What Happens in the First Therapy Session? (Step-by-Step)
Starting therapy can feel both hopeful and intimidating. If you’re considering counselling, you might find yourself wondering: What actually happens in the first therapy session? Will I have to talk about everything right away? What if I don’t know what to say?
If these questions sound familiar, you’re not alone. Many people search for therapy not because they have all the answers, but because something inside them feels heavy, confusing, or hard to carry alone.
This post will walk you through what typically happens in a first therapy session, step by step, so you know what to expect — and what not to worry about.
Step 1: Arriving (and Settling In)
Your first therapy session often begins before any talking happens.
You may notice your body feels tense, your thoughts are racing, or you’re questioning whether you’re “doing therapy right.” All of this is completely normal. Starting therapy means stepping into the unknown, and your nervous system may be on high alert.
Your therapist’s role is to help create a space that feels safe, respectful, and unhurried. There is no expectation to perform, impress, or share more than you’re ready for.
Step 2: Paperwork, Consent, and Confidentiality
At the beginning of your first session, your therapist will usually review:
Consent to counselling
Confidentiality and its limits
Fees, cancellation policies, and scheduling
Any intake forms you completed beforehand
This part may feel more administrative, but it’s important. It ensures you understand your rights, boundaries, and what you can expect from the therapeutic relationship.
You’re always welcome to ask questions here — nothing is too small or unimportant.
Step 3: “What Brings You In?”
This is often the first open-ended question in therapy.
You might share:
A specific concern (anxiety, low mood, relationship struggles, food and body concerns)
A general feeling of being overwhelmed or stuck
Or simply, “I don’t really know — I just know I’m not okay”
All of these are valid starting points.
You do not need a perfect explanation or a clear goal in your first therapy session. Therapy is a process of discovery, not something you’re expected to have figured out.
Step 4: Getting to Know You (at Your Pace)
Your therapist may ask gentle questions to better understand you, such as:
How long this has been going on
How it’s affecting your daily life or relationships
What coping strategies you’ve already tried
Any relevant personal, cultural, or family context
You’re always in control of what you share. If something feels too personal to discuss right away, it’s okay to say so. Therapy is collaborative, and trust develops over time.
Step 5: Understanding Patterns, Not Judging You
A first therapy session is not about diagnosing or labeling you. Instead, your therapist may begin noticing patterns — how your thoughts, emotions, body sensations, and experiences connect.
This might sound like:
Reflecting themes they’re hearing
Offering gentle observations
Normalizing reactions that once felt confusing or isolating
Many clients feel relief here — often for the first time — realizing their experiences make sense in context.
Step 6: Exploring What You’d Like from Therapy
You may talk about:
What you hope might feel different over time
What kind of support feels helpful (or unhelpful)
Any previous experiences with therapy
Goals can be specific or very open-ended. It’s also okay if your goals change as therapy unfolds.
Your therapist may share how they work and what therapy together might look like moving forward.
Step 7: Ending the Session Gently
Toward the end of your first therapy session, your therapist will usually:
Check in about how the session felt for you
Ask if you have questions or concerns
Discuss next steps, including scheduling another session if you wish
You are never obligated to continue therapy after one session. It’s important that the therapeutic relationship feels like a good fit for you.
What You Don’t Have to Do in the First Therapy Session
It’s just as important to know what is not expected of you:
You don’t have to share your deepest trauma
You don’t have to cry (or not cry)
You don’t have to know exactly what you want
You don’t have to say anything perfectly
Your presence is enough.
Common Feelings After the First Therapy Session
After your first therapy session, you might feel:
Relieved
Emotionally tired
Hopeful
Uncertain
Or a mix of everything
This is all normal. Therapy can stir things up before they settle, especially when you’ve taken a brave step toward caring for yourself.
Is It Normal to Feel Nervous Before Therapy?
Yes — extremely normal.
Feeling nervous does not mean you’re not ready for therapy. Often, it means you care deeply about your well-being and are doing something meaningful for yourself.
Therapy isn’t about fixing you. It’s about supporting you in understanding yourself more fully and compassionately.
A Gentle Invitation
If you’re considering therapy and wondering whether it’s the right next step, you don’t have to decide everything right now. Even reaching out for a consultation is a meaningful beginning.
Therapy is a space where you’re allowed to show up exactly as you are — unsure, hopeful, guarded, curious — all of it belongs.
If this resonates with you, you’re welcome to reach out to book a consultation or ask any questions you may have. You don’t have to navigate this alone.
