Avoiding the First-Session Jitters: What to expect from your first therapy session


“Please lie down on the couch and tell me about your mother.” Are you anxious yet? Many people fear all therapy sessions start this way (a stereotype left over from the days of Freudian psychoanalysis). Or they might imagine that first sessions require diving into an elegant description of one’s deepest darkest fears. Or maybe they have absolutely no idea what to expect from a first session with a mental health therapist. 


The unknown can be paralyzing. Not knowing what to expect can keep someone from getting help from a therapist, or at least significantly slow down the process. So, in the interest of you getting help when you need it without delay, allow me to demystify my intake process. I should note that not every therapist handles their intake sessions the exact same way, so if you aren’t sure what to expect, don’t be afraid to ask the therapist beforehand!


Typically, before a first session, I have already spoken to my new client or their parent. This phone conversation covers my philosophy on psychotherapy, the methods I utilize, and some of my basic office policies (cancellations and what not). I answer any preliminary questions and gain a basic understanding of the issue my client is seeking therapy for. I might ask questions like, “What are the reasons you are seeking therapy at this time?” and “Have you ever been in therapy before?”.


The main purpose of this initial phone call is to see if this will be a good therapeutic match. Sometimes I get a call from someone looking for a specific modality of therapy I don’t specialize in, or their primary reason for needing therapy is outside of my scope of practice. For instance, I will often refer out clients under the age of 6 (they benefit most from play therapy, which I am not certified in) or over the age of 70 (I don’t have sufficient experience with this age group). If you are looking for a new therapist, I suggest that you connect on the phone beforehand to make sure you feel comfortable with the therapist on the phone. You should feel that they are both competent at treating the issues you need help with and someone you could talk to. If it doesn’t seem like a good fit for you, don’t be afraid to call around! A good match between therapist and client is critically important to any therapeutic work.


If we’ve spoken on the phone and decided it’s a good match, I will next email you a confirmation with my intake forms attached to fill out before the session. During your intake session, I don’t want you to be burdened by completing paperwork, so I will ask you to complete it beforehand. For adults this includes basic client information (contact information, etc), a form detailing my policies and procedures, a HIPAA privacy practices notice, and, if needed, a release of information for any other professionals I may need to coordinate care with (such as a psychiatrist or other therapist). For children and teens I add to this list a child history form that the parent completes. 


Once you make it into my office, you can expect me to introduce myself and ask for your forms. If I’m treating a child, I will explain what my job is and what I help kids with. I will also let the child know what to expect (“first I will meet with you and parents, then just you, then just your parents”). Then comes the big first question: “What brings you in today?” 


“What brings you in today” usually leads us pretty naturally into a big list of other questions. I talk more (and write WAY more) in our first session than I will in any future sessions. I will be asking you questions about your symptoms, history of symptoms, relationships, medical history, family history of mental health concerns, substance use, past therapeutic work, and goals. It’s a lot to cover in an hour, but these answers will give me a base on which to build our therapeutic work.


One of the most important questions I will ask is “what do you hope to get out of therapy?” Your answer to this question helps us set goals for our work and plan which modalities of therapy will be most helpful. It’s ok if you don’t have a specific answer for this yet. Sometimes my clients don’t know exactly what they need, they just know they want to feel better. Or more like themselves again. Or “normal.” I will help guide you to uncover what these goals actually look like when they are achieved and what steps we need to take to get you there.


I often tell my clients that uncertainty is one of the most difficult human emotions to cope with. However, our anxiety about the unknown can lead us to unnecessary anxiety and spending far too long in a state of distress. If you think you need therapy, please reach out rather than waiting. If you don’t have a referral to a specific therapist from a friend, family member, or doctor, Psychology Today’s Find a Therapist search is a great place to start! If you need to have therapy covered by your insurance, you can call your insurance company for a list of in-network therapists in your area.