If you haven’t been to therapy before, you may be feeling anxious or worried about your first therapy session. Many people who begin therapy feel this way. When you’re unprepared and don’t know what to expect, it’s hard to get the most out of your time with your therapist.

Learning about some of the basics of therapy — and what to expect in your first therapy session — can go a long way toward providing some relief.

Different Therapy Formats

First, it’s important to understand that there are several different formats of therapy, and they don’t always look the same. The most common examples include:

  • Individual therapy
  • Group therapy
  • Virtual therapy
  • Adjunctive mental health therapies

Individual therapy is the traditional style and is what most people think of when they hear the word “therapy.” It involves sitting down one-on-one in person with a therapist to talk about your concerns and receive guidance. There are dozens of different styles of individual therapy, but they all share this format.

Group therapy is another common form of therapy, but instead of sitting with a therapist alone, you meet with both a therapist and a group of peers with a common mental health challenge. The group may include people who have been diagnosed with a specific mental health disorder, who are in substance use recovery, or who are coping with trauma, for example.

Both individual and group therapy can be offered in telehealth formats as well. While the core elements of these therapies stay the same, this service is offered online using secure videoconferencing software.

Finally, there are a number of treatments that use the word “therapy” but don’t focus on talking and listening as the primary treatment method. These include treatments such as hyperbaric oxygen therapy or deep TMS therapy, both of which can help people with common mental health conditions.

This article will focus on individual therapy, though many of the points made will also apply to group or virtual therapy sessions.

What Happens When You First Meet Your Therapist?

The first thing that happens when you start a therapy session is meeting your therapist. It really is as simple as meeting anyone for the first time, though many people are self-conscious about feeling analyzed, scrutinized, or judged. In reality, your therapist only wants to get a feel for who you are, what you need, and how they can help. There are a few other things your therapist may go over in your first session to help you understand the process.

Confidentiality Rules

Since therapy is a protected space, your first therapy session will likely start with some ground rules. Your therapist may have their own rules or standards that they share, but there are also confidentiality laws your therapist must follow.

What you say to your therapist is completely confidential, with a few exceptions that differ slightly by the state in which you receive therapy. These exceptions may include:

  • When the client poses an immediate danger to themselves or others
  • When a therapist suspects elder or child abuse
  • When a therapist is compelled to testify in a court case
  • When the client directs the therapist to disclose parts of their session

Apart from these exceptions, your therapist is bound by law and training not to speak about your sessions to anyone. This includes not only the content of your therapy session but any details that may identify you as their client.

Confidentiality is critical to providing clients with a safe and comfortable space to share their challenges. It offers assurance that what you say in therapy will not leave the room and that your therapist won’t share your information with anyone who seeks it out.


History-taking often happens in the first therapy session as well. This is essentially a process of your therapist learning some of the key contributing factors to your current concerns, such as whether you have a family history of the concern, how long it has been happening, and what supports or barriers you’ve faced in coping with it.

For example, suppose that you are seeking help from a therapist to deal with depression. Knowing that depression runs in your family could affect how your therapist approaches your treatment. It can also be important to share with your therapist whether you’ve received therapy before, for how long, and whether it helped.


During the first therapy session, your therapist may perform one or several assessments to understand the severity of your mental health challenges. Countless different assessment tools at your therapist’s disposal can be used to determine:

  • The severity or frequency of anxiety symptoms
  • The severity or frequency of depressive symptoms
  • The presence of trauma
  • Your overall well-being

These assessments provide the therapist with a baseline understanding of your presenting problems. Some therapists will return to these assessments regularly to track your progress, while others only use these tools as an initial screening to see whether your needs and their skills are a good fit.

Explaining the Process

Your therapist may also take this time to give a broad overview of how they view the therapy process and what they expect of you. They may use a specific therapeutic style that requires you to track mood changes or triggering events, for instance, and will explain the time and commitment required to get the results you hope for.

This is typically the best time for you to ask any questions you have about therapy and to learn more about the therapeutic process itself.

