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What To Expect From the First Therapy Session

Updated: Nov 24, 2021

You may be feeling nervous about trying therapy for the first time. This is understandable. Therapy is often represented in film and television as deeply personal, very serious, and intense. It can be all of those things but rarely is it all of those things all of the time. Here's a few things to expect from the first session.

Small Talk

There's probably going to be some small talk. Your therapist may ask you what you're watching on Netflix or what your favorite things to do with your kids are. This is to establish rapport and for both of us to feel more comfortable. Your therapist may share some minor personal details with you as well in order to show a bit of humanity. We want you to feel at ease. Some clients really appreciate small talk. I have had many clients who need to do about 5-10 minutes of small talk at the beginning of any session to ease in. If this is something that makes you feel comfortable, you can definitely mention it to your therapist. They would be happy to oblige.

Getting to Know You

Your therapist will ask you questions about your history. Every therapist does this in a slightly different way but I tend to start with mental health history. How old were when you first started experiencing anxiety/depression/etc? What sort of treatment have you had in the past? What was helpful? What was unhelpful? I will also ask where the client was born and raised, what their family of origin is like, and about their current living situation, their job, and the important people in their lives.


Most often therapists will not do a deep dive into your trauma during a first session. Usually I simply ask people if there's anything traumatic in their past that would affect our work together. I tell them that they don't have to tell me the details if they're not ready and we can circle back to it in future sessions when/if they are ready to discuss it. I will also ask them if the trauma has ever been discussed with another provider. Often it's not necessary to re-process trauma with a new provider so if it's been done before, we don't need to go down that road unless you want to.

Treatment Planning

The therapist will be considering what the treatment goals are as you are talking. Often I will clarify with the client to make sure I'm not missing anything. "So you would like to reduce your anxiety and increase self esteem? Am I missing anything else that you would like to focus on in treatment?" If there is something that you would like to be a focus of treatment, let your therapist know. If it's helpful, you can bring a list of things that you want to make sure to work on in treatment.

Overview of Practice Policies

You can expect that your therapist is going to review policies related to attendance, lateness, payments, etc. This is to prevent any miscommunication in the future and to establish clear expectations from the beginning. You should also feel comfortable asking questions. Some questions you may ask include whether the therapist is intending to change practice locations any time soon or if they are anticipating any changes in the insurances they can bill or rate changes. If you are hoping to include anyone else in your sessions - a partner, child, or parent, for example, you should ask if the therapist would be open to that.

In Summary

During the first session, your therapist will be doing their best to establish a rapport, get to know you and the reasons that you're seeking therapy. They will avoid any deeply personal content, deep dives into trauma, or unpacking complicated relationships. They will note the overall themes in terms of your stressors and coping mechanisms and identify areas that you both agree should be a focus of treatment. They will provide you with information about the rules of their practice and you should feel free to ask questions as well. You should feel no obligation at the end of the first session to book another session. You can always say that you will get back to them if you need to consider whether it's a good fit. If you feel positively, you can schedule another session.

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