So you’ve scheduled your first therapy session…now what? What to expect from your initial session and how to prepare

You took the leap. Sent the email, made the phone call, or filled out the online form, and now your first appointment with your therapist has been scheduled. Maybe you made the decision after encouragement or recommendation from a friend or family member, or maybe there’s been a recent change or stressor in life that has prompted you to seek therapy. Or perhaps this is a journey that’s been a long time in the making, and you’ve been thinking about therapy (or even researching and making calls to therapists) for quite a while. Regardless, it’s now official…you have an appointment booked, and thoughts, questions, and feelings might be swirling all around your mind.  

First off, a little bit of normalization is in order here: it is utterly normal to have any combination of thoughts and feelings as you anticipate the start of your therapy journey. As a therapist, I’ve sat across from many clients at their first session (what we often refer to as an “intake session”), and one of my first questions is always, “what are the feelings that have been coming up for you as you’ve been anticipating our session, and are any of those feelings here now?” The answers I’ve received from clients have spanned much of the spectrum of emotions. Many people are nervous, anxious, or even downright scared as they settle into the couch across from me in my office. That’s completely normal…therapy is a courageous journey, and while it’s absolutely worth it, it can be intimidating, especially in the getting-started phase! On the other hand, some people are relieved to finally be in a place where they can “let go,” and simply share openly and honestly, and experience what it’s like to have their emotions and experiences validated, held, and honored. They’re relieved to be taking steps towards change and finally be embarking on a journey of healing, change, growth, and wholeness. Similarly, I’ve heard clients tell me they’re excited for the session and for the journey of therapy as a whole. Some clients, on the other hand, are a little frustrated that therapy has become a necessary step in healing or growth for them, or are apprehensive if they’ve had negative therapy experiences in the past. This isn’t even an exhaustive list–the emotions that can come up as you prepare to get started in therapy can be many and varied. The bottom line? All of these feelings are normal, and all of these feelings are welcome in the therapy space. 

So, as far as “what to expect from your initial session,” the very first thing you can expect is to be validated in whatever emotions you find yourself experiencing. In initial sessions with my clients, we spend the first portion of the appointment simply processing and holding some of those feelings to whatever degree feels necessary for each client. 

It’s also normal to have some questions. Making sure that clients have a felt sense of safety throughout the therapy journey is of utmost importance in my work as a therapist. Without that, progress cannot be made, and healing will not happen. Because of this, the initial session is also for asking questions and having your concerns addressed. This can (and should!) be happening throughout all of therapy, but it’s especially important at the beginning when the therapeutic relationship between the therapist and client is just beginning to form, so when I work with my clients, I make sure to devote as much time as possible during that first session to addressing any questions or concerns they may have. 

Aside from exploring and addressing any initial feelings, concerns, and questions that clients have, the first session is also a time for lots of information-gathering. The therapy journey is just beginning, and the therapist needs to become familiar with the brand-new client (and vice versa!) so that they can effectively work together as a team. For us therapists, that means understanding the main concerns and goals of the client…what’s been going on for them that has brought them to therapy? What are they here to work on? What changes would they like to see? It’s a time when the therapist is able to get an initial snapshot of the strengths, needs, preferences, clinical concerns, medical concerns, current health of relationships, family experiences, spirituality, and many other factors that provide a better understanding of the general wellness of the client. For this reason, I always warn clients at the beginning of the first session by saying, “I’ll be asking many more questions today than I usually do with clients, and I promise that our sessions won’t always be this question-heavy!” If at any point of your intake session any of the questions your therapist asks makes you uncomfortable, or if you don’t understand the purpose of the question, it’s important that you know it is totally okay to stop the therapist and ask any questions or share any concerns you have. 

Because the intake session is the beginning of the therapy work, there are also a lot of important policies and procedures to review during the appointment. I refer to these things as the “housekeeping stuff” when I explain it to clients, because reviewing these things ensures that my clients and I are on the same page. It gives us a chance to clarify policies, procedures, and expectations, essentially “de-cluttering” any confusion, so that we can shift gears in future sessions and focus on the therapeutic work the client is here for! That means I take time to review with the client things like confidentiality and limits of confidentiality, payment, scheduling, cancellation policies, what it means that I am a mandated reporter, and a few other less-exciting things. I also explain just a little bit about my own therapeutic approach, and what my clients can expect from me. And as always, we take time at the end of that to go over any questions the client might have about these policies or procedures. For this reason, I do much more talking in the initial intake session than I will do in any other session for the rest of my work with each client!

In a nutshell, that’s it! That’s a general sense of what you can anticipate from your initial therapy session. Now, what can you do to prepare for it? If you’ve made it this far reading through this, I’m assuming this is still a question on your mind. Good news! It just so happens that there are indeed a few specific steps that you can take prior to this appointment to set yourself up for the most positive experience of an intake session possible.

-Carve out plenty of time for this appointment. Do your research ahead of time…will you be attending the appointment in person, and if so, how far away is the office? Budget more time than you think you’ll need for the drive–that way, normal issues like traffic, the possibility of getting lost, or having a difficult time finding the office won’t cause you to be late, and therefore, stressed. Even if the appointment will be virtual/telehealth, if you can, pause what you’re doing at least five minutes prior to the start time of your session. Give yourself time to go to the restroom, make sure you have a glass of water or mug of tea and a box of tissues, and perhaps a notepad and pen to jot notes down during the session if it feels like that might be helpful. Getting into the “therapy mindset” before virtual appointments is often very helpful.

-Similarly, as you’re planning your day around this therapy appointment, try to set aside five to ten minutes after the appointment before you need to be back at work, driving home, or tending to any other obligation. This will make sure that you have time to collect yourself and your thoughts, visit the restroom if needed, engage in some mindfulness practices if necessary (grounding strategies, deep breathing, or anything else that is helpful to you), and shift back into your regular routine and mindset. 

-Reflect ahead of time! Spend some time thinking, and perhaps journaling or list-making, about any questions you have as well as what you’d like to accomplish in therapy. What are your concerns that are bringing you to therapy, and what are some concrete changes you’d like to see in yourself and in your life? Do you have any questions for your therapist? Write any of these things down and bring them with you to your appointment. 

-If you feel comfortable, share with a trusted and safe friend your decision to start therapy! This one is totally optional, because this isn’t a step that everyone feels comfortable with, and depending on the support people in your life, it might not even be a safe decision. But if you can identify a safe and trusted person in your life who you know will be supportive of your decision to start therapy, tell them you’ve decided to go! They can celebrate with you, support you, and if you’d like, they can help you process things outside of therapy sessions. 
Starting therapy is a courageous and very exciting decision! The first session can feel scary and intimidating, but the hope behind this blog post is that you’d walk away with a better understanding of what to expect in a typical first session, and how to walk into it prepared. While the information and details included here are, for the most part, going to be present for most therapists during most intake sessions, it’s also important to keep in mind that individual therapists vary, and I wrote from the perspective of what I know, and the style and flow toward which my intake sessions tend to lean. If you’re thinking about beginning therapy and are reading this out of curiosity to learn more about what it might be like to get started in that first session, know this: I would love to work with you! I’m licensed in Vermont and can work with anyone living in this state virtually, but if you live in or around Burlington and the surrounding Chittenden County, and are interested in exploring what in-person therapy would be like, I would be honored to hear from you. Contact me today, and let’s talk some more about whether therapy with me would be a good fit for you.