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What’s therapy like? 4 things to expect from your first appointment

16 July, 2021

So what exactly happens in your first therapy appointment? Here, we aim to demystify the process so that you can know what to expect…

Starting therapy can feel daunting — after all, it’s natural to worry about what will happen in that very first session. You might wonder what your therapist will expect of you or worry that you will be pushed to reveal too much, too soon. What exactly happens when you take your seat on a couch across from a stranger for the very first time?

If you’ve never been to therapy before then you might have some very understandable fears. For instance, some people worry that they will somehow be judged, for instance, that their therapist will somehow consider their problems to be ‘trivial’, or view them as a ‘bad person’, or might even see them as ‘crazy’. But therapists understand that people aren’t perfect, that we all make mistakes and that life can be very hard at times. They are there to support you with whatever you’re going through — not to pass judgement or criticise you.

Others fear that they might become tearful, angry or emotional in their first session, but again, counsellors are very used to seeing clients get upset and will create a safe space for feelings to be expressed. And while it’s understandable for you to be nervous about the whole process, a good therapist will do their best to make sure you feel at ease.

In fact, it might reassure you to know that while every therapist is different and there are a wide range of approaches, most introductory sessions tend to be quite similar. With this in mind, here are four things that you can expect from your first appointment:

1- Gathering practical information

Most therapy sessions last for 50 minutes, although this can vary - particularly for the first session which you might book as a shorter session to get a feel for the therapist and to see if you’re a good fit together. In general, many first appointments begin with a simple but important step: paperwork. This means that you will probably be asked to provide basic personal details, as well as your GP’s name and emergency contact information. You might also be asked about any previous or current physical or mental health issues and about any medications you might be taking.

This could happen in the appointment itself, in the waiting room beforehand or, if you’re doing your therapy online, via an emailed form. The purpose of it isn’t to pry but to let your therapist gather essential background information about you so that they can support you better. Also, for the vast majority of therapists, taking these details is also a legal requirement to protect both you and them. (Speaking of waiting rooms, not all therapists have these so it can be a good idea to check if there is somewhere to sit if you get there early. Otherwise, you will need to arrive at the exact appointment time).

2- Breaking the ice

Once you have completed any forms, you will then move onto the introductory part of the session. Your therapist may tell you a little bit about themselves, including their background and their approach. They will likely also ask for basic information about you, such as your age, current circumstances and whether you’ve had therapy before. This is just to get a general feel for who you are. If you’ve had therapy before, then this part of the appointment is also a great opportunity to mention if any aspect of that wasn’t helpful, so that you can try not to replicate it together.

Bear in mind that some therapists will take notes while you’re talking while others won’t, it just depends on their individual process. Some may also ask you for permission to record the session. Either way, your notes and recordings will stay confidential.

3- Talking about what you’re going through

Next, your therapist will ask you why you’ve come to therapy (they may also have asked you this at the booking stage, but a conversation enables more information to be gathered). However, it’s fine if you don’t have clear or detailed answers straight away. Perhaps you feel sad, anxious or angry sometimes but don’t quite know why. Or perhaps you feel that you’re experiencing the same problem again and again (in romantic relationships, in jobs or with eating patterns) and again, don’t quite know why. This is all completely fine, as there are so many reasons why people go into therapy.

In other words, it’s okay for you to explain as best as you can and give your therapist a general picture of what you’re going through. They won’t expect you to be an expert on your problems, or be super articulate, or have all the answers — in fact, one of the main points of therapy is to get to the bottom of those feelings and behaviours that don’t always make sense to us. This is a process that can take time, as getting to know yourself — and opening up to another person — is a journey. Also, it’s fine if you don’t feel ready to disclose certain private, painful or triggering things during your first appointment. Your boundaries are important and you can just share what you are able to, at your own pace.

That said, you might have a clear idea in advance of what you need from therapy and the changes that you want to see in your life. If so, it can be really helpful to express this to the therapist, so that they know what your goals are and can structure sessions around this. And if you have made some notes that you want to bring to your first session, then this is fine too. There’s no pressure to come prepared though, as the therapist will likely ask you questions to open up the conversation further.

4- Ending the session and deciding on your next steps

A therapist will usually wrap up the last few minutes of your first session by summarising what you’ve told them, then letting you know whether they feel they can help you or not. If they think that you would be better suited to a different approach from what they offer, then they will tell you this and may even refer you to a fellow professional. Bear in mind that if they do this, it’s not at all personal — they are just trying to make sure you get exactly the support you need.

If the therapist feels that they can help you, they will usually ask if you would like to keep meeting with them. If you don’t feel that their approach is right for you (or you just don’t click), then it’s completely fine to say no, as you aren’t at all obligated to see them again. It’s also fine for you to take a little bit of time to think about it.

A good therapist will also give you the opportunity to ask any questions you might have. This is a chance to find out more about their process, how sessions will be structured and how long your therapy journey might take. You can also ask about practical things such as payment arrangements and cancellation policies. It’s also a good opportunity to express any fears or concerns you have about therapy.

In general, your session will end with scheduling your next appointment, which will usually be the same time the following week. Your therapist might also give you ‘homework’ to do (particularly if they are CBT-based), for instance, noting down when you notice a particular pattern that you discussed. And after that it will be time to say goodbye until the next session.

Also, it’s worth remembering that therapy appointments have a set start time and end time, regardless of what happens in the session. At first, it might feel a little strange to have someone bring an appointment to a close when you feel you’re in the middle of a conversation — this is not because the therapist is disinterested or uncaring, it’s just because boundaries are very important in therapy.

As it’s probably become clear to you by now, this first meeting is usually just a chance for you both to get to know each other and decide if you want to take the relationship forward. You probably won’t get too deep into the actual work of therapy in your initial appointment, it’s more about sharing information and getting a feel for the therapist’s approach. That said, providing a summary of things that are troubling you or giving an account of many of the difficult times in your life for the first time can be quite intensive in a first appointment. So you might want to make sure you have time to decompress or rest after your meeting, if needed.

One thing to remember is that it can take a few sessions to build rapport and to really know if someone is right for you. In the meantime, don’t be afraid to trust your gut and ask as many questions as you need to. It is a big part of a therapist’s job to listen, understand and put you at ease, so pay attention to whether this is your experience.

And if you’d like to learn more about the therapeutic process from both a therapist and client perspective, then Maybe You Should Talk to Someone by Lori Gottlieb and Love’s Executioner by Irvin D. Yalom are two memoirs on the topic. People have also been generous enough to share aspects of their therapy journeys with us, including an account of what it is like to have EMDR.

Taking your first step into therapy can be life-changing. It is a valuable chance for you to get to know yourself at a deeper level, explore any underlying beliefs, blocks and fears that might be holding you back, and form a healthy, open and trusting relationship with another person in a safe, non-judgmental space. And while making that initial appointment might feel a bit intimidating, it can also be the beginning of a rich and rewarding journey.

Thinking of trying therapy for the first time? All of MTA’s world-class therapists are fully accredited and offer a wide variety of support, both online and face-to-face.

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