What to expect in your first therapy session and how to prepare

Feeling nervous about your first therapy session? That’s completely normal. You’re meeting someone new and talking about things that might feel deeply personal. Therapy is meant to be a safe and supportive space. Your first session is just about getting started and building a strong foundation. From the moment you sit down or log in, your therapist is there to help you feel heard, respected, and comfortable.

What happens in your first therapy session

In your first therapy session, you and your therapist will spend time getting to know each other. You’ll prepare to work together as client and therapist. The session should last around an hour.

Here’s a common timeline you can usually expect at your first appointment:

• Introductions – You and your therapist will introduce yourselves.
• Confidentiality – Your therapist may explain privacy policies. This includes situations where they are required by law to break confidentiality, like if there is a risk of harm to yourself or others, or a report of abuse. If you share that you’re feeling overwhelmed or having thoughts of self-harm, that doesn’t automatically mean emergency services will be called. Therapists are trained to assess safety and support you with care, not judgment. You can talk honestly about how you’re feeling.
• Intake – You’ll answer questions to help your therapist understand what’s going on in your life. This might include your background, relationships, and values. You may also review intake forms and sign paperwork. These should include Health Insurance Portability and Accountability Act (HIPAA) and consent forms.
• Goal setting – You’ll talk about why you’re starting therapy and what you hope to gain from it. This helps your therapist begin creating a personalized treatment plan for you.
• Approach – Your therapist may walk you through the way they work and the type of therapy they use.
• Questions – You’ll have a chance to ask any questions you may have. These can be questions about realistic expectations or your therapist’s experience.
• Closing – At the end, you’ll go over things like scheduling your next session. You might also handle details like how to pay for your therapy sessions.

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

Yes, feeling nervous, uncertain, or awkward before your first therapy session is normal. Whether it’s your first time in therapy or you’re seeing a new therapist, it’s okay not to know exactly what to expect. Some people feel hopeful, some feel anxious, and others aren’t sure what they’re feeling at all.

It’s all valid. If you’re nervous, let your therapist know, and they can help ease you in. If you’re not sure what to talk about, that’s okay too. A good first step is to share what brought you in, even if it’s just a general feeling that something is off.

How to prepare for your first therapy session

You don’t need to have it all figured out before your first therapy appointment. Showing up is a big, important step. Still, reflecting on a few key things ahead of time can help you feel more confident going in. Here are some helpful ways to prepare:

• Think about your goals – What are your goals? What brings you to therapy? Maybe it’s managing your symptoms or improving relationships. It could be processing something difficult or exploring personal growth.
• Make a list of questions – Write down some questions you want to ask. You might want to know how the therapist works, when they’re available, or what a session is like.
• Write down what’s been on your mind – Think about what’s been bothering you lately. It could be feeling overwhelmed at work or having trouble sleeping. Jotting down a few quick notes can help to organize your thoughts.
• Review your intake forms – Take a look at any forms you received before your first session. They might ask about your health history or what you’re hoping to get from therapy. Filling them out ahead of time can help your therapist get to know you.

Preparing doesn’t need to be perfect. Taking a moment to reflect can help ease nerves and make your first session more productive.

Preparing for online therapy vs. in-person therapy

A little planning can make your first session feel less overwhelming and more intentional, whether you’re meeting with your therapist in person or online. Taking a few moments to prepare can help you feel more present, less rushed, and better able to focus on why you’re there: to care for yourself.

In-person therapy

• Plan your trip – Map your route and consider parking. 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 a beverage or a blanket handy.
• Submit documents – Send any forms or questionnaires ahead of time.

What should you talk about in your 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. A good starting point is to share what gave you the idea to start therapy and what you hope to achieve.

Therapy is a safe space to explore all aspects of your life. It can be helpful for anything on your mind. No topic is too big or small, and your therapist will guide and support you without judgment. You can try starting by talking about:

• What led you to schedule the session
• Anything that’s been weighing on your mind
• A general feeling that something’s off, even if you can’t name it yet

What kind of questions will your therapist ask?

During your first therapy session, your therapist will likely ask you lots of questions to get to know you and what brought you in. These questions help your therapist understand you better. They use your answers to start planning how to support you. That way, your care fits your needs.

To get to know you better, your therapist may ask questions like:

• Do you have any current mental health symptoms or concerns?
• What’s your medical and mental health history?
• Have you or your family members experienced any mental health conditions?
• What does your support system look like (friends, family, community)?
• What’s your daily life like (work, school, routines)?
• What are your values? Your goals?
• What is your cultural background?

The types of questions might also vary depending on your therapist’s background.

Do you need to know your family’s mental health history?

No, you don’t need to know your family’s history for therapy to be successful. Many people go to therapy without knowing this information. This is especially true if mental health wasn’t openly discussed in their homes.

If you know about mental health conditions in your family, it can be helpful to tell your therapist. It gives them a better picture of your background and helps them offer more personalized care. Some conditions, like autism, ADHD, depression, and schizophrenia, can run in families. But having a family history doesn’t mean you’ll definitely have the same condition. Genetics and environment work together to shape mental health.

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

Is it normal to cry during therapy?

