What to Expect in Your First Therapy Session
“Sometimes the bravest and most important thing you can do is just show up.”
If you’re thinking about starting therapy, it’s completely normal to feel unsure—about what you’ll be asked, what you “should” say, whether you’ll cry, or whether you’ll even know where to begin. Many people arrive with a mix of hope and nerves: I want support… but I don’t know what this will be like.
A first therapy session is usually not an intense deep-dive. It’s more like an informed, gentle beginning: a chance to understand what’s bringing you to therapy, how therapy can help, and whether the relationship feels like a good fit.
This guide walks you through what typically happens in a first session, what you can expect from your therapist, and how to prepare in a way that feels kind—not pressurising.
The purpose of the first session
Think of your first session as a foundation-setting meeting. Together, you and your therapist begin to:
understand what’s been happening and what’s hard right now
identify what you’d like support with (even if it’s unclear at first)
explore any relevant background at your pace
agree a way of working that feels safe and realistic
decide next steps (frequency, focus, and what therapy might look like for you)
You’re not expected to “fix” anything in session one. You’re allowed to start exactly where you are.
What happens at the start: practicalities and confidentiality
Most therapists will begin by covering a few essentials so you know where you stand.
Confidentiality (and the limits)
Your therapist will explain confidentiality and the specific exceptions. In the UK, these exceptions typically relate to serious risk of harm, safeguarding concerns, or legal requirements. This isn’t about catching you out—it’s about creating a clear, boundaried space where you can speak freely and understand what is protected.
Consent, boundaries, and how therapy works
You may also cover:
session length (often 50 minutes) and fees
cancellation policy
how to contact your therapist (and what’s appropriate between sessions)
whether you’re working short-term (time-limited) or open-ended
how notes are kept and how your information is stored (often within GDPR-aligned systems)
If anything feels unclear, you can ask. Therapy should never feel mysterious.
The question you’ll almost always be asked
“What’s brought you to therapy now?”
This can be answered in a hundred different ways—and you don’t need a tidy story.
You might say:
“I’ve been feeling anxious and on edge.”
“Something in my relationship has shifted and I can’t ignore it anymore.”
“I’m functioning, but I don’t feel like myself.”
“I’m grieving and I don’t know how to hold it.”
“I don’t know what’s wrong—I just know I’m not okay.”
A therapist’s job is to help you find language for what you’re carrying—especially when you don’t have the words yet.
What you might be asked (and why)
Your therapist may explore some of the following, depending on what you bring:
What’s happening in the present
symptoms (anxiety, low mood, panic, numbness, overwhelm)
relationship patterns (conflict, distance, people-pleasing, trust issues)
work stress, identity changes, life transitions
intimacy concerns (desire, disconnection, shame, performance anxiety, communication)
How it’s affecting daily life
sleep, appetite, energy, motivation
concentration and memory
confidence, self-worth, or self-criticism
how you cope (or don’t cope) when it gets intense
What you’ve tried already
This helps your therapist avoid repeating things that haven’t worked and build on what has.
A gentle look at background (only as needed)
Some therapists will ask about family, significant relationships, or earlier experiences—especially if patterns feel long-standing. You can always say:
“I’m not ready to go there yet.”
“Can we take that slowly?”
“I need time before I talk about that.”
That is therapy: learning your pace and respecting it.
A brief wellbeing / risk check is normal
Many therapists include a short check around safety and support, especially if you’re feeling low or overwhelmed. You might be asked about:
self-harm thoughts
suicidal thoughts (even passive “I don’t want to be here” feelings)
substance use (if relevant)
immediate support systems and what helps you get through difficult moments
If these questions appear, it doesn’t mean you’ve said the “wrong” thing. It means your therapist is being responsible and making sure you’re supported safely.
Do you have to cry? Do you have to talk about trauma?
No—and no.
