Starting therapy can feel a little strange. You're meeting someone you've probably never met before, sitting down, and somehow you're supposed to start talking about your life.
Where do you even begin? Do you start with what happened this week? Your childhood? Your relationship? The thing that finally made you decide to make the appointment? And what if you don't actually know what's wrong, and you just know you haven't been feeling like yourself?
If you're nervous about your first therapy session, you're definitely not alone. One of the things we hear from new clients is some version of:
I don't really know where to start.
The good news is: you don't need to.
Your therapist will gently guide the conversation, ask questions along the way, and help you figure out where to begin. You don't need to arrive with your story perfectly organized or a list of therapy goals ready to go.
Is the first session the same as the free consultation?
No. Before you ever book a full session, we start with a free phone consultation. It's short, usually ten to fifteen minutes, and there's no cost and no obligation. You tell us a little about what's bringing you in, we ask a few questions, and together we work out whether we're the right fit.
You don't have to explain everything on that call. It's a conversation, not an intake.
If it feels like a fit, we schedule your first full session, which is fifty minutes. That session is what the rest of this post is about.
If it doesn't feel like a fit, that's a completely fine outcome too. We would rather help you find the right person than be the wrong one.
So, what actually happens once you sit down?
What happens at the beginning of the first session?
Before getting into what brought you to therapy, your therapist will usually spend a little time going over the practical side of working together. This includes confidentiality and its limits, the cancellation policy, communication between sessions, fees, and other office policies that are important for you to understand.
Admittedly, this probably isn't the most exciting part of your first session. But it's important that you understand how therapy works, what you can expect from your therapist, and what your therapist expects from you. It's also an opportunity to ask any questions you have before getting started.
Once that's out of the way, we get to the much more important part: getting to know you.
What will my therapist ask me?
Your therapist will usually start by asking about what brought you to therapy and, importantly, why you're starting now.
Sometimes there's an obvious answer. Maybe you recently went through a breakup, your anxiety has gotten harder to manage, you're struggling in your relationship, or something happened that made you realize you could use some support.
Other times, there isn't one big event. Maybe you've been feeling overwhelmed for a while. You keep repeating the same patterns and don't understand why. You're doing okay on paper, but internally something doesn't feel right. Or you've been thinking about therapy for years and finally decided you're ready.
All of those are perfectly valid reasons to start.
You don't need to make a convincing case for why you're there. Your therapist is simply trying to understand what's happening in your life right now, what feels difficult, and what made this feel like the right time to reach out.
Will we talk about my childhood and family?
Probably, but you don't have to tell your entire life story in the first session.
Your therapist will likely ask some questions about your family and what it was like growing up. Who was in your family? What were your parents or caregivers like? Who did you go to when you needed comfort? How did your family handle conflict? What role did you tend to play?
You might also talk about siblings, friendships, school, significant experiences, or other parts of your childhood that help your therapist understand where you come from.
This isn't because we're trying to blame everything happening in your life today on your parents. Your early relationships and experiences simply give us useful context for understanding the patterns you developed, how you learned to cope, and what relationships came to mean to you.
Sometimes things you've never quite understood about yourself start making a little more sense when we look at them in context.
Will my therapist ask about my relationships?
Most likely. Our relationships, past and present, can tell us a lot about how we experience connection, conflict, trust, and vulnerability.
Your therapist may ask about significant romantic relationships you've had, your current relationship if you're in one, your friendships, and the support system you have around you. We may explore whether there are patterns you've noticed across relationships or what tends to happen when you feel hurt, disconnected, or need support from someone.
Again, we're not trying to analyze every relationship you've ever had in 50 minutes. We're beginning to understand you as a whole person rather than looking only at whatever brought you into therapy that week.
Do I need to know my therapy goals?
No.
Some people come into therapy knowing exactly what they want to work on. Others know what they don't want anymore but have a much harder time describing what they want instead.
Both are okay.
Your goal can be something specific, like wanting to have fewer panic attacks or communicate differently with your partner. But it can also be something much more ordinary:
- I want to stop overthinking everything.
- I want to trust myself more.
- I don't want to feel so overwhelmed all the time.
- I want to understand why I keep doing this.
- I want to feel like myself again.
And sometimes the answer is simply:
Honestly, I don't know yet.
Figuring that out can be part of therapy too.
One question that can be helpful is: if therapy were working, what would look or feel different in your life? Your therapist can help you take your answer, even if it's vague at first, and begin turning it into something the two of you can work toward together.
What if I don't know what to talk about?
This is probably one of the most common worries people have before starting therapy.
You do not need to walk in and carry the conversation for 50 minutes.
Your therapist will ask questions, follow up on things you share, and gently guide the session. Part of our job is knowing what questions to ask to begin understanding both your history and what's happening in your life now.
If you don't know where to start, you can literally say:
I don't know where to start.
That's enough.
You also don't have to share everything immediately. There may be things you aren't ready to talk about yet, and that's okay. Therapy is a relationship, and trust takes time. Your therapist can begin getting to know you without needing every detail of your life during your first meeting.
There is no prize for getting through your entire life story in one session.
What if my session is on video?
Our sessions happen online, and most people are surprised by how quickly it stops feeling like a video call.
A few things that help. Find a spot where you won't be interrupted and where you're not worried about being overheard, because that worry is usually what keeps people from speaking freely. Headphones help more than you'd expect. And it's okay to have tea, a blanket, or your dog next to you. You're allowed to be comfortable.
If your internet drops or someone walks in, we work around it. It happens, and it isn't a problem.
What should I expect to feel after the first session?
There isn't one right way to feel.
You might feel relieved because you've finally said some things out loud. You might feel emotional or tired because you talked about things you don't usually talk about. You might leave with a new perspective on something. Or you may simply feel like you spent an hour giving someone a lot of background information.
All of those experiences can be normal.
The first session isn't supposed to solve everything. It's the beginning of your therapist understanding who you are, what's happening in your life, and how the two of you might work together.
More than anything, I hope you leave with some sense of:
Okay, I think this person gets me. I think I could talk to them.
Because the first session isn't only about your therapist deciding how to help you. It's also your opportunity to start figuring out whether this therapist feels like someone you can be yourself with.
You don't have to be good at therapy.
There really isn't such a thing.
You don't need to know the right things to say. You don't need to cry. You don't need to have a breakthrough. You don't need a diagnosis, a perfectly defined problem, or an impressive amount of self-awareness.
And you definitely don't need to organize your life into a perfectly coherent story before you walk through the door.
Maybe all you know is:
I don't really know what's wrong. I just know I don't want to keep feeling like this.
That's enough to start. Show up as you are. We'll help you figure out where to go from there.
Show up as you are.
Written by
Keisha is a licensed marriage and family therapist and the founder of LifeBloom Therapy in Los Angeles, specializing in anxiety and relationships.