Yes, it’s totally okay to cry during therapy. Many people do. But if you don’t cry, that’s okay too. Some people find it hard to open up right away or describe how they’re feeling, and others may not feel tearful at all. There’s no “right” way to be in therapy.

You can talk about your day, sit in silence, or start with the smallest detail that feels safe. However you show up is enough. Your therapist is there to meet you where you are, not to judge or rush you.

Paying for your first therapy session

Before your first session, it’s helpful to know what to expect when it comes to cost and payment. What you’ll pay and when depends on your therapist’s policies and whether you’re using insurance or paying out of pocket. The good news is that there are flexible options, and you don’t have to figure it out alone. Many therapists and platforms are here to help you understand your benefits and find care that fits your needs and budget.

If you’re using insurance: 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. Your therapist may be in-network with your insurance, but you may still have a co-payment. To find a therapist near you or online who accepts your insurance, you can use Grow Therapy and filter by insurance.

If you’re paying out-of-pocket: If you’re paying for therapy out-of-pocket, costs can vary. Some therapists will offer sliding scale fees based on income, and others charge a flat rate. You’ll usually pay at the end of your session, but some therapists may ask for prepayment.

How to know if your therapist is a good fit

A good therapist helps you feel safe, respected, and understood. They remain professional even when the work gets uncomfortable. But like any relationship, finding the right fit can take time. During your first few sessions, ask yourself:

• Do I feel heard?
• Can I be honest with this person?
• Do I feel safe sharing difficult things?
• Are we working towards goals that matter to me?

A good match doesn’t always mean you’ll immediately be comfortable. Therapy can bring up hard emotions, and part of your therapist’s role is to help you handle them. But if something feels off, trust your instincts. Knowing the signs of a poor fit can help you recognize when it might be time to explore other options.

What to expect after your first therapy session

After your first therapy session, you might feel a mix of emotions. Feelings like fatigue, relief, uncertainty, hope, or even wishing you’d shared more.  Any thoughts or feelings that come up are valid.

Check in with yourself and give yourself credit for doing something brave. If you’re unsure about your therapist, know that building trust takes time. If the connection still feels off after a few sessions, it’s okay to consider finding a new therapist who feels like a better fit.

Tips for making the most out of therapy

Therapy isn’t about showing up with everything figured out. It’s about giving yourself space to explore what’s been weighing on you. Therapy works best when you show up with openness and a willingness to engage.

Here are some ways to make the most of your sessions:

• Be honest. Share your thoughts, fears, and doubts as openly as you can, even when it’s uncomfortable. Your therapist is there to support you, not judge you. The more real you are, the more helpful therapy can be.
• Commit to the process. Progress doesn’t always look linear. Some sessions may feel light, and others may feel heavy. Both are valuable. Keep showing up, even when it’s hard.
• Set goals. Talk with your therapist about what you hope to get out of therapy, whether it’s feeling less anxious, improving relationships, or learning how to manage stress. Revisit those goals as your needs evolve.
• Do your homework. If your therapist suggests practices or exercises between sessions, give them a try. They’re designed to help you apply what you’re learning in real life.
• Ask questions. Therapy is a two-way conversation. If you’re confused, unsure about a technique, or wondering why something matters, say so. Your therapist wants to collaborate with you.
• Notice what’s happening outside of therapy. Growth often shows up between sessions. Pay attention to what’s feeling different, what’s getting harder, and what’s starting to shift. These reflections can deepen the work you’re doing together.
• Be patient with yourself. Healing isn’t instant. It’s okay if it takes time to feel safe, understood, or clear about your next steps. Every moment of reflection and effort counts.

Starting therapy is a powerful investment in your well-being. Your first session is the beginning of a therapeutic relationship, which can become a steady source of support, insight, and real, lasting change over time.

Frequently asked questions

How long does a therapy session last?

Most therapy sessions last between 45 and 60 minutes. Some intake sessions might be slightly longer.

What should I bring to my first therapy appointment?

For your first therapy appointment, bring any forms you’ve filled out. Don’t forget your insurance card (if you’re using insurance) and a way to pay. It can also help to bring notes about what’s been on your mind or any questions you want to ask.

Do I need a mental health diagnosis to start therapy?

No, you don’t need a mental health diagnosis to start therapy. Many people start therapy simply because they want support or clarity.

Can I switch therapists if it doesn’t feel like a good fit?

Yes, you can switch therapists if it doesn’t feel like a good fit. You deserve a therapist you feel comfortable with. If something doesn’t feel right after a few sessions, it’s okay to look for someone who’s a better match for you.

Will I have to talk about everything right away?

No, you won’t have to talk about everything right away. You’re allowed to go at your own pace. A good therapist won’t pressure you to share more than you’re ready for.

Is the first therapy session awkward?

The first therapy session might feel awkward at first, and that’s completely normal. You’re meeting someone new and talking about personal things. But the right therapist will help you feel safe and supported from the start.

Do I have to start medication when I start therapy?

No, you don’t have to start medication just because you begin therapy. Many people benefit from therapy alone, while others find that a combination of therapy and medication works best for them. Your therapist can help you explore what feels right for your situation. They may refer you to a provider who can prescribe medication if needed.