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March 27, 2014
by Elizabeth Earnshaw, MFT

What to Expect in Your First Therapy Session

March 27, 2014 02:55 by Elizabeth Earnshaw, MFT

If you have never been to therapy before, waiting for the first session can be both exciting and nerve-wracking. You are ready to feel relief and get the weight off of your shoulders but at the same time might be afraid of the unknown. You wonder what might be discussed, if you will actually like the therapist, and whether or not it can really help. You might also not know how much it is going to cost, how long it will last, or what the therapist expects from you. 

Here is a list of things that occur during most first sessions:

1. Paperwork - Most therapists will ask you to arrive about 30 minutes early in order to fill out paperwork. Paperwork should also include confidentiality forms, notice of privacy practices, and consents for treatment. The therapist might also ask you to sign an agreement to pay, fill out questionnaires, and give demographic information.

2. A Conversation - The first session is all about what has been going on for you. You should be given most of the space to talk about anything and everything that is in your head. If you are uncertain about what to say next your therapist will ask you questions to get a deeper understanding of the issue. Some questions might include "what have you done before to try to make this better?" or "how long have you been feeling this way?". Your therapist might also ask questions to get a deeper understanding of you, "what are some things that would not be helpful?" or "if you ever feel frustrated in therapy, how will you let me know?". You should not feel as if the therapist is just going through a list so he or she can check off boxes or like they are reading questions from a sheet of paper. 

3. Empathy and Trust Building - By the end of the first session you should feel that your therapist empathized with you and was kind. If you leave feeling that the therapist was cold or aloof than you might want to search somewhere else. Of course you won't have full trust right away, but you need to believe that eventually you could trust the therapist.  if you aren't buying it in the first session then check someone else out. 

4. What will happen next: Towards the end of the session the therapist should fill you in on what will happen next. He or she will let you know what their style of therapy is, how they believe they could help you, the layout of future sessions, and how often they would like to see you. 

5. Cost of Therapy- Some therapists offer first sessions free and some do not. It is important that you ask this information of the therapist prior to seeing him or her so that you are well aware of how much it is going to cost you and if you can afford it. If the session was a free consult then the therapist will talk with you about cost towards the end of that session. The therapist will also let you know how frequently he or she would like to see you and how many months they believe you will be in therapy. 

6. Homework - Your therapist might give you homework to complete prior to your next appointment. Sometimes this homework is just thinking about something and other times it might actually include completing an activity or filling out paperwork. 

7. Scheduling - You will schedule your next appointment at the end of the session. If you are not sure that you want to continue therapy you have the option of calling later and scheduling once you are sure. 

Here is a list of things you can do to feel prepared:

1. Ask for a phone consult -  Your therapist should be willing to talk with you by phone prior to meeting. Use that time to find out more about how he or she works, how much success they have had in the past with your particular issue, and what the cost of treatment will be. 

2. Jot down your concerns - During the days leading up to your first appointment, start jotting down whatever is bothering you. If you notice yourself unable to sleep write it down. Did a theory pop into your head about why you've been feeling this way? Make a note of it. Bring this list with you to the first meeting. You can either read it off, use it as a reminder, or just leave it with the therapist before you leave. It can be a huge relief to feel like you got everything off of your shoulders. 

3. Start imagining  Start to imagine what life might be like if things could change. Having a mental picture of yourself feeling better can be a big motivation for going to the first appointment and can actually make it seem pretty exciting!


Although therapy can feel a little scary, the first meeting should be a time that gives you a sense of relief. You will not solve all of your problems during the first session, but you should feel as if you have a person that understands you, is willing to work with you, and genuinely cares about helping you to reach your goals. If you still find yourself feeling concerned about the meeting, send the therapist an e-mail prior to your appointment asking him or her to lay out what that meeting will look like. 


About the Author

Elizabeth Earnshaw Elizabeth Earnshaw, LMFT, CCTP

Every person's experience is different & I approach each session with genuine interest, openness, & empathy for your particular situation. We will work together to identify unhelpful patterns & beliefs so that you can release emotional pain.

Elizabeth Earnshaw has a clinical practice in Philadelphia, PA

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