February 19, 2025
Starting therapy can be a big step—one that brings a mix of emotions, from excitement and hope to nervousness and uncertainty. Many people delay seeking therapy because they’re unsure what to expect, which can make the process feel intimidating. This blog will walk you through what typically happens in a first therapy session, helping you feel more prepared and confident about taking this important step toward mental well-being.
1. The Therapist’s Introduction and the Informed Consent
Before the first session, your therapist will introduce themselves and explain their qualifications, approach, and what therapy with them might look like in a consultation session. They’ll also discuss confidentiality, explaining that what you share in therapy is private, with a few exceptions (such as if there is a risk of harm to yourself or others) and seek your informed consent.
Understanding these boundaries can help you feel safe and comfortable opening up. Studies by Horvath et al. (2011) indicate that transparency in therapy builds trust, making it easier for clients to engage in the process.
2. Understanding the Purpose of the First Session
The first therapy session is all about building rapport and knowing the process. It’s an opportunity for you to share your concerns, experiences, and goals, while the therapist gathers information to better understand how they can support you. This session also helps determine whether you and the therapist are a good fit, which is a key factor in therapy success.
Research highlights the importance of the therapeutic alliance—the working relationship between client and therapist. According to Lambert and Barley (2001), the strength of this alliance accounts for approximately 30% of therapy outcomes. A strong, trusting connection with your therapist can make a significant difference in your progress.
3. Talking About Why You’re Seeking Therapy
Your therapist will likely ask open-ended questions such as:
a) “What brings you to therapy?”
b) “How have you been feeling lately?”
c) “Have you been in therapy before?”
d) “What are some things you hope to work on?”
You don’t need to have all the answers or know exactly how to express your feelings. Therapists are trained to guide these conversations and create a supportive environment where you can explore your thoughts at your own pace. According to Norcross and Wampold (2011), therapy is most effective when it is tailored to the client’s unique needs. That’s why the first session is often exploratory—your therapist is gathering information to personalize their approach and help you develop a treatment plan.
4. Exploring Your Personal and Emotional History
While you don’t have to share everything right away, your therapist may ask about your background, including:
a) Past or current mental health challenges
b) Family history of mental health concerns
c) Relationships, work, and daily stressors
d) Coping strategies you’ve used in the past
This part of the session helps your therapist understand patterns in your thoughts, emotions, and behaviors. Research by Swift & Callahan (2009) shows that when clients understand and engage in the therapy process, they experience better results.
5. Setting Goals for Therapy
A significant part of therapy is goal setting. Your therapist may ask what you hope to gain from therapy, whether it’s managing stress, coping with anxiety, improving relationships, or understanding your emotions better. Many therapists use the SMART goal framework (Specific, Measurable, Achievable, Relevant, and Time-bound) to help structure therapy objectives.
Research by Karoly (1993) shows that having clear, structured goals in therapy increases motivation and engagement, leading to better outcomes. Some examples of therapy goals include:
a) Learning to manage anxiety through mindfulness techniques
b) Improving communication in relationships
c) Developing healthier coping mechanisms for stress
Don’t worry if you’re unsure what goals to set—your therapist will help you clarify and refine them over time.
6. Discussing the Therapy Approach
Different therapists use different approaches, such as:
a) Cognitive Behavioral Therapy (CBT) – Focuses on changing negative thought patterns
b) Psychodynamic Therapy – Explores past experiences and emotional patterns
c) Mindfulness-Based Therapy – Incorporates meditation and awareness practices
d) Attachment-Based Therapy – Examines relationship patterns and emotional needs
e) Humanistic approaches- focuses on self-growth
Your therapist may explain which methods they use and how these approaches can help you. Understanding these methods can enhance engagement and reduce dropout rates in therapy (Olfson et al., 2009).
7. Addressing Any Questions or Concerns
Your first session is also a chance for you to ask questions. Some common questions clients ask include:
a) “How long will therapy take?”
b) “What happens if I don’t feel like I’m making progress?”
c) “How often should I come to therapy?”
Therapists welcome these conversations, as addressing concerns early on helps establish trust and clarity. According to Duncan et al. (2009), when clients feel informed and in control of their therapy experience, they are more likely to stay committed to the process.
8. Next Steps and Scheduling Future Sessions
By the end of the session, you and your therapist will discuss the next steps, including:
a) Whether you’d like to continue therapy
b) How often you’ll meet (weekly, biweekly, etc.)
c) What you might focus on in the next session
Some people leave their first session feeling relieved, while others may feel emotionally drained—it’s completely normal. Therapy is a process, and meaningful change takes time.
Final Thoughts: Taking the First Step
Your first therapy session is about exploration, understanding, and building a foundation for future work. If you feel comfortable with your therapist and the process, that’s a great sign. If not, it’s okay to explore other options—finding the right therapist is key to a successful experience. Therapy can offer a unique opportunity for individuals to explore themselves, gain insight, and make positive changes in their lives. By taking the first step, you’re already making a significant commitment to your well-being.
If you’re considering therapy and have any questions, contact us for a Free 15-minute Consultation today —it’s a great way to see if therapy is the right fit for you!
References
- Duncan, B. L., Miller, S. D., Wampold, B. E., & Hubble, M. A. (2009). The heart and soul of change: Delivering what works in therapy. American Psychological Association.
- Horvath, A. O., Del Re, A. C., Flückiger, C., & Symonds, D. (2011). Alliance in individual psychotherapy. Psychotherapy, 48(1), 9-16.
- Karoly, P. (1993). Goal systems: An organizing framework for clinical assessment and treatment planning. Psychological Assessment, 5(3), 273-280.
- Lambert, M. J., & Barley, D. E. (2001). Research summary on the therapeutic relationship and psychotherapy outcome. Psychotherapy: Theory, Research, Practice, Training, 38(4), 357.
- Norcross, J. C., & Wampold, B. E. (2011). Evidence-based therapy relationships: Research conclusions and clinical practices. Psychotherapy, 48(1), 98-102.
- Olfson, M., Mojtabai, R., Sampson, N. A., Hwang, I., Druss, B., Wang, P. S., & Kessler, R. C. (2009). Dropout from outpatient mental health care in the United States. Psychiatric Services, 60(7), 898-907.
- Swift, J. K., & Callahan, J. L. (2009). The impact of client treatment preferences on outcome: A meta-analysis. Journal of Clinical Psychology, 65(4), 368-381.
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