What Should I Expect During My First Therapy Session?

It can be really nerve wracking to make the decision to attend therapy. If you’ve already gone through the gauntlet of combing through options and finding someone you feel could be a good fit, you may now be facing the ever intimidating question; what should I expect during that first session? Let’s demystify the first therapy session so you can feel calm and confident coming in.

In this article, I’ll break down the following:

• How do I know it’s time to go to therapy? 
• What happens during my first therapy session? 
• Questions your therapist may ask
• How to prepare for your first therapy session

By the end of the article, you’ll have a better idea of whether therapy is the right move for you, what your first therapy session may look like, and how to best prepare.

How Do I Know It’s Time to Go to Therapy?

We all go through low spells, moments of anxiety, or difficult events. How do we differentiate life’s natural ups and downs from situations when we actually need support? 

The truth is, there’s no “perfect” threshold you have to cross before you’re allowed to seek therapy. You don’t need to wait until you’re in crisis, and you don’t need to have a major life event to justify opting for support. Therapy can be just as valuable for understanding yourself, improving relationships, or building healthier coping skills as it is for navigating significant challenges. 

Here are a few signs it may be time to consider reaching out:

Emotions feel difficult to regulate

Your anxiety might be getting in the way of your relationships. Your sadness might be making your day-to-day tasks feel impossible. A sense of overwhelm might make Mondays feel like a threat. 

If your feelings are consistently interfering with your daily life, therapy can provide tools to help you process and cope.

You’re noticing the same patterns over and over again

Maybe you keep finding yourself in unhealthy relationships, choosing the wrong people without recognizing why. You might be struggling with boundaries at work, accepting tasks from others even when you’re overwhelmed. Perhaps you notice yourself reacting to others with anger in ways you don’t fully understand. 

Therapy can help you uncover what’s driving those patterns, and provide pragmatic tools to break the cycles.

You’ve experienced a major life transition

Perhaps you’ve made a big move, changed careers, become a parent, ended a relationship, or lost someone you love. Major life transitions can uproot us and finding a sense of balance can be tough.

Therapy can help you process the emotions associated with big changes, and help you regain a sense of grounding and routine.

You’re relying on unhealthy coping strategies

Using substances, withdrawing from others, avoiding responsibilities, overworking. I call them “fragile strategies;” they might help us in the moment, but in the long run, we know they make things worse. 

If you’ve noticed yourself engaging in behaviours that help you escape rather than heal, it may be a sign that additional support would be helpful.

You don’t feel like yourself or something’s off

Sometimes, there isn’t one obvious reason you can name to go to therapy. You may simply feel stuck, disconnected, unmotivated, or unlike the version of yourself you know. That’s reason enough to explore therapy.

The reality is that you don’t have to be certain you “need” therapy before booking an appointment. If you’re even wondering whether it could help, that curiosity is worth exploring. The first session isn’t a lifelong commitment, it’s just a chance to meet with someone, ask questions, and decide whether it feels like the right fit for you.

What Happens During My First Therapy Appointment?

TV shows and movies have us picturing our first therapy session lying on a couch while someone silently takes notes. You can put that image aside; most first therapy sessions are much more conversational than people expect. Let’s break down exactly what happens during that intimidating first session:

Consent and confidentiality

First and foremost, a therapist will go through confidentiality and consent for services. 

Confidentiality is the backbone of therapy. It means that, with some exceptions, your therapist will never share what you talk about outside of therapy without your explicit permission. During this portion of the session, they will define confidentiality and clearly state the situations when they’d have to break confidentiality.

Typically, confidentiality is an ongoing conversation, and they may keep bringing it up in future sessions (especially if you talk about more sensitive topics where breaking confidentiality might be in the cards). 

They will also give you a breakdown of what therapy services typically look like. During this breakdown, you’ll learn what you can expect from treatment. You’ll also be asked to confirm that you understand what services look like and whether you consent to these services. 