You might cry. You might not. You might feel emotional, flat, awkward, relieved, or all of the above. Some people go blank. Some people talk fast. Some people apologise for having feelings (you don’t need to).
And you do not have to disclose trauma in the first session. Therapy is not about forcing your story open. It’s about building enough safety and steadiness that your system can tolerate being understood.
How the session may feel: common first-session experiences
People often leave session one feeling:
lighter (because they’ve finally said it out loud)
tired (because sharing takes energy)
emotional (because the body releases what it’s been holding)
uncertain (because therapy is new)
hopeful (because something felt different—more supported, more real)
Any of these responses are valid. Therapy is not always instantly soothing; sometimes it’s clarifying first.
Will you set goals in the first session?
Sometimes. If you have clear goals, great. If you don’t, also great.
You might shape therapy around outcomes like:
calmer nervous system and fewer spirals
stronger boundaries and less people-pleasing
improved communication and relational confidence
processing grief, trauma, or loss safely
exploring identity, self-worth, or cultural belonging
rebuilding trust, intimacy, or desire
Or you may start with something simpler:
“I want to feel steadier.”
“I want to understand why this keeps happening.”
Goals can emerge as you go. Therapy isn’t a performance review—it’s a process.
What happens at the end: next steps and a loose plan
Most first sessions end with a practical check-in:
How did this feel for you?
What would you like to focus on next?
How often should we meet (weekly/fortnightly)?
Do we need to prioritise stabilisation first (grounding, coping skills, support planning)?
Some therapists offer a small between-session suggestion (not “homework” unless you want it). It might be as gentle as noticing what triggers you, tracking emotions, or practising one grounding exercise.
How to prepare (without pressuring yourself)
If you’d like to feel more anchored, here are simple options:
Before the session
Write down (even on your phone):
What feels hardest right now
What you want to be different
What you’re nervous about in therapy
If you freeze easily, bring one sentence you can read:
“I’m anxious about starting, and I’m not sure where to begin.”
During the session
You are allowed to ask questions. Helpful ones include:
“How do you work with someone like me?”
“What might we focus on first?”
“What if I get overwhelmed in session?”
“How will we know therapy is helping?”
After the session
Try to leave a bit of space afterwards if you can. A walk, a shower, a simple meal, an early night—anything that tells your body: You’re safe. You’ve done something hard.
How to know if it’s a good fit
Therapy works best when the relationship feels emotionally safe and respectful.
After session one, you might ask yourself:
Did I feel listened to—without being judged or rushed?
Did the therapist feel clear and boundaried?
Did I feel able to be myself, even a little?
Do I feel I could build trust here?
If it doesn’t feel right, you’re allowed to choose someone else. That isn’t failure—it’s self-respect.
FAQs
“What if I don’t know what to talk about?”
That’s common. You can start with a feeling, a situation, or simply “I don’t know.” Your therapist will help you find a starting point.
“Will my therapist tell me what to do?”
In most counselling/psychotherapy, the focus is on understanding, choice, and collaboration—not advice-giving. Some therapists may offer psychoeducation or suggestions if it’s helpful, but it should feel respectful and not prescriptive.
“Is online therapy different from in-person?”
The structure is similar. The main differences are practical (privacy, your space, technology). Many people find online therapy just as effective, especially when the relationship feels strong.
A gentle closing thought
Starting therapy doesn’t mean you’re broken. It often means you’re ready to stop carrying everything alone.
If you’re considering therapy and want a calm first step, you can book an initial conversation to ask questions, share what’s bringing you, and see whether working together feels like the right fit.
If you’d like to arrange an initial session or a brief call to see how I work, you’re welcome to get in touch. Therapy is most effective when it feels safe, collaborative, and at your pace.
Monica C | Integrative Counsellor, MBACP
Therapy with Monica I hello@therapywithmonica.com
This article is for informational purposes only and is not a substitute for mental health care. If you need urgent support, please contact your GP or Samaritans at 116 123.