How to Get the Most Out of Your First Therapy Session

Keeping a few things in mind in your first therapy session can dramatically change the benefits you experience for the entirety of the therapeutic process. These tips are designed to help you become a more active and engaged participant in therapy and ultimately lead you toward a faster and more thorough recovery.

You Don’t Have to Know the Rules

Like so many other spaces in life, there are unspoken rules and expectations about what happens in therapy. But importantly, you don’t need to know these rules — and you’re not expected to. Instead, you should feel free to ask your therapist about their rules, their expectations, and how the process works.

It’s not your responsibility to know the process. Instead, it’s your therapist’s responsibility to help you understand it. If you’re unsure about what happens next, what you’re supposed to talk about, or how you’re supposed to communicate, you can address this concern directly with your therapist in the first session.

As you continue working with your therapist, you’ll get a feel for how the conversations tend to flow. But when you feel stuck or unsure, the best way to facilitate the process is to explain this feeling to your therapist.

All You Need to Start is a Concern

Most people don’t start therapy because they’re feeling great. Instead, they tend to schedule their first therapy session when they feel stressed, anxious, depressed, or unable to cope.

As a client, all you need to begin the work of therapy is to be able to identify this concern. You only need to tell your therapist, “I’ve been feeling very sad” or “I’m struggling in my relationships” to begin the healing work of talk therapy.

Of course, there is much more to the process of therapy down the line, but your therapist will be of most benefit to you if you share this initial concern with them directly.

Therapy is an Active Process

Sometimes, people seek out therapy in the hopes that a therapist will do all the work and fix their problems. But therapy is always a two-way street; there’s nothing a therapist can say or do in a session to cure you of your problems if you don’t take what you learn in therapy and apply it to the real world.

No matter how skilled the therapist is, the healing power from therapy always comes from within the client. You have to be an active participant if you hope to achieve recovery, while the therapist’s role is to guide you along the process. They can show you the way, but you have to take the steps to healing on your own.

It’s Okay if You’re Not a Fit

The most critical element of any therapeutic process is the relationship you have with your therapist, sometimes called the therapeutic alliance.

You should look for a new therapist if you don’t like your therapist for any reason, if they don’t make you feel comfortable, or if you’re not confident that you can achieve your mental health goals with this particular therapist.

It’s often helpful to think of your first therapy session (or even the first few therapy sessions) as a job interview with your therapist. Take this time to decide whether they are the right person to help you achieve recovery.

If you’ve decided that the fit doesn’t seem right, share this with your therapist. Don’t worry about hurting their feelings; a therapist’s primary goal is for you to receive the best possible care.

In many cases, the therapist will refer you to a colleague who more closely aligns with your goals or who has a different approach to therapy that may be more beneficial for you.

Honesty Is the Best Policy

Being open, honest, and authentic with your therapist is the best way for them to help you and for you to get what you need. This applies to nearly every possible situation that may come up in therapy, including:

  • What emotions you’re feeling
  • What events in the past caused you to feel triggered
  • Whether you use addictive substances
  • Whether you’re taking any prescribed medications
  • Whether you like your therapist
  • Whether you feel like therapy is working or not

Your therapist will ask for information that helps them empathize and understand your position. But this is only possible if you are open, transparent, and communicative about your experiences.

How to Take the First Steps

We understand how difficult taking the first steps toward getting help can be. Reaching out to a therapist can often be a nerve-racking experience, leading you to doubt whether you need help at all, whether you’ll be able to achieve recovery, and whether therapy is the right choice for you.

At Plus by APN, our team understands the myriad of thoughts and emotions that our clients go through in this process. But by calling to speak to one of our specially trained mental health experts, you can get the guidance and support you need to make the best decision for your mental health.

Start Therapy at Plus by APN

Reach out to our team by filling out our confidential online contact form, using the live chat function on our website, or calling us at 424.644.6486 — and start your path to wellness today.


  • Ackerman, Steven J., and Mark J. Hilsenroth. “A Review of Therapist Characteristics and Techniques Positively Impacting the Therapeutic Alliance.” Clinical Psychology Review, vol. 23, no. 1, 2003, pp. 1-33, https://doi.org/10.1016/S0272-7358(02)00146-0. Accessed 16 May 2024.