During this portion, a therapist might also go through things like cancellation and no-show policies, cost of services, how billing works, and insurance coverage.

Feel free to jump in with any questions about your rights or anything else you need clarified.

Reason for seeking therapy

Your therapist’s primary goal during this portion is to understand what brought you into therapy. Some people don’t quite know exactly why they’re in therapy, others have a very good idea, many are in between; all scenarios are completely fine. 

I have heard a variety of reasons and they’re all valid:

“I’m not exactly sure, I just know I feel anxious a lot of the time.”

“I feel like my childhood has been extremely difficult and I want to understand how it’s affected me and break some of those patterns.”

“I’m going through a break up and I’m struggling a lot more than I thought I would be.”

“I just wanted to try therapy out.”

Don’t worry if you don’t know where to start or feel emotional. Your therapist isn’t expecting you to have the perfect explanation for why you’re there. Trust that they will help carry the session, and ask open ended questions to get a better idea of where you are and what your concerns are. Although openness in therapy can be really helpful, the first session might still be a place when you’re feeling your therapist out, and you are more than welcome not to answer any questions you’re not comfortable with yet.

Intake process

This part will probably differ the most from therapist to therapist, but most therapists will have some sort of background-gathering process. This is when they learn about what your life looks like, and begin building a relationship where you feel comfortable enough to be honest over time.

During the intake process you might be asked about your upbringing, your job or schooling, who you live with, and your social circle. A therapist may also ask you about your psychological history, including any prescriptions, diagnoses, or history of services related to mental health.

If relevant, they might also ask questions about more sensitive topics like sex, recreational drug use, thoughts of self-harm, or history of abuse. Again, while honesty is an important part of therapy and you are covered under confidentiality, you do not have to share anything you’re not comfortable opening up about from the get go. The therapy relationship builds over time, and it makes total sense not to feel entirely comfortable right away.

Goals for therapy

During the first session, a therapist will often begin to identify goals for therapy, even if they’re still a little unclear. Again, you don’t have to have everything figured out, and your therapist will help guide you through the process of goal-setting. Additionally, as you begin to uncover more in therapy, your goals are likely to become more specific or shift altogether, so you don’t have to worry that you’re “stuck” with what you originally decided. 

Everyone’s goals differ, but some common objectives include: 

• Managing anxiety, stress, or overwhelming emotions.
• Improving symptoms of depression or low mood.
• Building healthier coping skills.
• Exploring the impact of trauma.
• Increasing self-confidence and self-esteem.
• Improving communication and relationships.
• Setting and maintaining healthy boundaries.
• Processing grief, trauma, or difficult life experiences.
• Navigating major life transitions or big decisions.
• Reducing people-pleasing or perfectionistic tendencies.
• Better understanding thoughts, emotions, and behavioural patterns.
• Developing healthier habits and routines.
• Managing work-related stress or preventing burnout.
• Learning emotional regulation skills.
• Healing from relationship challenges or breakups.
• Feeling more connected to yourself and living in alignment with your values.

Remember that there isn’t a “right or wrong” therapy goal. A good therapist will meet you where you’re at and help you identify a path and treatment plan that aligns with your needs.

Questions for them

The first session is also an opportunity for you to interview your therapist, and somewhere during the appointment many therapists will give you the opportunity to ask them questions. Finding the right fit matters, and it’s completely okay to ask questions about their approach, experience, or what future sessions typically look like.

Keep in mind, it’s totally okay not to have any questions from the get go. You might also just check in to see how it feels being with your therapist, if you’re comfortable, and if you see yourself opening up to them.

Questions Your Therapist May Ask

Every therapist is different, but they’ll typically cover topics like:

• Mental health history
• Relationships
• Stressors
• Coping strategies
• What brought you to therapy.

