4 min read
What to Expect in Your First Therapy Session
Author
Karen Vincent
LICSW
If you have never been to therapy before, it is normal to wonder how the first session actually works. Will you be asked a lot of emotionally loaded questions? Do you need to prepare anything in advance? How much are you expected to share? If you have any of these concerns, you are not alone, since most people come to therapy with a simple goal: to feel better than they do now as quickly as possible.
It is important to know that the first therapy session is not about fixing everything at once, and certainly not about pushing you into anything before you are ready. When you know what to expect in your first therapy session, the experience often feels more manageable and less anxiety provoking. Instead of worrying about what should happen, you can focus on how the conversation feels and whether the support is right for you which makes it easier to show up just as you are.
Why the First Therapy Session Matters
The first therapy session sets the tone for everything that follows. It is where you and your therapist begin establishing trust, clarity, and a mutual understanding about your goals. This early connection, often called the therapeutic alliance, plays an important role in how effective therapy becomes over time.
At the same time, it helps to be clear about what the first session is not. It is not a deep dive into every painful experience you have ever had. It is also not a test you need to pass by having the “right” answers to questions, and it is not a place where all answers suddenly appear. It’s also not a place where you will be judged for what you are sharing. Therapy works gradually, and the first session lays the groundwork so that meaningful work can unfold over time. Many people leave their first session feeling a mix of relief, emotional release, hope, and tiredness. Others feel unsure or simply thoughtful. All of these reactions are valid and common.
How to Prepare for Your First Therapy Session
There is no formal requirement for how to prepare for your first therapy session, but a bit of preparation can make the experience feel smoother. The first visit often involves discussing what brought you to therapy, reviewing logistics, and beginning to gather some background information and outline your goals.
Before your appointment, think about the main reasons you decided to seek therapy at this point in your life. Is there something that has been weighing on you recently? This might include stress, anxiety, a recent life change, relationship challenges, something from the past that keeps popping up, a behavior or thinking patterns you want to change, a challenging relationship, or a general sense that something feels off, even if you are not completely sure of what it is.
Some people find it helpful to jot down a few notes, while others prefer to reflect mentally. You can also prepare practical details, such as questions about confidentiality, session structure, or scheduling.
What Happens in Your First Therapy Session
Many people worry about saying the wrong thing or not knowing how to begin. In practice, therapists are trained to guide the conversation so you do not have to carry that responsibility alone, and there is nothing you will say that will be judged or that will be “wrong”.
1. Welcome and Orientation
Your therapist will begin by introducing themselves and explaining their role. They will review confidentiality, session length, and how therapy generally works. This part of the session helps establish clarity, transparency, and trust from the start.
2. Intake Conversation
Next, the therapist will invite you to share what brought you to therapy so that you can start with what feels most important to you. They will guide the conversion asking questions about current concerns, emotional patterns, symptoms you are experiencing now or in the past, relevant life events, and any previous experience with therapy. They will be curious about anything that has changed recently, as well as the history behind any challenges you are experiencing. They will ask about any risk concerns since your safety will always be their number one priority.
Finally, they will ask about who supports you, what you identify as your strengths, and what things you enjoy doing that help you feel good or better. If you struggle to come up with answers to these types of questions, that is completely okay. Having this information will help your therapist identify that maybe one or more of these areas should be a goal of therapy, so that you can strengthen them.
The more your therapist understands your situation, the better able they are to talk about the approach they feel may support you best and collaborate with you on your therapy journey. With that said, you are always in control of how much you share. Nothing needs to be disclosed before you feel ready.
3. Goals and Hopes
You will also spend time discussing goals. These might be short-term or long-term goals. Initially you may still feel unclear about exactly what your goals are, which is completely normal. Therapy goals often evolve, especially early on, and your therapist will help you shape them collaboratively. Your therapist will work with you to make your goals measurable in some way so that together, you can easily measure your progress over time. If you want to think more about this in advance, exploring how to set therapy goals can be helpful.
4. Understanding the Therapist’s Approach
After gaining a better understanding of what brought you to therapy and what you are hoping to accomplish through your work together, your therapist will share their therapeutic approach and what sessions typically look like. This is a time where you can ask for clarification, or give feedback about what you think may be most helpful for you. Remember, therapy is a collaborative process and you are the expert in your own life, so your voice is important and valued. Especially for people new to therapy or those attending sessions online, this is very helpful.
5. Your Questions and Next Steps
You will also have time to ask questions about the process, therapy expectations, scheduling, frequency of sessions, costs, next steps, and anything else that feels important. The session usually ends with a brief summary and a conversation about what comes next, including whether you want to schedule another session.
This overview reflects what happens in your first therapy session for many people. But ultimately, your needs and your therapist’s style are what shape each experience.
What the First Session Is Not
Clear therapy expectations can prevent unnecessary pressure. The first session is not the place to resolve everything at once. Healing and insight develop over time, not in a single conversation.
You are not expected to share your entire life story or your most painful experiences right away in one sitting. Many people feel awkward or unsure during their first session, and that does not mean therapy is failing. It is also normal if the connection with your therapist does not feel immediate. Rapport can take time, and it is okay to notice how the fit feels.
Feeling emotional, relieved, tired, or thoughtful after your first session is common. These reactions often reflect the effort to open up and engage in something new. It’s always okay to share your reactions to the first session with your therapist in your next session so that they understand what your experience was like. You are always welcome to give feedback so that adjustments that may be beneficial can be made if needed.
What to Expect in Your First Therapy Session at Octave
Octave’s approach to the first session is structured but flexible. Clients are thoughtfully matched with licensed clinicians trained in evidence-based modalities and experienced in working with a wide range of concerns.
Octave therapists will carefully guide you through your sessions, starting with the very first one. They want to understand what brought you in, what kind of support may be helpful, and how to create a collaborative plan that fits your needs. You are not expected to have clear answers or goals right away because honesty and openness matter more than having everything figured out.
Because Octave also offers virtual care, many clients appreciate the ability to attend their first session from a familiar environment. This can make starting therapy feel more accessible and easier to maintain over time.
Common Questions About the First Therapy Session
Reflection and Next Steps After the First Session
After your session, take a few quiet moments to notice how you feel. You might think about what felt supportive, what felt unclear, and how comfortable you felt overall. Sometimes it helps to write down these thoughts to process the experience and decide what you want to do next. Therapy is a process, and the first session is simply the starting point.
Ready to Begin Therapy?
Knowing how to prepare for your first therapy session and what to expect makes this decision feel more approachable. If you are ready to take the next step, Octave offers evidence-based, supportive care to meet you where you are.
