.

If you’re wondering what to expect during your first therapy session, you’re not alone. Many people only know about therapy from TV or the movies, which is often not the same as it is in real-life. Knowing what to expect going in to your first session can help you feel more comfortable and get the most out of therapy from the start.

In your first therapy session, your clinician will likely first review the limits of confidentiality with you. Based on HIPAA and their ethics code, therapists are required to maintain confidentiality. This means that what is said in the therapy room, stays in the therapy room. There are certain exceptions to this. If you are a danger to self or others, the therapist would be ethically required to break confidentiality to keep you and/or others safe. Therapists are also mandated reporters of child abuse and elder abuse. In addition to reviewing these rules, the therapist uses the initial session to determine if therapy is the best fit for you. They can also work with you to help you find additional resources as needed.

The following are things to expect at your first therapy session, along with tips to help your first session of therapy be as productive as possible.

1) The first session is usually Q & A format. You may be surprised to learn that your first session of therapy is not really therapy. It is called an Intake evaluation, where the therapist is getting to know you and assess what your current issues are. The therapist will conduct a risk assessment and determine if you are a danger to self or others. You may be asked things that make you uncomfortable, such as your family history and current/past drinking or drug use. They may ask about your childhood, medical history, and what your current relationships are like. All of this is to get a clearer picture of who you are and what your needs are. This is important and sets the stage for good therapy later.

2) Be as open and honest as possible. If you have any concerns and things that are bothering you in your life and your mental health, this is the time to let them know. Try to be as open and honest as you can, so they can know what is going on and how best to help you. They are there to help, and they can’t help you unless they know what the issues are. A skilled therapist will ask questions in a professional and comfortable manner. If you don’t want to answer something, you don’t have to. Just let your therapist know that you are uncomfortable with the question or talking about a particular topic.

3) Talk therapy isn’t just about talking. Talk therapy, also called psychotherapy, is about helping you cope with feelings, solve problems, and change behavior patterns that may be contributing to symptoms. It involves talking as well as feeling uncomfortable feelings and listening to suggestions, advice, and guidance that your therapist gives you.

4) Tell your therapist what you want. In therapy, you are an active participant. It is not something that just happens to you. A good therapist will use their training, techniques, and skill to help you identify problems and work with you to help find solutions. The more active you can be from the start, the better. At this first session, you can get a sense of what therapy will be like and whether the therapist is a good fit for you and your needs. Therapy is also a time to listen to what the therapist’s suggestions might be. The most successful therapy leads to the development of a strong working alliance, which means that you and the therapist work together as a team to help you reach your goals.

5) Don’t hesitate to ask questions. If, at the end of your first session of therapy, you have questions, ask them. This is your therapy and it is what you make of it. If you’re not sure how often you will have sessions or have questions about payment, ask the therapist. If you have any reservations or concerns, let them know. This will help you feel more comfortable and engaged with the process. If, for any reason, you are not a good fit with this therapist, let them know and ask to be transferred to another therapist. Any good therapist will understand that the therapist-client fit is important for therapy success and can help you find a better match.

It is my hope that, with some of these tips, that you can have a productive first session of therapy and can help to start changing your life for the better. If you are thinking you may need to talk to a therapist and don’t know where to start, the Local 1619 Peer Support Team can help. You can call their 24/7 hotline at (240) 343-1619, contact a Peer Support Team member, or go to their website at

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