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What to Expect During Your First Therapy Session (Part 3 of 3)

You may have some mixed emotions prior to your first session, which could include uncertainty, anxiety, excitement, sadness and a variety of other emotions. Everyone shows up in different ways, and there is no right or wrong way to feel. You’re meeting someone for the first time and preparing to open up to them about things you may have never spoken to anyone else about before; this is not an easy thing to do. Remember though that this is just the first session, you don’t need to open up just yet if you’re not ready, so it is OK to be quiet and unsure. On the other hand, you may be feeling that you have so much to say and you just need to get it out, and that is OK too. There is no right way to handle the first session. Take some time to get a feel for the therapist throughout the session to see if you feel comfortable in their presence (This may be more of a “virtual presence” now as most therapists are offering video sessions only due to social distancing). While a therapist’s training and expertise is important, I find that often the most powerful aspect of therapy is the relationship between the client and the therapist, so how you feel in the session really matters!

Your first session will mainly be focused on both you and your therapist gathering information, building rapport, and getting to know one other. Here are some things your therapist will likely ask about:

- Your symptoms: What you are feeling, how long you have been feeling this way, and how you feel these symptoms are impacting your life?

- Your goals: What you would like to see change in your life or yourself?

- Your history: Family history, childhood/adolescent life, mental health history, employment, hobbies, relationships, substance abuse history, trauma history, etc.

- Your expectations: What kind of therapy are you looking for? How often do you want to meet? What do you expect from your therapist?

It is also important to note here that you should not feel pressured to talk about things you are not ready to talk about. This is only the beginning of your therapy journey, and you may need time to build trust. If you don’t feel comfortable talking about a specific topic, don’t be afraid to say so. A trained and empathetic therapist should understand this.

The first session is also your opportunity to ask your therapist questions. It may be nerve wracking to do this, but building this relationship with your therapist is a two-way street. I would recommend writing down a list of things you would like to know. For example:

- What can I expect during the course of this therapeutic relationship?

- What made you want to become a therapist?

- What is your cancellation policy?

- Ask about their experience and ask them to describe their style of therapy, for example, should you expect structured sessions or more of a free and exploratory style?

At the end of the session, your therapist may or may not give you a preliminary diagnosis. Some therapists may feel that giving a diagnosis could impede the therapeutic process, however if you are using insurance a diagnosis may be required. While learning of your diagnosis can feel scary, it can also help both of you understand what it is that you are struggling with and begin to develop a plan of action to address these concerns. This is also a good opportunity to talk to your therapist about what treatment will look like and set expectations for the both of you.

Your therapist should also review confidentiality with you before leaving. It is vital for therapy to be a trusting environment so you can feel comfortable exploring and speaking honestly. For this reason, almost everything in therapy is confidential and cannot be shared by your therapist with anyone else. The only exceptions to this policy are if you are planning to harm yourself or someone else, and if you disclose abuse/neglect to a child, elderly person or developmentally delayed individual. This is for your safety and the safety of your community, and it is important to be honest with your therapist if you are having these thoughts.

Before wrapping up, you can expect to be asked if you’d be interested in a follow up session, and if so you can schedule a time for next week. If you’re not sure, don’t feel pressured to set up a follow up appointment at this time, but know that you will have the opportunity to do so. You may also want to discuss long term scheduling to make sure you’ll be able to be seen on an ongoing basis.

I hope this answers some initial questions you may have about setting up and attending your first therapy session. If you have further questions that you’d like to ask me or have a topic you’d like to see me cover, please email me at

Best of luck finding the right therapist for you!

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