Welcome to Your First Therapy Session!

Written By: Sarah Schufreider, MSW, LCSW

Congratulations! You’ve conquered the many obstacles that make it so challenging to get connected to therapy. You’ve researched therapists; explored insurance and financial options; challenged your own pre-conceived notions and stigmas about mental health and of what someone going to therapy looks like. And, finally you scheduled your very first appointment with your new therapist. Mission completed!

Or, it is until you start to wonder more about what it is actually like to be in therapy. What does a first session even look like? Do you need to prepare for it? Will you have to tell your whole life story? Here is a cheat sheet of what to expect in a first therapy session to help you feel more prepared.

Learning the Rules of the Game

As with anything in life, it’s important to know the rules of the game before you start to play. That way, you know what to expect and can more confidently engage in what you are doing. Therapy is no different. In the beginning of your first session, you can expect to have a better explanation of informed consent for therapy. Meaning, your therapist will likely run you through the administrative housekeeping list to make sure you are all set to start. These things can look like:

• Intake Paperwork: Making sure all intake forms are filled out and signed.

• Confidentiality: Therapeutic relationships are based on trust and in order to develop trust, you need to know what things are kept private, when confidentiality needs to be broken, who has access to your therapeutic records, and how information is shared. This is an essential part of any first session because it lays the foundation of your relationship with your treatment provider.

• Billing and Insurance Information: Therapy is not only a big emotional commitment, but is often also a financial commitment. As such, you deserve to know what you are signing on for. Each therapist handles billing, insurance, and financials differently, so you want to make sure you understand your therapist’s process. While this will all be outlined in the intake forms, it is important to clarify all of this in your first session.

• Attendance Policies and Cancellation Fees: You want to know the expectations for in person sessions versus virtual sessions, cancellation policies, and any possible fees associated with them. 

• How to Contact Your Therapist Outside of Session: Establish the best ways to reach your therapist whether via email, phone, text, etc. Also, the therapist should explain their hours of operation. Many outpatient therapists do not function as crisis clinicians and you want to understand who to call in an emergency.

How Does This All Work?

After all the nitty gritty details of administration is discussed, another important part of the first session is understanding a basic outline of what therapy will look like for you. Questions you will likely have answered include:

• How often will you meet with your therapist? Weekly, biweekly, monthly? Oftentimes, weekly sessions are recommended in the beginning in order to help build trust and make the assessment period go more smoothly. But, talk to your therapist to discuss your individual needs. 

• How are the sessions structured? Depending on the therapist and on the modality of therapy you are engaging in, sessions can range from being highly structured to client-led. Your therapist can help get a better sense of what your goals are and give you some options for structuring your sessions.  

• Who leads the session? As the owner of your life, you are always the premiere expert in your life. Therefore, your opinion matters a lot. Ideally, therapy is a collaborative experience between client and therapist. It is helpful to discuss your preferences and comfort level with sharing information with your therapist. They can help take the lead in the beginning to help you increase your comfort with the goal of eventually co-steering. 

Getting to Know Each Other

The rest of the session is dedicated to beginning to know each other and getting a better understanding of your goals for seeking out therapy. It is a chance for BOTH the client and the therapist to begin to develop a trusting and caring relationship with one another. 

• Therapists may have a list of questions that they want to ask. Remember that you always have the right and the option to only answer as much as feels comfortable at the time. You can also ask to skip a question. Again, trust is something that is built. So, if you aren’t ready to share vulnerable things with someone you just met, that is ok!

• This is a great time to discuss your initial goals for coming to therapy. It is totally normal if the goals are just rough drafts or incomplete ideas. We are always tweaking and reassessing goals throughout the therapy process. 

• The client is allowed to ask questions of the therapist too. Therapists are trained to field questions while maintaining professional boundaries. In the same way that the client has an option to limit or prefer not to answer a question, the therapist can too. But, it is always ok for a client to ask as long as they are respectful of any boundaries that are given. 

When Can I See You Again?

At the end of the session, you will confirm the time for your next session.

And just like that, your first session is finished! You made it! Congratulations again on investing in your wellness and protecting your mental health!