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17 Things to Expect From Your First Therapy Appointment

Megan Griffith
Man Sitting On Couch Meeting With Male Counsellor In Office

One of the most anxiety-inducing aspects of starting therapy is not knowing what to expect. After all, there aren’t a lot of experiences in life that can prepare you for your first therapy session. Middle-aged soccer moms may have those kitchen towels that say “Wine is my therapy!” but I assure you that a wine night with friends is not the same as a therapy session (and if wine is how you cope with your life, you may want to look into some real therapy, by the way). As a seasoned therapy veteran, I thought I could help ease some of these first-time jitters by outlining 17 things you can expect from your first appointment with a therapist. Hopefully, this list will help you feel more prepared, and thus, less anxious, about starting on this journey toward feeling better.

  1. All the vulnerable, squishy stuff doesn’t start right away. No therapist is going to welcome you into their office and immediately ask something like “So what are your deepest fears?” Usually, your first visit will start with a confirmation of insurance/payment method, so make sure you bring your insurance card and/or checkbook.
  2. They will, however, probably ask something along the lines of “So what brings you here today?” Even if you filled out a ton of paperwork ahead of time answering exactly that, even if you told the person on the phone when you made an appointment why you wanted to be seen, they will likely ignore all that and ask you again. Personally, I dread this question. I feel like my issues are so nebulous and difficult to pin down, I have a hard time summarizing why I’m in therapy in a nice little blurb. I think people starting therapy often feel the same way, so here’s a tip: I like to come prepared with an answer to this question. Spend some time the night before your first visit trying to articulate why you’re doing this, what issues you’re experiencing, and what you’re hoping to change.
  3. You can sit wherever you want. Seriously, therapists do not care where you sit. It can be confusing, because many therapist’s offices have several seating options including chairs and couches, but that’s usually on purpose, so that you can choose the seat that makes you feel most comfortable. Don’t worry about which spot is their “usual” spot; if they have a preference, it is their responsibility to let you know. If they don’t direct you to a specific seating option, then trust me, they just want you to sit wherever you feel most comfortable.
  4. For some reason, they will likely ask you something along the lines of “How are you today?” This is a totally normal social nicety, but in therapy, it’s such a loaded question. Feel free to answer however you want. Sometimes I use this as a prompt to pour out my heart, but other times, especially if I’m feeling particularly anxious, I just respond with the typical “Good, you?” even if I’m actively dying inside. I seriously wish therapists would stop doing this, but almost every single one I’ve ever seen asks how I am at the beginning of appointments, so I thought I should prepare you.
  5. Your first appointment is known as an “intake appointment” and it differs in a couple of key ways. First, it may be more expensive than a normal session. You’ll have to check with your insurance to know for sure. Second, intake sessions are sometimes longer, lasting anywhere from 45 minutes to 2 hours depending on the office. Finally, your initial session may involve an intake questionnaire. Again, even if you already filled out a bunch of paperwork, there’s a chance they’ll have you basically do it again, just in person, with them asking the questions. I have no idea why every therapist’s office does this, but it seems to be the normal protocol. Try not to tear your hair out.
  6. If you panic and decide to cancel, make sure you look into the office’s cancellation policy. Oftentimes, there is a fee if you cancel less than 24 hours from your appointment time. If you find yourself panicking but it’s too late to cancel without paying a fee, call and see if you can reschedule and push it back a few days to give yourself more time. Or call a friend and ask for some support.
  7. It is completely normal to ask someone to come with you to your first appointment. Going alone can be terrifying, and it can be so comforting to know that someone who loves you is out in the waiting room, whole-heartedly supporting you. In my experience, the person you ask won’t feel like it’s a burden — in fact, they’ll probably be touched and happy to come with you.
  8. Crying in the first session is normal. Starting therapy is scary, and emotional, and it can hit you like a ton of bricks. I promise your therapist is not judging you. I used to have this great therapist who would tell me “If you can’t cry in therapy, where the hell are you supposed to cry?” whenever I apologized for crying in her office. It’s scary to cry in front of a stranger, but hopefully they won’t be a stranger for long, and it can be really helpful to just let it all out.
  9. Not crying in the first session is also totally normal. Some people, like me, react to new experiences and fear with lots of tears, but others react by shutting down emotionally. I have plenty of friends who constantly ask “What’s wrong with me?” because they don’t cry when they feel like they’re “supposed” to. But remember, therapy is the last place where you need to worry about what you’re “supposed” to do. If you get through your first session completely dry-eyed, you aren’t alone at all.
  10. At some point, they will almost definitely ask a question (or lots of questions) that you don’t know the answer to. That is OK.  This isn’t school, you aren’t expected to know everything. If you don’t know, just say so. They may be able to help you sift through your thoughts and find an answer. Again, I promise they aren’t judging you. After all, if you already knew everything about yourself, you wouldn’t be there.
  11. This is not a job interview. You are not expected to dress up, speak eloquently, and/or make eye contact the whole time. Sometimes I dress up because it helps me feel better, but other times I barely drag myself out of the house to get to therapy, wearing a stained T-shirt and some sweatpants from high school. As for speaking well, no one is overly articulate when it comes to discussing their own pain, so don’t hold yourself to some impossible standard. Just try to be honest, even if that means you’re rambling. Therapists are fluent in rambling. Finally, if eye contact makes you uncomfortable, you are totally OK to avoid their eyes the whole time. Heaven knows I do for the most part.
  12. Feel free to bring things with you! I almost always bring my journal and some artwork to a first session with a new therapist because I feel that they help me explain my situation more clearly. If I say “I’m kind of obsessed with my mental health” they’ll be like “Oh, OK.” But if I bring in my journals from the last four years and show them the literal hundreds of entries obsessing about my brain, they’ll be like “Oh, oh dear, OK, you mean actually obsessed.”
  13. You don’t have to bare your entire soul in the first appointment. After all, this is literally a total stranger. It’s completely normal and OK if it takes you a few sessions to warm up to your therapist and really let them into your inner world. Try your best not to straight-up lie, because that will only create problems down the road, but feel free to say “I’m not comfortable talking about that yet” if the therapist asks anything that’s just a bit too personal for the first session.
  14. In fact, the first session is mostly about testing the waters to see if you and the therapist are a good fit together. A therapist can be perfectly qualified and just not gel with you and your personality, or they may more inclined to treating different conditions or issues, or they may be a complete and total hack. It happens sometimes. Your first session is the perfect time to determine if this relationship has the potential to go somewhere productive for you, or not. Not sure how to tell? I actually wrote a series of posts about how to find a therapist that may be able to help, you can check them out here.
  15. You might not come away from your first appointment feeling a million times better. Sometimes it feels like a huge weight has been lifted off your chest because you’re finally starting on the journey toward feeling better, but other times, it can feel more like “What the hell have I gotten myself into?” That’s OK. Just keep going to your appointments, and I promise the improvement will follow.
  16. At the end of the appointment, the therapist will likely ask if you’d like to schedule another one. If you liked them or at least felt comfortable enough with them to come back, go ahead and schedule another appointment right then and there. If you’re not so sure you actually want to see them again, simply say that you need to check your calendar, and is it OK for you to give them a call? This way you don’t need to make any decision on the spot. If they were truly horrendous and you want to make it very clear that you are not coming back, feel free to give them a piece of your mind.
  17. It is a great idea to reward yourself in some way for making it through your first session. Don’t feel silly, don’t feel wasteful, just go get yourself a smoothie or a new book or whatever small treat you want. Starting therapy can be intimidating, and it’s so important to let your brain know that despite all the fear, you did a good thing. Rewards are a great way to do that.

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