What to Expect at Your First Therapy Session

by Maggie Jordan

Seeing a therapist for the first time may be daunting if you don’t know what to expect. This first session, often referred to as an intake, follows a different format than future sessions. It's more of a "get-to-know-you" style, so the therapist may ask you more questions than they normally will.

While every therapist operates differently, hopefully this general outline will give you an idea of what you may experience the first time you walk into a therapist’s office and help calm some of the first-session jitters.

The length of the first session may be longer than is typical

For example, it could be upwards of 60 minutes, whereas future sessions may only be 50. It's a good idea to clarify how long your first meeting will be in advance!

You'll fill basic paperwork out when you arrive

Your first therapy session is typically not that different from what you might experience at an initial primary care physician visit.

If you’re seeing a therapist in-person within a group practice or clinic setting, there will likely be an administrative assistant to greet you and give you some basic paperwork to fill out. If you’re seeing a solo practitioner, you’ll typically be given the same paperwork at the beginning of the session, or the therapist may send it to you electronically to complete before your first session.

This paperwork will likely include:

  • Questions to gather demographic and insurance information
  • Questions about your medical and psychiatric history
  • A mood or anxiety screening

You’ll also have to sign papers regarding patient privacy, confidentiality limitations, practice policies, and a consent to treat. If you want them to be able to speak to other members of your treatment team, like a dietician or psychiatrist, they'll likely ask you to sign a release of information, which gives them permission to reach out.

For in-person sessions, the therapist will come get you from the waiting room when it's time for your session to start

If you're seeing a therapist in-person, you’ll likely have a short wait in the waiting room, and your therapist will come get you when they’re ready and lead you to their office. Some providers have a "doorbell" system, where you press a button on a sign next to their name, to signal to them that you've arrived.

Wondering what that staticky noise is as you walk to the office? Many therapists use white noise machines so you can’t hear anything that’s said in the office from the outside in order to protect patient privacy. If you’re in a building with a lot of therapists, it can sound like the ocean waves as you walk down the hallway.

You'll discuss your past and present (though only as much as you're comfortable with)  

Your therapist will tell you where to sit, typically on a couch or comfy chair across from them. Then they may walk you through the paperwork you already filled out and ask follow up questions about anything that needs to be clarified.

Many therapists also use the first session to ask history-gathering questions that will help them understand your past and what’s bringing you in. These might include questions about:

  • Past events
  • Your relationship with family members
  • What your current, daily life is like

If you’re uncomfortable answering any of the questions up front, that is completely okay. Just let your therapist know you’d rather move on and revisit the topic later – they won’t pressure you to share more than you’re comfortable with.

The therapist will ask about your past therapy experiences and what you hope to gain in sessions

Your therapists' questions might include topics like:

  • Whether you've been to therapy before
  • What the experience was like
  • If there are any approaches or techniques that worked particularly well or didn’t work at all
  • What you’d like to get out of your time working together  

They will also probably tell you more about themselves and the approaches they use, as well as covering logistical details such as their cancellation policy.

You'll have the opportunity to ask any questions you have as well  

Don’t be afraid to say what you’re thinking!

You might want to ask about:

  • How long clients typically see them for
  • What challenges they often help clients work through
  • Whether they have experience working with clients from different backgrounds or identities – and if not, if they’d be willing to learn.

You'll decide whether you want to return for future sessions

Therapists value the client-therapist fit, and ultimately they’re looking out for your best interests.

If after the first session you don’t think they’re the one for you, you can tell them that. While “breaking up with a therapist” might seem awkward, they’ve been through it many times before and won’t take it personally.

If you’re not comfortable or don’t know how you feel right away, when they ask if you’d like to schedule another appointment, you can just say you’ll call them after you’ve had time to think about it. But you should call and leave a voicemail, even if the answer is no.

The session will end with the session payment

At the end, if you’re using insurance, you’ll be responsible for your copay; if you’re not using insurance or are using out-of-network benefits, you’ll be responsible for the full fee. Pay by card, cash, or check.

Then take a deep breath. You’re on your way!