For a lot of people, booking the first appointment is the hardest part. You’ve thought about it for weeks, maybe months. Then the day comes closer and the questions start. What will they ask me? What if I don’t know what to say? What if I cry, or don’t feel anything at all?
It helps to know what you’re walking into. A first therapy session isn’t a test, and there’s nothing to get right. It’s mostly a conversation.
It’s mostly a conversation
Your therapist’s main job in a first session is to get to know you. They’ll ask what brought you in, and why now. Something may have happened recently. Or something may have been building for a long time and finally feels like too much to carry alone.
They’ll also ask what you hope will change. That answer doesn’t have to be polished. “I want to stop feeling like this” is a perfectly good place to start. So is “I don’t know, but something has to be different.”
You set the pace. You can share a lot or a little. If a question feels like too much, you can say so, and a good therapist will take that seriously. Nobody expects you to tell your whole life story in one sitting.
What you’ll likely cover
Every therapist works a little differently, but most first sessions touch on the same few things:
- What’s going on for you now, and how it’s affecting your sleep, work, relationships or mood
- Some background, such as your family, your health and what support you already have
- What you’d like to be different, which becomes the start of your goals
- How confidentiality works, including the few situations where a therapist may have to share information
- Any questions you have about how therapy works
Confidentiality is worth a moment of its own. Your therapist will explain what stays private and the limits on that privacy, which usually relate to someone’s safety. If anything about it is unclear, ask. It’s your information, and you have every right to understand how it’s handled.
Goals in a first session are usually rough. They get clearer as you go. Sometimes what you came in for turns out to sit on top of something else, and that’s normal too.
Before you come
You don’t need to prepare much, but a little thought beforehand can make the session feel less daunting. Try jotting down a few notes: what you want help with, anything that’s been on your mind lately and questions you’d like to ask. Having them in front of you means you won’t walk away thinking, “I meant to mention that.”
Since sessions are by video, find a private spot where you won’t be overheard or interrupted. A parked car, a bedroom with the door closed or a quiet office all work. Headphones help. Test your camera and microphone a few minutes early so the first thing you talk about isn’t the technology.
You don’t need a perfect story
Many people worry that their reason for coming isn’t serious enough, or that they’ll explain it badly. They start sentences with “This probably sounds silly, but…” or “Other people have it much worse.”
You don’t need a dramatic event, a clear diagnosis or the right vocabulary. You don’t need to have it all figured out. Feeling stuck, tired, anxious or just not like yourself is reason enough to talk to someone. Making sense of it is part of what therapy is for.
It’s also fine to feel awkward. Talking to a stranger about personal things is unusual. Most people find it gets easier, often within the first session itself.
Deciding if the fit feels right
Toward the end, you’ll usually talk about what comes next. Your therapist may share some first thoughts on how they could help and how often you might meet.
This is also your chance to notice how the conversation felt. Did you feel listened to? Did you feel judged? Could you imagine saying harder things to this person over time? You don’t need to feel completely at ease after one meeting, but you should feel respected.
The relationship with your therapist matters. If it doesn’t feel right, you’re allowed to say so, and you’re allowed to try someone else. A good therapist won’t take it personally. They want you to get help that works for you, even if it isn’t with them.
At Talk It Out Clinic, the first step is a free 15-minute phone consultation with our intake coordinator. It’s a low-pressure way to ask questions, describe what you’re looking for and get matched with a therapist who suits you. You don’t need a referral. Sessions are by secure video anywhere in Ontario, in English, Hindi, Urdu or Russian, and many extended health plans cover sessions with a Registered Psychotherapist.