What Happens in Your First Therapy Session?


Starting therapy can be an anxious time. Therapists have all undertaken therapy as part of their own training, so they’ve had the first session experience, too. They know how you feel, want the process to go as smoothly as possible, and will want you to feel comfortable and at ease.

It’s Normal to Be Nervous

People are often very nervous ahead of their first therapy session because they don’t know what to expect. Sometimes, they can become overwhelmed and upset. I’ve had clients cry from the moment they sit down, and that’s okay; it’s either because they know they are about to deal with something difficult or they feel relieved to get started on their therapy journey.

Therapists do this every day so you are in safe hands and can trust them to gently guide you through your first session and the therapy process as a whole. Your emotional response to the situation will not surprise them and your therapist will do everything they can to put you at ease and make you feel safe.

What Happens in Your First Therapy Session?

Initially, I will take some basic details from you, such as address and date of birth and then tell you a bit about myself and the therapy I deliver. The first session, and often the first few sessions, is about understanding the difficulties that have brought you to therapy.

If you want to feel prepared, it can be helpful to consider the following questions ahead of your first session:

– Think about what has brought you to therapy – why now?

– Do you have any specific worries or concerns that you would like help with?

– What are your goals for therapy?

– How would you know if therapy was successful for you?

Don’t feel like you need to have everything figured out. Some people come to therapy because they want to give it a go, explore the patterns of their mind or work on being the best version of themselves. Others come to therapy to work on something specific.

Other Things to Expect

Confidentiality – Your therapist will outline the boundaries of confidentiality and circumstances under which it might be broken.

History Taking – We will explore your personal, medical and psychological history.

Note-Taking – Not all therapists take notes in therapy sessions, but it’s very common and nothing to be concerned about. Read What Is My Therapist Writing About Me to find out more.

Therapeutic Agreement and Logistics – We will discuss details about session frequency, duration, fees, cancellation policies, etc.

Questions and Next Steps – I will invite questions about the next steps, including scheduling future appointments and outlining initial focus areas based on our discussion.

Homework or Reflection – We might think about a task or consideration to complete before the next session, that would support the process.

Therapy Takes Time

Your first therapy session can feel like a jumbly mess. Don’t worry; experienced therapists are used to unpicking and making sense of things. The purpose of the first session is for us to get to know each other and to begin to develop a good overview of what has brought you to sessions. Follow-up sessions become more and more focused.

In between appointments, your therapist will reflect on what is most useful and will receive clinical supervision. This is where your therapist discusses their practice with another accredited and experienced therapist. The information discussed is confidential and the aim is to review the therapy they’re providing and receive advice on supporting you to achieve your therapy goals. This ensures a high standard of therapeutic practice is achieved at all times and it is a requirement to maintain accreditation.

How to Get the Most Out of Your First Session

Adopt an Open Mindset – Go into your first and subsequent sessions with an open mind and readiness to engage.

Take Notes – You talk through a lot during sessions so taking notes can be really useful.

Reflect on Your Goals – Use the questions I shared earlier to think about what you want to achieve in therapy.

Prepare Questions – Jot down any questions about the therapy process, the therapist’s approach, or anything else you’re curious about. If you think of a question after the session ends, send a follow-up email or note to ask it next time.

Gather Information – Make sure you have any relevant medical or psychological information to hand, including previous therapy experiences, if any.

Think About Logistics – Set yourself up for success by considering your availability, budget and any other practicalities related to attending therapy before your first session. If you have any concerns, raise them with your therapist as soon as possible.


Your first session is as much about you assessing the therapist as it is about the therapist assessing you, the client. It’s an opportunity to see if there’s a good fit, and preparation can make this process more effective and comfortable.

However, don’t worry if you don’t immediately click with your therapist. It’s very common to feel this way, especially if seeking therapy is outside your comfort zone. Give the relationship time, but don’t be afraid to move on and find a different therapist if needed.

What to Read Next

What is Cognitive Behavioural Therapy?

How to Choose a CBT Therapist

What is EMDR Therapy?

What Is Compassion Focussed Therapy?

What is My Therapist Writing About Me?

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Sarah Rees

Sarah is a fully accredited Cognitive Behavioural Therapist and mental health writer delivering Modern Mental Health for you and with you in Mind. Sarah is the author of ‘The CBT Journal’ which helps you write for your wellbeing incorporating CBT techniques. For more information and to keep in touch have a look at sarahdrees.co.uk.