Reaching out to a therapist can be daunting. It’s normal for folks to feel anxious when setting up an intro call or attending their first scheduled (intake) session. Whether it’s your first time in therapy or not, you may have a lot of questions about the process — What happens? What does it look like? Where do I begin? In this post, I explain what to expect during your first therapy session in hopes of demystifying the therapeutic process. 

1. Greeting

The first few minutes is an introduction and I typically like providing an overview of how the first session will flow before we jump into it. I also encourage folks to ask any burning questions they may have or wait until the end to seek clarity on anything that may have been confusing or unclear.

2. Review Informed Consent, HIPAA Policy, and Other Policies

I ask the clients I serve to review, complete, and sign all forms prior to the intake session, because it allows for a more seamless process. I explain to clients that therapy is a relationship, but a very different type of relationship from all the others. One that has its unique boundaries and expectations. Thus, I like to review these forms to expand on this idea of therapy being a relationship, the ways in which its different from other relationships, and how it impacts confidentiality and its limitations, dual relationships, and self-disclosures. I’ll also review policies such as the telehealth policy, missed appointment and late cancelation policy, and what to do in case of an emergency.

3. Intake Assessment

As I mentioned above, I ask clients to review and complete all paperwork prior to the first session and one of these forms will contain questions about your current problems, symptoms, mental health background, family, work, school, other important relationships, etc. Reviewing this with clients helps me to begin to understand them and the full picture. This initial session may be overwhelming for lots of people because it covers a lot of ground. Sometimes it takes several sessions to complete the intake and that’s okay too.

Gentle reminder—Therapy is a process and it takes time. Therapy is not a quick fix. It is a gradual unfolding to help you gain more awareness and equip you with the tools you’ll need to navigate emotions, problems, relationships, and your life. I encourage you to allow any feelings to come up. It’s okay to feel scared, guarded, or doubtful. It’s also okay to feel excited and eager to start.

4. Identifying Therapy Goals and Objectives

Once the review of the intake assessment form is complete, I like to hear their ideas for therapy goals. Depending on how long the intake process takes, I may do this during the first session or on the third one. Additionally, I like to make this as collaborative as possible, but if clients have trouble identifying goals for therapy, I will help and guide them. We’ll brainstorm together. It’s important to consider what you might want to accomplish in therapy and also consider the following — What will I feel like and what will it look like once I’ve accomplished my goals?

5. Orientation to Treatment

I will also spend time orienting clients to the therapeutic process and I will do this by providing information on the treatment modality or interventions that may be appropriate to target your issues. I will also review the agenda and structure for regular therapy sessions so you’ll know what to expect and how to prepare for therapy. Attending therapy sessions requires some preparation. For example, perhaps journaling more often and taking note of what you notice (moods, thoughts, behaviors, relationship dynamics and conflicts, etc) as this will help you and I figure out what to target.

6. Questions, Concerns, Feedback

At the end of each session, I encourage clients to ask questions, seek clarity, express any concerns, or provide positive and constructive feedback. For example, consider — How was today? What’s the take home message? Was something unclear? — It’s important to know how you’re feeling about therapy, how things are going for you, whether you find the interventions helpful or unhelpful, because it helps me understand whether we’re on the right track or whether we need to switch gears and explore other options.

Closing Thoughts

Here are a few other things I like to review with clients:

1. The importance of being patient with the process.

2. The importance of putting in the work.

3. The importance of being transparent with yourself and your therapist (this takes time and looks different for each person).

4. Pacing yourself (there will be time to address your concerns and it won’t happen all at once).

5. The importance of building a safe and trusting relationship with your therapist, Check out this article for more info: Better relationships with patients lead to better outcomes.

6. Understanding therapy brings up a lot of feelings, even feelings of anger or resentment towards your therapist or the therapeutic process, which is totally normal. For example, people may feel sad (and worse) after processing experiences they’ve never shared before. Also, unpleasant feelings may come up as therapy will ask you try things that are uncomfortable. Growth and change may require discomfort.

Be aware, each therapist will have their own style and approach. Don’t be afraid to ask your therapist questions about their style, approach, how to prepare, and what to expect. Therapy can be daunting and so is figuring things out alone. Though intimidating, there is no shame in reaching out for help.

I'm a therapist in California providing therapy to CA residents. I’d be honored to support you in your journey. Reach out today to schedule an intro call.