What to Expect in Your First Therapy Session

Whether you’re starting therapy for the first time, or starting with a new therapist, anticipating the first session can evoke a range of emotions. You might feel:

• proud of taking this step to work toward your personal growth and self-understanding

• hopeful that this therapist is a good fit for you 

• uncomfortable about the idea of being emotionally vulnerable with a stranger

• unsure about where to even start in telling your therapist about yourself

 All of these feelings (and more, I assure you) are right on time. Your emotional system is preparing for a new experience and these feelings are indicators of that. (Yay growth!) That said, it can be helpful to have a rough idea of what to expect in that first session to help you calm any nerves and make the most of it. While every therapist approach and client situation is unique, this blog outlines some general things you can expect in your first therapy session, based on my perspective as both a therapy client and provider:

1.  INITIAL GREETINGS & ADDRESSING ANY TECH CHALLENGES

Therapy is built on a relationship between the therapist and the client. As such, it’s commonplace to exchange initial greetings/pleasantries when first meeting. A quick “Hi, nice to meet you face-to-face” or “How’s your day going?” is pretty standard. Many clients feel that it may be uncouth to ask the therapist anything about themselves. And generally speaking, the therapist will keep the session focused on you, not them (you’re investing a lot of time and energy, and they have their own therapist!) but these initial greetings are pretty typical.  

Secondly, given that many, if not most therapists are still practicing via telehealth during the pandemic, you can also expect that there might be a minute or two of working out any tech challenges (audio, video, Wifi connectivity, etc.). These challenges might arise on the therapist’s end or your end. While frustrating, any tech issues can typically be quickly resolved.

2.  HOUSEKEEPING ITEMS: THE LOGISTICS OF THE THERAPEUTIC RELATIONSHIP

This may be a bit surprising if you’re anticipating exploring some deep emotions about yourself, but in many cases, at the beginning of the first session, the therapist will want to walk you through some basic administrative points to make sure you’re on the same page and to reduce any unnecessary surprises about the nuts and bolts of the therapeutic relationship. 

At G&STC, in our first sessions we walk through the intake forms that clients have completed, discuss the confidentiality and cancellation policies, and ask the client if they have any questions or concerns about any of these items. This might seem tedious, but it is just a couple of minutes, and it does offer the opportunity for you to make sure you feel clear about how things work. Many clients have questions about the confidentiality policy, as this directly relates to their feeling of security in sessions, so if you have questions about this, ask away! The therapist will be happy to explain how it works and what you can expect. 

3.  DIVING IN: AGREEING ON A GOOD PLACE TO START

Once you’ve gotten through these initial logistics, it can sometimes be hard to know where to start. My advice? Start where you feel ready to do so. Some therapists might be silent, and just wait for you to fill the space with whatever’s on your mind. This happened to me once, years ago, well before I became a therapist myself. The silence felt super uncomfortable and I didn’t continue seeing the therapist after that first session. In retrospect, and especially after training in therapy, I can now understand the value in an exercise like this – the silence gives space to begin however and wherever you wish. In any event, with whatever is on your mind, it might feel difficult to know the best entry point. 

As a therapist, I typically start not with silence, but by directly asking the client, “Is there anywhere in particular that you’d like to start?” The client might say yes and dive in on a topic, or might say “I don’t know where to start actually. Can you ask me questions? That would help me kind of get thinking,” or “I don’t know where to start, I’m kind of looking for you to guide me here.” These are both valid responses to both silence from the therapist or an initial question like the one I ask.

No matter where you start, it can be helpful to think of it in terms of giving a history of the issues or topics that are bringing you to therapy.  Using a history frame in the first session can be very useful because this might be the first time you’re actually speaking that full history out loud, to another person or to a new person. It’s powerful stuff–this history organizes your thinking in terms of most relevant events and experiences while also illustrating the ways that you interpreted those events. You might feel a lightness in yourself begin to emerge as you empty yourself of this narrative. On the same token, in hearing your story, the therapist can begin to work with you to identify patterns in experience and interpretation and to consider modalities, techniques, and exercises that are best suited to you.

4.  FEELING ALL THE FEELS: NOTICING WHAT COMES UP FOR YOU AS YOU TALK

As this may be the first time you’re telling this information ever, or at least the first time you’re telling it in this context, you may experience a range of emotions as you speak. Beyond feeling comfortable with and confident in your therapist’s professional training, there is no “normal” or “appropriate” way to feel in the first session. There is only getting insight from noticing the feelings and naming them yourself. You can name them out loud with the therapist, or just notice them internally as you go through. Maybe you notice, as you tell your story, that you “really identified with the pride you felt about that relationship that ended,” or that you actually “feel so relieved now that you’re no longer at that job you worked so hard at for years.” Maybe you’ll tear up a bit, or maybe you’ll feel like you are sharing too much too fast. We can often be quick to label such feelings as “good” or “bad” but from a therapeutic perspective, these feelings are all neutral insights that can be unpacked and reflected upon. 

