Therapy 101: What to expect in a first therapy session

So you’ve made the decision to start therapy, you’ve found a qualified therapist who meets your initial parameters, and you’ve scheduled your first appointment. First of all, congratulations! This can be the hardest part of the process and the decision to commit to therapy can take a lot of courage. In order to make the most out of this initial appointment, you should have a general sense of what to expect and what to prepare for ahead of time.


The first session is often called an “intake” appointment. The essential goal of this appointment is not only for the therapist to collect information about you and what you’re looking to work on, but also for you to feel out the therapist and see if it feels like a good fit. Similarly, the therapist is assessing if their skillset will be beneficial to you, or if you need to be referred to someone with a different expertise or style. Don’t expect much “therapizing” to take place during this first session. It’s somewhat akin to “syllabus day” in school where you go over the semester and expectations, but you don’t actually start learning anything just yet.


The following process should be semi-consistent among therapists but may vary a bit based on numerous factors such as their training, theoretical orientation, and general professional preferences. However, you can generally expect the following. First, there will be intake paperwork, similar to things you’ve filled out at other medical appointments. At the very least this will include your contact information and your emergency contact’s information. Insurance information will be collected if you’re seeing someone who accepts it. And then you are likely to fill out a questionnaire of various symptoms so the therapist can get a quick glance at what’s going on for you. Often times, this is a one-size-fits-all form that is administered to each client regardless of presenting concern (what we call your reason for coming), so don’t be surprised if some of the questions feel irrelevant. Then there will likely be a copy of HIPPA and privacy practice information to peruse and something to sign saying you’ve been given an opportunity to read them. The last major piece of paperwork is called a “disclosure statement” or “consent to treatment” form which outlines the potential risks of therapy, the therapist’s policies, information on billing and record keeping, and often a recap of how confidentiality works. Many therapists have moved this paperwork online and will have you download and bring in, or even electronically sign the materials ahead of time. Other therapists will have you fill it out when you arrive, maybe suggesting you arrive a few minutes early to do so.


The therapist will then take you into their office, introduce themselves, and ask if you have any questions about any of the policies outlined in the forms. You’ll likely go over the paperwork together so the therapist can ask more in depth questions surrounding some of your answers. And just to be especially redundant—I mean thorough—the therapist will likely explain the limits of confidentiality one more time for good measure. From there, the therapist will lead you through what’s called a “clinical interview,” asking for more information about your reasons for seeking therapy at this time, your medical and mental health history, your family’s medical and mental health history, any past experiences with therapy, and a psycho-social history. All that to say, they basically ask you a million questions about yourself and your life to get a good foundation of context around your current issue. Depending on the therapist, there may be more or less emphasis on certain topics such as your childhood, relationships, and medical history. As such, if you have a complicated history or fear you’ll struggle to think clearly in the moment, jotting some notes down ahead of time may be helpful.


Finally, the therapist will likely speak to if they believe they can help, what their style of therapy is, and other things to expect moving forward should you continue seeing them. As I mention in my “How to Find a Therapist” article, it is very important to feel good about the therapist; to feel as though you like them, they understand you, and that generally you’re on the same page. This is a great reason to ask your therapist questions that are important for you such as “will you give me tangible things to work on between sessions?” or “I really need someone to challenge me, is that part of your style?” Sometimes the therapist may not have an answer yet, especially for questions predicting length of treatment or prognosis since they still working from somewhat limited information, but that should become clearer in the next few meetings.


When I meet a client for the first time, I reiterate this importance of fit and encourage them to assess me just as I assess them. I tend to balk at any therapist who claims to be the “best” or who guarantees results right off the bat.  The fact is, different clients will connect with different therapists, just as we’re attracted to certain types of people and personalities more than others in everyday life. I encourage clients to let me know at any point if they have wants or needs that are not being met and that they will never hurt my feelings by making such a request or giving that feedback. While it may not feel like it, you are the boss; technically, we work for you. You can hire and fire your therapist as needed and I promise that if the first therapist you meet doesn’t feel like a good fit, there are many more out there to try. There can be some complicating or even clinical components to wanting to fire your therapist which I’ll delve into at another time, but overall, pay attention to how you feel in the room with this person. Do you feel comfortable being candid about intimate topics? Do you feel they’ll require a lot of educating about you and your issues or do you feel they have a good grasp on your world? Do they have an authoritative style or a more collaborative feel (and which works better for you personally?).


Ideally, you should leave your first session feeling heard, understood, and hopeful. If you have any negative reactions that don’t seem to be related to the simple fact that you’re spilling your guts to a total stranger, maybe this wasn’t the right therapist for you. If you have found a good fit, another congratulations! Next session, the work begins! Stay tuned for more information on what to expect early in therapy and how to make the most of it.


As always, if you’re in the Denver area and are seeking services, please feel free to contact us at or 720-432-9780.

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