Some common therapy questions include:

• What brought you to therapy at this point in your life?
• What are you hoping to get out of therapy?
• Have you been to therapy before? If so, what was that experience like?
• How have you been feeling emotionally lately?
• What does a typical day look like for you?
• What do you usually do when you’re feeling stressed or overwhelmed?
• Who do you turn to for support?
• What do you do for school or work?
• Can you tell me a little about your family or important relationships?
• How have you been sleeping, eating, and taking care of yourself?
• What are some of your strengths or things that help you get through difficult times?
• Is there anything you think is important for me to know about you?

Remember that you do not have to answer every question, and that even answers like “I don’t know” are completely valid. Your therapist is not there to judge or appraise you in any way, they’re there to get to know you so they can help.

How to Prepare for Your First Therapy Session

There’s very little you have to do to prepare for your first therapy session. The heavy lifting will be done by your therapist; you don’t need a plan. With that in mind, there are a few things you can do to make the process easier for yourself.

Think about goals

Firstly, consider this question: how would I know that therapy is finished? Think through what your life, relationships, sense of self, or career might look like. Identify the things that would signal to you that you’re doing better.

Then, build goals out of that. For example, if you struggle with social anxiety, you might consider that life would look better if you no longer overthought what you’re going to say or spiralled into negative self-talk after a social event. Your goal for therapy might therefore be building enough confidence that you feel at ease with others and are able to speak up without questioning yourself.

It’s absolutely not necessary, but thinking through goals beforehand can help you and your therapist visualize what therapy treatment might look like.

Bring questions

This step isn’t essential either, but taking a little bit of time to think about any questions you have can help you feel more prepared going into your first session. Your therapist will cover a lot during that initial appointment, but if there’s something that’s important to you or you’re curious about, having those questions in mind can help ensure you leave feeling informed and confident.

For example, your therapist might have forgotten to share their cancellation policy with you. Asking them if they have one and what the fees look like may help you both avoid unwelcome surprises in the future. 

If you need help coming up with questions, check out this article that includes 23 questions to ask your therapist.

Arrive (or log in) early

Whether you’re meeting in person or virtually, aim to arrive or log in 5-10 minutes before your appointment. This gives you a chance to settle in, test your internet connection if you’re meeting online, and avoid feeling lost or rushed before the session even begins.

If you’re attending virtually, try to find a quiet, private space where you feel comfortable speaking openly. You don’t need the perfect setup, but minimizing distractions can help you get the most out of your session. You can learn more about how to set up your online therapy space here.

Fill in any forms

A lot of therapists will send intake forms before your first appointment. These usually include questions about your medical and mental health history, emergency contacts, consent forms, and payment information.

If you’re able to complete these beforehand, you’ll spend less of your session focused on paperwork and more time talking about what’s bringing you to therapy. If you don’t understand a question or you’re unsure how to answer it, don’t stress. Bring it up during your session, your therapist will be happy to walk through it with you.

Be open

Remember, you don’t have to tell your therapist everything in your first session, and you certainly don’t have to share anything you’re not ready to talk about. Trust takes time to build, and that’s completely normal.

That said, try to be as open and honest as you feel comfortable being. Your therapist can only work with the information they have, so being truthful about what you’re experiencing (even if it feels messy or difficult to explain) will help them better understand how to support you.

It’s also okay to say if something isn’t making sense, if you’re feeling nervous, or if you’re unsure where to begin. Many people worry they’ll “do therapy wrong,” but there really isn’t a right or wrong way to show up. You don’t need to have the perfect words or a neatly organized story.

Finding the Right Therapist in Toronto

No matter where you’re starting from, deciding to go to therapy is an investment in yourself. You don’t have to have everything figured out before booking that first appointment, you just have to be willing to take the first step.

If you’re interested in booking a first session with me, you can book a free call or shoot me an email. If you’d like to learn more about what to expect during our initial intake call, click here.

Want to learn about whether therapy is worth it for you? Click here.

Need tips on finding a good therapist? Learn more here.