What to Expect from Your First Therapy Session

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It’s time for your first therapy session. You’re anxious and a bit uncertain, but you’re also excited to get started and to start feeling better. Before the appointment, here’s what to expect from your first therapy session.

What Will Your First Session Look Like?

Your first therapy session isn’t like the others you will attend. The appointment’s goal is for you and your counselor to get to know each other. The majority of the session might feel like “housekeeping” as you and your therapist lay the foundation for successful treatment.  

Completing Paperwork

As with any other medical appointment, you have to complete a fair amount of paperwork before your first therapy session. Just like with another doctor, completing paperwork is only necessary once, so there is no need to worry that you’ll have to deal with it every time. 

You likely will be given forms or told where the paperwork is online when you schedule an appointment. It’s also possible that they’ll ask you to complete some or all of the forms and return them before your first session. The early submission allows your counselor to review your concerns and medical history before your session, so they understand your issues beforehand. 

It’s important to be as thorough as possible in completing the paperwork, as you can expect your therapist to review anything you left blank. If you are seeing your therapist in person, they also may ask you to attend your first session early to complete paperwork.

Paying for Services

You may be asked to pay for your session before or after you meet with your counselor. Most counselors receive payment after the session so you can book your next appointment at the same time. Therapists charge $75-$300 per session often depending on a therapist’s training, experience, and qualifications. 

Many health insurance plans cover therapy, and some therapists file insurance for you, so you may be asked to submit your insurance information. Even with insurance, you’ll likely need to pay a copay of $10-$80. 

Health Screening

The counselor’s staff may ask you to do a short health screening each time you arrive for an appointment. An assistant may do the screening, which could include weighing you and checking your blood pressure or temperature. They will then document this data in your chart for your therapist. These screenings help your counselor assess whether a physical health issue may be causing or exacerbating your mental health concerns. Not all counselors do these screenings. 

Answering Basic Questions

Although you’ve completed the paperwork, your therapist likely will ask you basic questions during your appointment. After you introduce yourselves to each other, your therapist will review your medical history and the reason for the session.

Your therapist likely will ask you about things like:

  • Where do you live?
  • Who do you live with?
  • How would you describe your home life?
  • Where do you work?
  • How long have you worked there?
  • Where did you grow up?
  • Do you have siblings?
  • What are your relationships with your family like?
  • What was your parents’ relationship like?
  • What was your household like?
  • Any addiction, mental health issues with members of your family?

As a trauma therapist, I often have my clients complete the ACE Inventory to discover their ACE Score. The ACE Inventory helps a therapist assess for various types of childhood trauma under the age of 18.  Adverse Childhood Experiences in children, left untreated, often lead to various physical and mental health challenges as adults. Examples of these concerns include diabetes, heart disease, substance use disorders, anxiety, depression, disordered eating, and Post-Traumatic Stress Disorder.

Discussing Concerns

Your therapist needs to know why you’re seeking therapy. This need means they’ll ask you many questions about why you’re seeking treatment, your symptoms, and how you’ve been coping.

Your therapist will ask mental health questions like:

  • What brought you to therapy?
  • What are your symptoms?
  • How long have you had these symptoms?
  • How have you been handling these feelings?
  • Have you sought treatment in the past?
  • How did that work for you?
  • Are you currently working with another therapist?
  • Do you have any mental health issues in your family history?
  • How is your home life? 
  • Are you thinking about harming yourself or others?
  • Do you have a history of suicidal thoughts or self-harm?
  • What do you hope to achieve from therapy?

Remember, it is important to be honest with your therapist. They can only help you when they know what is really going on. 

As a therapist, I am aware of how challenging a first appointment can be for some people.  A perfect stranger is asking you to expose your soul to them. Of course, that would feel uncomfortable. That’s why it’s so important to do your homework when selecting a therapist

A therapeutic relationship is built on trust and honesty. If you don’t feel comfortable with your therapist and something feels off, you may want to consider finding another therapist.

Asking Questions

Your counselor will offer to answer any questions you have about therapy. I often encourage clients to come to counseling prepared. You may want to jot down questions in advance, so you don’t forget them when you’re at the appointment. It’s also helpful to come with a pen and paper to take notes of things you don’t want to forget.  