Noticing what comes up for you, and naming those feelings can be super helpful as they give vast amounts of emotional context to the way you understand yourself and your circumstances. Grasping this context is one of the most valuable components of therapy.

5.  NOTICING AND ADVOCATING FOR CHANGES TO THERAPIST STYLE

In addition to noticing and naming the feelings that come up for you about the content of what you’re sharing, recognize how the dynamic feels with your therapist. Does it feel like it’s vibing? Why or why not? Is there anything you’d change about how the therapist interacts with you? I once had a client tell me that they found it distracting that I called some of their commentary “profound” because in their words, “this is not ‘profound’ this is just my word vomit.” It was a helpful redirect! Contrary to what common assumptions folks may make about therapists, we are actually trained that you – the client – are the expert on your life, not the other way around. We provide a space to unearth that self-expertise and join you in making change where you feel necessary and ready to do so. 

So notice in the first session if there’s anything you’d prefer to be different about your therapist’s style and feel free to communicate that in that first session, in a follow up email after it, or in the next session after you’ve had some time to process it. Maybe you want the therapist to ask more questions, make more observations for your reflection, or talk less so you can get out everything on your mind. Whatever you think would support you in your therapy work, feel free to ask the therapist if they can modify their style to meet that. 

I do have a couple of caveats to this point, however. First, for therapists who specify in a particular modality (e.g., Cognitive Behavioral Therapy, Dialectical Behavior Therapy, Internal Family Systems) rather than being eclectic/integrationist (where they use a combination of modalities), the therapist might respond that some of their style is actually a key part of the modality and it’s intended to evoke emotional responses that can be insightful for you. In such a case, if that still doesn’t sit right with you, feel free to ask for more context on how to get the most out of the modality given that it’s not immediately clicking for you.

Second, sometimes the session just doesn’t pass the vibe check and you might learn that the therapist is simply not a good fit for you at this time. That can be frustrating to feel (especially after the work of searching for providers and doing consult calls), but it absolutely happens and is totally fine. If you feel like the therapist is not a good fit for you, and you don’t want to continue, you can share that in session, at the end of the session, or in a follow up email. You can also ask your therapist for referrals to providers with specific characteristics or a style that you feel the current therapist may not have.

6.  IDENTIFYING AND LEANING INTO TRANSFERENCE

In my opinion, one of the concepts that clients tend to under explore is transference. Transference includes the feelings and thoughts that you develop in response to and about the therapist you are working with. Transference shows up as soon as you have any kind of interaction with the therapist – even when reading their profile page and in that very first session. You might think the therapist likes you, or doesn’t like you, is non-judgmental or judgmental. You might wonder about the therapist’s personal experiences and perspectives and how these impact their responses to what you’re sharing. Far from being bad or something to ignore, these transferential thoughts and feelings are excellent sources of information for your therapeutic journey. 

Notice what you are transferring onto the therapist and ask yourself: “why am I transferring these thoughts and feelings onto them?”  “Does the therapist evoke in me a particular interpersonal reaction (e.g., anxiety, comfort) that I could explore with them?” 

For example, as a gay man, I grew up with an intense anxiety when interacting with cis het men. When seeking my current therapist, I chose one who incorporates spirituality in a way that feels helpful for me. But in that first session, I noticed I was feeling some anxiety–not about anything he was saying, but a familiar anxiety I had felt earlier in life–the anxiety of interacting with cis het men! In the following sessions, I shared with my therapist how I felt like he represented, in some ways, a cis het man authority that I felt I always had to cower to in order to feel safe. 

Bringing that transference into my conscious awareness, naming it and incorporating it into my therapeutic work allowed me to talk about it openly with the source of the anxiety: a cis het man stranger. This was profoundly healing, as I learned I didn’t have to hide these feelings, that they served me in the past in some ways, and in many ways I have outgrown their utility. I encourage you to do the same with the transference that you notice comes up for you with your therapist. 

 Wherever you are on your therapy journey, I hope your first session is a positive experience. 

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BLOG AUTHORS ALL HOLD POSITIONS AT THE GENDER & SEXUALITY THERAPY CENTER (G&STC). THIS BLOG WAS WRITTEN BY G&STC THERAPIST BRIAN ACKERMAN. FOR MORE INFORMATION ABOUT OUR THERAPISTS AND SERVICES PLEASE CONTACT US.