What Happens at a First Therapy Session?

Reviewed by Spring Berriman, Registered Psychotherapist

Quick Answer: What Happens at a First Therapy Session? A first therapy session is usually a chance for you and the therapist to understand what brought you in and decide what you may want help with. The therapist may ask about what you have been experiencing, relevant parts of your history, your relationships, current stressors and what you hope might change. You may also discuss confidentiality, fees, scheduling and how the therapist works. You do not have to tell your entire life story or discuss anything you are not ready to explore. The first session is also your opportunity to decide whether the therapist feels like someone you could work with. If you would rather start with a shorter conversation, you can book a free 30-minute consultation first.

You have booked your first therapy appointment. Now you are wondering what you are actually supposed to say when the therapist appears on screen or sits across from you.

Do they expect you to start talking immediately? Will they ask about your childhood? What if you cry? What if you do not know what is wrong? What if you sit there and have no idea where to begin?

A first therapy session is usually more straightforward than people expect. It is a conversation about what brought you to therapy, what has been happening in your life and what you may want help with.

This article explains what adults in Ontario can generally expect from a first psychotherapy session.

You do not have to arrive with a diagnosis, a perfectly organized story or a list of therapy goals.

What usually happens at the beginning of a therapy session?

The therapist will usually start by introducing themselves and explaining some practical details about working together.

This may include:

• How long sessions last
• Fees and payment
• Cancellation policies
• How online or in-person appointments work
• How the therapist keeps records
• Confidentiality and its limits
• How to contact the therapist between appointments

In Ontario, Registered Psychotherapists are required to obtain informed consent and explain important information about therapy, including confidentiality and its limits, before or as treatment begins.

This part of the appointment may feel administrative, but it matters. You should understand what you are agreeing to and have an opportunity to ask questions before therapy gets underway.

What will the therapist ask you?

After the practical information, the therapist will usually ask what brought you to therapy.

You do not need an elaborate answer. You might say:

• “I have been really stressed.”
• “My relationship is struggling.”
• “I have not felt like myself lately.”
• “I keep overthinking everything.”
• “I feel anxious all the time.”
• “I am dealing with something that happened in my family.”
• “I honestly don’t know what is wrong.”

The therapist may ask follow-up questions to understand what you have been experiencing and how it is affecting your life.

Depending on why you came to therapy, they may ask about your mood, sleep, work, relationships, family, health, past experiences or ways you have been coping.

You are not being tested, and there are no right answers.

Do you have to know what you want from therapy?

No. Some people begin therapy with a specific goal, such as managing anxiety, grieving a loss, improving a relationship or setting better boundaries. Others simply know that something does not feel right.

You might want to feel less overwhelmed, understand why the same problems keep happening or have somewhere to talk without worrying about another person’s reaction.

That is enough to begin.

If you are struggling to explain what is happening, our guide to whether therapy can help when you don’t know what’s wrong may help.

Your goals can also change. You may start therapy because of work stress and later realize that perfectionism, family expectations or difficulty saying no are part of the problem.

Do you have to talk about your childhood?

Not necessarily. Your therapist may ask about your family or earlier experiences when they are relevant to what you are dealing with now. That does not mean every first session involves a detailed discussion of childhood.

Some forms of therapy place more emphasis on past experiences. Others focus more closely on current thoughts, behaviours, relationships or practical coping skills.

You can also ask why the therapist is asking a question if you are unsure how it relates to your concerns.

How much should you share in the first session?

As much as feels manageable.

There can be pressure to explain everything because you have finally decided to see a therapist. You may arrive with years of experiences you want someone to understand. You do not need to cover them all in one appointment.

Therapy develops over time. It is reasonable to begin with the most important reason you came in and allow the rest of the story to emerge gradually.

You can also say:

“I am not ready to talk about that yet.”

A therapist may ask whether a subject is important to return to later, but therapy should not depend on forcing you to disclose something before you are ready.

Is therapy confidential?

Therapy is generally confidential, which means your therapist does not normally share what you discuss without your consent.

There are legal and professional limits to confidentiality. Your therapist should explain these before or at the beginning of therapy so you understand when information could potentially have to be disclosed.

If you are worried about privacy, ask directly:

• “Who can see my records?”
• “Under what circumstances would you have to share something I tell you?”
• “What information do you keep in my file?”

You are entitled to understand how your information is handled.

What if you cry in your first therapy session?

You can cry. You can also not cry.

Some people become emotional almost immediately because they have been holding something in for a long time. Others feel calm, nervous, embarrassed or unable to access much emotion at all.

None of these reactions determines whether you need therapy or whether the session is going well.

A therapist is accustomed to sitting with emotion. You do not need to apologize for crying or quickly pull yourself together for their benefit.

