Your first therapy session

If your first therapy session is coming up, then congratulations — you’ve taken an important first step in your journey toward better mental health. As your session approaches, you may be wondering what to expect, how to prepare, or what the process will look like. In this article, we’ll explore these topics and more, helping you ease into therapy with confidence. Our goal is to make this transition as smooth as possible so you can focus on the meaningful and transformative work ahead.

Is it normal to feel nervous before my first therapy session?

It’s entirely normal to feel nervous when starting therapy (or working with a new therapist). You might be wondering What will we talk about? Or, What if I don’t know what to say? The good news is that your therapist will help you figure these things out.

Even so, if you’re feeling excited, uncertain, or something else entirely, know that your feelings are valid. While talk therapy can be deeply rewarding, it also requires effort, openness, and sometimes working through tough inner challenges. A supportive therapist will validate your emotions, meet you where you are, and ease you into the process, creating a safe space for your unique journey.

What happens in the first therapy session?

In your first session, you and your therapist will spend time getting to know each other and preparing to work together. Your therapist will ask questions, you’ll have an opportunity to do the same, and you’ll discuss logistics as well. Here’s what to expect:

1. 1. Introductions – You and your therapist will introduce yourselves to one another.
   2. Confidentiality – Privacy policies will be explained, ensuring your conversations are private unless something arises that your therapist is required to report. These requirements vary from state to state, but often include situations in which there’s imminent harm to yourself or others or a report of abuse.
   3. Intake – This will make up most of the session. During intake, you’ll share your reasons for seeking help through therapy. Your therapist may ask questions to gather additional information about things like your personal history, living situation, relationships, values, and interests. The more they know, the better they can support you. You may also sign consent forms, review HIPAA, and address billing or insurance details.
   4. Goal setting – Your therapist will ask about your goals for therapy in order to tailor a treatment plan.
   5. Approach – Your therapist will share information about their approach, theoretical orientation (e.g., cognitive behavioral therapy (CBT), psychodynamic therapy, etc.), and specialties.
   6. Questions – You’ll have an opportunity to ask questions about your therapist’s treatment style, recommendations, or approach.
   7. Closing – The final minutes will be used for scheduling your next session and handling logistics like payment.

What should I talk about in my first therapy session?

If you aren’t sure what to say, you can share that with your therapist and they can help guide the discussion. There are no right or wrong topics to bring up in your first session — or in therapy more generally. However, a good starting point in your first therapy visit is to share what led you to seek mental health care in the first place, and what you hope to achieve.

Therapy is a safe space to explore all aspects of your life, from relationship challenges and personal goals to past experiences or anything else on your mind. No topic is too big or small, and your therapist will guide and support you without judgment. Take a deep breath, be yourself, and trust that therapy provides a confidential space for growth and self-discovery.

Do I need to prepare for my first session?

You don’t need to spend hours preparing for your first therapy session, but it can be helpful to reflect on a couple of key things. First, think about why you’re seeking therapy and what your goals are. Are you looking to develop coping skills, process unresolved trauma, navigate a major life change, improve relationships, or manage mental health symptoms?

If you’re unsure about your goals, that’s okay, too. You and your therapist can work together to define them. You may also want to consider what questions you have for your therapist. You can ask about their approach, the type of therapy they practice, or any concerns you might have.

This is a great opportunity to clarify expectations, foster a better understanding of how therapy will work for you, and ensure they are the right therapist for you.

How should I prepare for online therapy vs. an in-person session?

A little planning can make your first session go more smoothly, whether it’s online or in-person. Here are tips to reduce stress and feel ready for your first session:

In-person therapy

• Plan your trip – Map your route, consider parking, or allow extra time for public transportation.
• Dress comfortably – Wear clothes that help you relax.
• Bring payment – Have your insurance copay or out-of-pocket payment ready.
• Prepare documents – Print and bring any intake forms if not submitted online.

Online therapy (also known as teletherapy)

• Ensure your privacy – Choose a space where you feel safe to speak freely.
• Check your tech – Test your internet, camera, and microphone in advance.
• Create a comfortable setup – Decide on your seating, and keep water, tea, or a blanket handy.
• Submit documents – Send any forms or questionnaires ahead of time.

Taking the first step to schedule your counseling session is a big accomplishment — preparation is just icing on the cake.

What will my therapist ask me in the first session?

The first therapy session, and sometimes even the first few, will differ from the rest of your sessions. These initial meetings are often focused on intake, during which your therapist will ask a range of questions to get to know you and your history. This helps them gain a more holistic understanding of you and the life experiences that have affected you.

Questions might include your physical and mental health history, interests, upbringing, key relationships, support systems, and employment background. While you may feel like you are answering a lot of questions, this process is typically limited to the beginning of therapy. Afterward, the sessions become a space for you to explore what’s on your mind safely.

Do I need to know my family history?

Many mental health conditions, such as autism, ADHD, bipolar disorder, depression, and schizophrenia, may have genetic or hereditary components, meaning they can run in families. However, genetics interact with environmental factors, so a family history doesn’t necessarily mean you’ll develop these conditions.

Understanding your family’s mental health history can help you better understand your own experiences and support your mental health professional in providing personalized care. It’s okay if you don’t know your family history — many people grew up in an environment where mental health was not discussed.

If it’s safe for you to do so, you can always get in touch with biological relatives to ask questions, but it’s not required for your treatment. Keep in mind that mental health is shaped by a mix of genetic, environmental, social, and personal factors.

Is it normal to cry during therapy?

Yes, it’s completely normal to cry during therapy. Therapy is a space where you’re often exploring and processing some of life’s most challenging experiences, and crying can be a natural response. At the same time, if you don’t cry, that’s okay, too.

Therapy is a safe, non-judgmental space that’s all about you — your thoughts, feelings, and experiences. There’s no right or wrong way to engage in therapy. It’s your journey, and it’s about finding what feels right for you, whether that involves tears or not. The most important thing is participating in a way that feels authentic to you

Do I pay before or after the session?

The cost of therapy and when payment is due depends on several factors. If you’re using health insurance, how much you pay out of pocket depends on your plan’s coverage. If you’ve met your deductible, your plan may cover the full cost of therapy.

Sometimes, your therapist may be in-network with your health insurance, but you could still have a co-payment. If you’re paying out-of-pocket, payment is usually made at the end of the session. To find a therapist who accepts your insurance, you can use Grow Therapy and filter by insurance provider.

How will I know if my therapist is a good fit for me?

A therapist should have the education, training, and credentials to provide psychotherapy while maintaining professional and ethical boundaries. This means they should not engage in intimate relationships or blur into friendship territory.

Beyond that, whether a therapist is a good match for you is personal. You should feel safe, supported, seen, and heard in their presence. However, therapy isn’t always easy — your therapist should support your growth, invite you to consider other perspectives and help you explore new ways of thinking, as that’s often where meaningful change begins.

Ask yourself: Do you feel safe and respected enough to share your full self with them? Your answer can guide your decision.

What should I expect after therapy?

After your first therapy session, you might feel a mix of emotions — fatigue, relief, uncertainty, hope, or even wishing you’d shared more. Whatever you’re feeling is valid. Check-in with yourself and give yourself credit for doing something brave. If you’re unsure about your therapist, know that building rapport and trust takes time.

That said, if your therapist makes you feel uncomfortable or acts unethically, it’s okay to explore other options. Remember, therapy is a journey, not a quick fix. The first few sessions are about getting to know you and setting the foundation for meaningful progress ahead.