Questions you may want to ask your counselor include:

  • Are our sessions confidential?
  • Is there a time when they wouldn’t be?
  • How long have you been a therapist?
  • Why did you become a therapist?
  • What therapeutic approaches do you use?
  • What do you think about what you’ve heard from me so far?
  • Can you help me?
  • What type of experience do you have assisting other people like me?
  • How often will we need to meet?
  • What kind of work should I plan to do between sessions?

For some people, it’s also important to know if their counselor attends therapy or ever has. If this question (or any others) makes you feel more comfortable about your counselor’s ability to treat you, you should ask it. 

I think therapists need to do their own work. Meaning, they need to either see a therapist themselves or attend intensive workshops to work on themselves. They also should go to training and consult with other therapists. I don’t recommend seeing a therapist who doesn’t do these things.

Revealing Initial Thoughts

Likely toward the end of your session, your counselor will tell you their initial thoughts about the concerns that brought you to therapy. If they don’t volunteer their thoughts, ask them, so you aren’t left wondering after the session. Your therapist may be confident in an initial diagnosis after your brief meeting. They also may need more information. But they can tell you what they think based on your first therapy session. This diagnosis may change as your therapist learns more about you and your specific situation.

Creating a Treatment Plan

In the first session, you and your counselor will agree on a therapy treatment plan. This collaborative plan will include the length of your sessions, how frequently you’ll meet, what they suspect you’re experiencing, and how they plan to treat it. Your treatment plan also may change as you work together more, but your counselor should always keep you informed of any changes. You also can refuse or refute changes if you disagree with them.  

It’s important to remember that most therapists are trained to “meet a client where they are.” This adage means the therapist may need to change your plan if new concerns arise. For example, if you have a treatment plan that you’ve agreed to work on reducing your anxiety, and you come into your next session and state that your grandfather just passed away, it would be appropriate for your therapist to shift the plan to help you process your feelings around your grandfather’s passing.

The change doesn’t mean the therapist isn’t tending to the treatment plan. They are meeting you where you are. You could expect your therapist to return to the treatment plan as long as that is how you want to use your scheduled time.

Addressing Immediate Concerns

Before the end of your first session, your therapist will address any immediate mental health concerns. They may ask you to start taking a specific prescription, give you homework, or even send you to the hospital if you are a danger to yourself or others. Your counselor wants to make sure you are safe and able to take care of yourself after you leave.  

Don’t Get Discouraged

About 20% of people who seek help stop their counseling too soon. The most common reason people become discouraged after their first therapy session is because they don’t necessarily feel better. They didn’t have the breakthrough they were expecting after the first session. But the first session is about establishing a patient/counselor relationship and laying the groundwork for future treatment. You should ask yourself how you felt about the session, but don’t get frustrated if you don’t feel better immediately. You’ll notice more progress after subsequent sessions.  

Some people terminate treatment because they change their mind about wanting help. For example, they may decide they no longer want to work on their marriage or stop drinking. I always explain to clients that my door is always open for them, if they decide they want help.  

Some people just need a break from therapy because it is hard work. It takes time for people to change. It doesn’t happen overnight. But, if you stick with it, you usually begin to feel some relief from your symptoms. You get even better over time.

Adjust if Needed

You may determine at any time that a specific counselor is not the right fit for you. You may even make this decision after the first therapy session. You have to feel comfortable with your counselor and feel like you’re moving in the right direction. If you don’t, make a change. 

If your therapist isn’t sharing information about their diagnosis with you, isn’t encouraging you to make progress, or helping you learn and grow, I suggest you seek help from someone else. While it may be disappointing, it will be worthwhile when you’re partnered with the right counselor and on your way to healing.  

How All Counseling Can Help

Your first therapy session should not be intimidating or stressful. The session’s purpose is for you and your counselor to meet and get to know each other. If you don’t feel like the counselor is right for you, you can change at any time. All Counseling wants to help you find the right counselor to help you get the mental health support you deserve. Use our searchable therapist directory to find the counselor you need.

Are your clients leaving too soon?. (2021). Retrieved 30 September 2021, from https://www.apa.org/monitor/2015/04/clients

What to Expect In Your First Therapy Session. (2021). Retrieved 30 September 2021, from https://www.lyrahealth.com/blog/what-to-expect-first-therapy-session/

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