What if you feel awkward or nervous?

That is common. You are meeting someone new and being asked to talk about parts of your life that you may not discuss very often.

The first session can therefore feel different from later sessions. You are both still learning how to talk with each other.

You might ramble, forget something important, laugh because you are nervous or leave the appointment remembering something you meant to say.

None of that is a problem. You can bring it up at the next session.

What if you don’t know what to say?

Tell the therapist that. “I don’t know where to start” is a perfectly reasonable place to start.

A therapist can ask questions about what has changed, what has been most difficult recently or what made you decide to book the appointment now rather than six months ago.

If your mind goes blank, you can also describe a recent example.

Instead of explaining your entire relationship, tell them about the argument that made you realize something needed to change. Instead of explaining years of stress, describe what happened last week when you felt you could not cope anymore.

The therapist can help you work outward from there.

Will the therapist diagnose you in the first session?

Usually, the main goal of an initial psychotherapy appointment is to understand what you are experiencing and begin deciding how therapy might help.

A therapist may ask questions about symptoms or mental health history, but one first conversation does not necessarily produce a diagnosis.

Not every person who attends therapy needs a diagnosis. If a formal diagnosis or another type of assessment becomes relevant, your therapist can explain what they can provide within their professional scope and whether another health-care professional should be involved.

Will you set goals for therapy?

You may discuss what you would like to be different, but the goals do not have to be formal or permanent.

Here are some possible goals:

• “I want to stop feeling overwhelmed all the time.”
• “I want to understand why I shut down during conflict.”
• “I want to be able to say no without feeling guilty.”
• “I want to enjoy things again.”
• “I want to get through this breakup.”
• “I want to understand why I keep ending up in the same situation.”

As therapy continues, those broad goals can become more specific.

What should you ask the therapist?

The therapist is learning about you, but you are also learning about them.

Useful questions include:

• Have you worked with people dealing with this issue before?
• What type of therapy do you use?
• What might our sessions look like?
• How often do you usually recommend meeting?
• How will we know whether therapy is helping?
• What happens if I don’t think the approach is working?

You do not need to interview the therapist formally. Ask what you need to feel informed and comfortable enough to decide whether to continue.

How do you know if the therapist is a good fit?

You do not necessarily need to feel an immediate emotional connection during the first hour. You might be nervous. It can be unnerving when discussing difficult material. You also may need to adjust to talking with a stranger about yourself. Instead, consider whether you felt listened to and respected.

Did the therapist seem interested in understanding you rather than jumping to conclusions? Could you ask questions? Did they explain things clearly? Did you feel pressured or judged?

Our guide to choosing a therapist and what to expect can help you think through if there is a therapist fit for you in more detail.

It can take more than one session to judge this, but you are not obligated to continue simply because you attended an appointment.

What happens after the first therapy session?

Near the end of the appointment, the therapist may summarize what you discussed and suggest what you could focus on next.

You may talk about how frequently to meet and schedule another appointment. You can also decide that you want time to think. There is no rule that says you must immediately commit to ongoing therapy. If you are still deciding whether therapy is the right next step, read Do I Need Therapy or Am I Just Stressed?. If you are ready to explore care, see our psychotherapy services in Peterborough.

If the therapist does not seem like the right fit, you can speak with another therapist. Finding the right working relationship may take more than one conversation.

How should you prepare for your first therapy session?

You do not need to prepare extensively. If it helps, think about three things:

• What made you book therapy now?
• What has been hardest lately?
• What would you like to be different?

You can write down a few points if you are worried that nerves will make you forget them.

For online therapy, choose a private location where you feel comfortable talking and check your internet connection, camera and audio beforehand.

Most importantly, do not feel responsible for running the session. That is part of the therapist’s job.

What if you are still unsure about starting therapy?

Being uncertain does not mean you should not go to a session.

You may be asking whether what you are experiencing is serious enough, whether you can solve it yourself or whether talking to a therapist would actually help.

Our guide to whether you need therapy or are just stressed can help you think through those questions.

You can also use a consultation as a low-pressure first step. You can describe what has been happening, ask questions and decide whether you want to book a full therapy session.

If you are ready, you can book a free 30-minute consultation with one of our Ontario psychotherapists.

You do not have to commit before you feel ready

The first session does not have to explain your entire life or solve everything in an hour.

You and the therapist are beginning to understand what brought you there, what you may need and whether working together makes sense.

You are allowed to ask questions, take your time and decide how much you want to share.

If you would like to take the first steps, you can book a free 30-minute consultation or read our guide to choosing a therapist and what to expect before deciding whether you want to move forward with therapy.

Frequently asked questions about the first therapy session