Entering psychotherapy for the first time can feel daunting, especially if you’re uncertain about what to expect. People often arrive at therapy feeling overwhelmed, anxious, or unsure of how the process works. Understanding what typically happens during a first session can help alleviate anxiety and prepare you for a productive therapeutic experience. This article outlines what to expect in your first psychotherapy session, from initial introductions to goal-setting, and explains how therapists create a supportive environment for healing.

Starting psychotherapy can be a life-changing decision, yet it often brings uncertainty, anxiety, and curiosity—especially when it comes to the first session. Many people feel nervous about opening up to a stranger, unsure of what will happen or whether the experience will be helpful. Knowing what to expect in your first psychotherapy session can reduce anxiety, prepare you to engage more effectively in the therapeutic process, and help you build a strong foundation for emotional growth and healing.

This article offers a comprehensive overview of what typically happens during a first psychotherapy session, including the initial introduction, clinical assessment, goal setting, discussion of confidentiality, and establishing the therapeutic relationship. It also explores different therapy approaches and provides insight into how you can get the most out of your experience.

The Purpose of the First Session

The first psychotherapy session serves several purposes. The primary goal of the first psychotherapy session is to establish a foundation for the therapeutic relationship. This meeting is often referred to as an “intake” or “assessment” session and is designed to gather essential information about your mental health history, current concerns, and treatment goals. It’s also an opportunity for both the therapist and client to determine if they are a good fit for working together.

According to Norcross and Wampold (2011), the initial encounter is critical for fostering the therapeutic alliance—a collaborative partnership that significantly influences treatment outcomes. The first session allows the therapist to evaluate whether they are the right fit for your needs and helps you decide whether you feel comfortable working with them. Establishing trust and rapport during this first interaction is essential. While therapy is often thought of as focusing on deep psychological issues, the initial session may be more about logistics, mutual exploration, and setting expectations (Corey, 2021).

Administrative and Legal Aspects

At the outset, your therapist will typically address administrative tasks such as reviewing informed consent, confidentiality policies, and payment information. Informed consent is a legal and ethical requirement that ensures you understand the nature of therapy, your rights as a client, and the limitations of confidentiality (Zur, 2007).

Key points discussed often include:

The therapist’s qualifications
The scope and nature of therapy
Confidentiality and its exceptions (e.g., danger to self or others)
Session duration and frequency
Fees and cancellation policies

Confidentiality is a cornerstone of psychotherapy. Everything you share in therapy is private, with a few legal exceptions such as imminent risk to self or others, suspected abuse of vulnerable individuals, or a court order (Zur, 2005). Understanding these limits upfront helps establish trust and clarity.

Getting to Know You: Background and Presenting Issues

Much of the first session will be devoted to gathering information. Therapists often use open-ended questions to better understand your background and what brought you to therapy. Topics may include:

Personal and family history
Significant life events or traumas
Current symptoms and stressors
Relationship and work dynamics
Medical or psychiatric history
Presenting problems (e.g., depression, anxiety, relationship issues)
Past therapy experiences
Substance use, if applicable
Social support and relationships

This stage allows the therapist to develop a preliminary formulation of your concerns and determine the most appropriate treatment approach. For instance, a client presenting with anxiety might benefit from cognitive-behavioral therapy (CBT), while someone dealing with complex trauma might be referred for trauma-focused therapy (American Psychological Association, 2017).

This assessment phase is not meant to feel like an interrogation but rather a dialogue that helps the therapist understand your unique circumstances. Some clinicians may use structured questionnaires or standardized assessments (e.g., PHQ-9 for depression or GAD-7 for anxiety) to quantify your symptoms and aid diagnosis (Spitzer et al., 2006).

Discussing Goals and Expectations

A critical part of the first session involves clarifying your goals for therapy. What do you hope to achieve? How will you know if therapy is helping? These questions help align the therapeutic process with your personal objectives.

Setting goals not only provides direction but also increases motivation and accountability (Cooper, 2008). Your therapist may suggest setting short-term and long-term goals, which can be revised as therapy progresses.

The therapist will typically ask what you hope to achieve from therapy. This is a crucial moment where you start to shape the direction and purpose of treatment. Some people come to therapy with clear goals, such as coping with grief or improving communication, while others may have more general desires, like feeling better emotionally or understanding themselves.

Goal setting in psychotherapy has been linked to better outcomes (Tryon & Winograd, 2011). A collaborative approach is encouraged—both therapist and client work together to define achievable, realistic goals that align with your values and needs.

Examples of therapy goals include:

Reducing symptoms of depression or anxiety
Improving communication in relationships
Developing coping skills for stress
Processing past trauma

Establishing Rapport and Safety

Therapists aim to create a safe, non-judgmental space where clients feel heard and validated. This emotional safety is essential for effective therapy and begins to develop in the very first session. Rogers (1957) emphasized that empathy, unconditional positive regard, and genuineness are essential conditions for therapeutic change.

Your therapist may use active listening, validation, and gentle questions to help you feel more at ease. If you’re nervous, it’s perfectly okay to express that. Most therapists are skilled at helping first-time clients navigate these initial uncertainties.

The first session also allows you to evaluate your comfort level with the therapist. Research consistently shows that the quality of the therapeutic relationship—often called the “therapeutic alliance”—is a strong predictor of successful outcomes (Horvath et al., 2011).

Pay attention to how you feel during and after the session:

Do you feel heard and understood?
Does the therapist show empathy and respect?
Are they engaged and attentive?

These impressions matter because therapy requires vulnerability, and a strong therapeutic bond fosters a sense of safety and openness.

