Starting Therapy? Here’s What to Expect

So you’ve made an appointment for a therapy session…now what? What will you talk about? Will it be awkward? And above all, will you actually lie down on a couch?

We put this guide together to demystify your first therapy appointment.

Let’s Talk Logistics.

You and your therapist have found a time that works for your first session. Usually, this session will last for 50 – 60 minutes. Sometimes, you’ll have already talked to your therapist on the phone for 10 – 15 minutes. In this case, you’ll already have a sense of your therapist’s style and personality.

Once you arrive at your therapist’s office, you’ll sit in a waiting room – just like any other doctor’s appointment. Many therapists share office space with other therapists, so don’t be surprised if other people are also sitting in the waiting room. Once your therapist is ready for your session, they’ll come to the waiting room to find you. It’s likely that their office will have comfy chairs, and maybe a sofa –  you can sit wherever you want. There will probably be Kleenex, in case you need them, and a clock, so you can see how much time has gone by.

Your therapist will kick things off by asking you to fill out a few forms. These will give you more information about payment and privacy.

Next, the session will start – more about this later! Your therapist might take notes, either on a computer or on paper.

At the end of the session, your therapist will ask you to make your next appointment. They may suggest meeting every week, or every other week. This is also when you’ll pay for the session. Your therapist should have already told you what their fee is. If you’re using insurance benefits, make sure that you bring your insurance card to the appointment.

What Should I Do Beforehand?

While you don’t need to do much of anything, taking some time to prep can make your session smoother and more effective.

First, think through what you’re hoping to get out of therapy. What made you make the decision to find a therapist? Was it a specific incident, or a more general feeling? What would success look like for you? Do you want to fight less with your husband, gain more control over obsessive thinking, or sleep through the night? If you don’t know exactly why you’re going to a therapy, or what you hope to get out of it, that’s normal and totally fine! Even this uncertainty is helpful information for your therapist.

We’ve also found that it’s super helpful to keep a journal – for the week or two before your first appointment, jot down a quick daily entry. How did you feel? What went well, and what didn’t? Did anything trigger specific thoughts or emotions? Having this journal will help you give your therapist a clear sense of what’s going on. Without this, we’ve found ourselves just talking about whatever happened the morning of our appointment. The recency effect is powerful!

If you’ve seen a therapist before, spend a little time thinking about what did and didn’t work well. Did you love the way they gave you homework between sessions? Hate that they always started appointments five minutes late? Find the way they talked about their own life kind of awkward? Sharing these preferences with your therapist upfront can help you build a great relationship.

Last, if you’re hoping to use insurance benefits, check beforehand with your insurance provider to see what their mental health coverage is like. Make sure to bring your insurance card and a method of payment to the appointment.

What Will We Talk About?

 Drawing a blank? Photo by  Mike Tinnion  on  Unsplash

Drawing a blank? Photo by Mike Tinnion on Unsplash

For a lot of people, this is the single most nerve-racking part of starting therapy. What will you talk about for a whole hour? Won’t it be awkward to share your deepest secrets with a stranger? Luckily, your therapist does this for a living, and knows how to make things run as smoothly as possible.

During the first session, your therapist will be trying to get to know you. Their goal is to get a better sense of your personality, your current situation, and your past experiences. This lets them figure out if they are equipped to help you, and design a customized plan for your treatment.

You can expect your therapist to ask lots of questions, and for you to feel like you are talking a lot. Your therapist will probably ask why you chose to seek therapy, what past experiences might be relevant to your current situation, and what symptoms you’re experiencing. They may direct the conversation by asking follow-up questions, or they may just let you talk.

You might feel like you’re rambling, or that your answers are unstructured – this is to be expected! It’s ok to say whatever comes to your mind. If you don’t know the answer to a question the therapist asks, feel free to say so. Similarly, if you don’t feel comfortable answering a question, or if you would prefer to get to know your therapist better before discussing a particular topic, this is also absolutely fine. Just let your therapist know that there is something there, but that you’d prefer to wait to talk about it.

Great therapists will make sure to discuss a few things before you walk out of their office: goals, feedback, and fit. In our opinion, it’s very important that you and your therapist are on the same page about your goals for therapy. These goals may (in fact, they probably will!) change over time, having goals will help you make the most of your time and money. If your therapist doesn’t ask you about your goals, feel free to start the conversation yourself. Additionally, your therapist should let you know when and how you can provide them with feedback. Do they ask for feedback at the end of each session, give you a feedback sheet to fill out, or just ask for feedback as it comes up? Finally, your therapist should let you know that during your first few sessions, you’ll both be assessing whether you two are a good fit. If the two of you aren’t a good match, your therapist should help you find the right therapist for your needs and preferences.

What Next?

You should feel proud of yourself for taking the first step and going to therapy! You are on the road to feeling better.

 Your mind on therapy. Your mind on therapy. Image by  Simson Petrol  on  Unsplash .

Your mind on therapy. Your mind on therapy. Image by Simson Petrol on Unsplash.

It’s important, though, to know that you may not always feel better immediately. Therapy can be like reorganizing your desk. The first step is to pull out all of your papers, pens, and post-its, and dump them on the floor…after your first therapy session, you may feel like you’re surrounded by old tax returns and letters from your college boyfriend. This is just part of the process. Only after you’ve gotten everything out this can you sort through the mess, figure out what to keep, and put it back together in a reorganized manner. This all takes time and effort.

We’ve found that it can be really helpful to end each therapy session by summarizing your key takeaways. Additionally, if you want, ask your therapist for things you can do in the week or two weeks before your next appointment. This “homework” can be anything from keeping a journal, to noticing the feelings in your body when you interact with family members, to meditating for five minutes every morning.

And That’s That!

We hope this made you less anxious about your first therapy session! If you live in the greater Boston area and are looking for a therapist, sign up at We’ll find a great fit for you from our network of 150+ therapists.

For a more comprehensive guide on starting therapy, click here.