Therapeutic Approach and Structure

The structure and tone of the first session may vary depending on the therapist’s theoretical orientation. Depending on their training and orientation, your therapist may explain the specific model of therapy they use. For example:

A CBT therapist may describe how thoughts, feelings, and behaviors are interconnected and introduce the idea of thought records or behavioral experiments. Cognitive-Behavioral Therapists may focus on identifying problematic thought patterns and behaviors from the beginning. They may give structured tasks or introduce concepts like cognitive distortions early on (Beck, 2011).
Psychodynamic Therapists may be more interested in exploring early childhood relationships and unconscious conflicts. Their style is often more exploratory and less directive. A psychodynamic therapist may explain how unconscious patterns influence current behaviors and how therapy will involve exploring past experiences.
A humanistic therapist might emphasize self-awareness and personal growth, focusing on the “here and now.” A humanistic therapist would likely focus on fostering self-acceptance in clients. They would emphasize a supportive and empathetic therapeutic relationship, encouraging clients to explore their feelings and needs without judgment. The therapist would also guide the client towards self-actualization, helping them realize their full potential.

Understanding the therapist’s approach helps build transparency and ensures that the method aligns with your preferences and needs (Wampold, 2015).

Emotions and Reactions During The First Session

It’s normal to feel a range of emotions during the first session. Some people feel immediate relief just by talking about their struggles, while others may feel vulnerable, anxious, or even skeptical.

Common emotional reactions include:
Nervousness about sharing sensitive issues
Doubt about whether therapy will help
Relief at being listened to
Frustration if the therapist doesn’t “get it” right away

These reactions are valid and can be discussed openly with your therapist. In fact, bringing up your feelings about therapy itself can deepen the relationship and improve the process.

Ending the First Session

Toward the end of the session, the therapist may summarize key themes that emerged and review next steps. They might ask if you have any questions or concerns and check in about how you feel about continuing therapy.

You may be asked to think about whether you want to schedule a follow-up appointment. Some therapists will offer reflections or initial insights, while others might focus on simply gathering information and letting things unfold in future sessions.

What You Won’t Be Expected to Do

Contrary to popular portrayals in media, you are not expected to divulge your deepest secrets in the first session. Therapy is a gradual process, and trust develops over time. You can share as much or as little as you feel comfortable with. The goal of the first session is to begin building that comfort and to establish a foundation for deeper work.

It’s also perfectly acceptable to ask your therapist questions about their experience, qualifications, and how they typically conduct sessions. The therapeutic relationship should be collaborative, not one-sided.

After the First Session

After your first session, you may feel a mix of emotions—relief, exhaustion, hope, or even vulnerability. This is a normal part of the process. Therapy involves exploring difficult topics, and it’s common to experience emotional fluctuations.

Some therapists will schedule a follow-up session immediately, while others may offer a brief summary of their impressions and propose a treatment plan. You’ll also have the chance to reflect on whether the therapist feels like the right fit for you. If not, it’s okay to seek another professional. The fit between therapist and client is one of the most important predictors of successful outcomes (Horvath et al., 2011).

After your first session, take time to reflect:

Did you feel emotionally safe?
Were your concerns taken seriously?
Do you feel hopeful or at least open to continuing?

Therapy is a personal journey, and not every therapist is the right fit for every client. It’s okay to try a different therapist if something doesn’t feel right. Your comfort, trust, and connection are key to effective therapy (Norcross, 2010).

Practical Ideas for Your First Session

To make the most of your initial therapy session, consider the following tips:

Arrive a few minutes early to fill out any necessary paperwork.
Bring a list of concerns or goals you’d like to discuss.
Be honest about what you’re experiencing—even if you’re unsure how to articulate it.
Reflect on your expectations and any fears or hesitations you have about therapy.
Don’t hesitate to ask questions about the process.

Tips to Get the Most Out of Your First Session

Be Honest: You don’t have to share everything at once, but honesty helps your therapist understand your needs better.

Ask Questions: Feel free to ask about the therapist’s background, approach, or anything unclear.
Clarify Goals: Share what you hope to achieve in therapy, even if you’re unsure—clarity can come later.
Reflect on Fit: Think about how the session felt emotionally and whether you’d like to return.

Your first psychotherapy session marks the beginning of a journey toward greater self-awareness, emotional health, and personal growth. While the idea of starting therapy can be intimidating, knowing what to expect can make the process more approachable. From establishing trust to setting goals and learning about the therapeutic approach, the initial session sets the stage for meaningful work ahead. With time, commitment, and the right therapeutic alliance, psychotherapy can be a transformative experience that supports lasting mental and emotional well-being.

The first psychotherapy session is a significant step in the healing process. While it may be filled with questions, uncertainties, and strong emotions, it also marks the beginning of a journey toward self-understanding and change. By knowing what to expect—confidentiality, a non-judgmental space, an initial assessment, and the beginning of a therapeutic alliance—you can approach your first session with greater confidence and clarity.

Remember that therapy is a collaborative process. It’s okay to ask for what you need, express uncertainty, or even change therapists if necessary. Ultimately, the goal of psychotherapy is to help you lead a more fulfilling, balanced, and authentic life.

Dr. Randi Fredricks, Ph.D.

Author Bio

Dr. Randi Fredricks is a leading expert in the field of mental health counseling and psychotherapy, with over three decades of experience in both research and practice. She holds a PhD from The Institute of Transpersonal Psychology and has published ground-breaking research on communication, mental health, and complementary and alternative medicine. Dr. Fredricks is a best-selling author of books on the treatment of mental health conditions with complementary and alternative medicine. Her work has been featured in leading academic journals and is recognized worldwide. She currently is actively involved in developing innovative solutions for treating mental health. To learn more about Dr. Fredricks’ work, visit her website: https://drrandifredricks.com

References

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What to Expect in Your First Psychotherapy Session