What to Expect in Your First Therapy Session

Maybe you’ve already had your free phone consultation. You shared a little about what’s been hard, heard a warm-enough voice on the other end, and booked a first session. Maybe you didn’t overthink it—or maybe you’ve been circling this decision for months. Now it’s here. And it feels… weird.

Starting therapy can stir up a surprising amount of static. It’s new. It’s personal. It might feel awkward, self-indulgent, even a little embarrassing—like your problems aren’t “real” enough to justify all this. Or maybe you’re secretly hoping this will finally be the thing that helps.

Whatever you're feeling—nervous, skeptical, relieved, numb—you're not alone. We therapists expect that first sessions bring up mixed emotions. And we remember our own, too. Most of us have been in that chair as clients. We’ve sat across from someone we didn’t know, trying to figure out what to say, wondering if it was okay to cry, if we were doing it “right.” So, yes, we get it.

This article walks you through what a first session is actually like—what to expect logistically, emotionally, and relationally. It won't answer every question, but it may help you feel a little less alone.

Getting Ready (Or Not)

People prepare for therapy in different ways. Some arrive with a mental bullet list. Others wander in, hoping something useful will happen. One person might feel tight with anticipation; another might feel totally blank. Some people cry within the first five minutes. Some don’t say much at all. You don’t need to prep or rehearse. You don’t need a diagnosis or a goal. Just showing up is the work.

(By the way, we therapists feel a bit of anticipation too. We’re meeting someone new and wondering what it’ll be like to sit with you, to hear your story, to see where this goes. Even if we look calm, we’re arriving with curiosity—and a bit of our own humanity.)

In Person or Online

If you’re meeting in person, there’s usually an unofficial ritual. Maybe you’re greeted in the waiting room. Maybe your therapist comes to the door. The office likely has a couch or two chairs, a box of tissues, maybe a few throw pillows. You’ll see a clock somewhere. There will be art on the wall. Some therapists even have good art. 😏

I once saw a therapist who had a giant print of an iceberg above her couch—a reminder that most of what matters is below the surface. Whatever the decor, the office becomes part of the experience. It helps set what we call the frame: the structure that contains the emotional work.

Online, things can feel more abrupt. One moment you're unloading the dishwasher, the next you're face-to-face with a stranger on screen. There's no hallway or door—just instant intimacy.

If possible, find a private, well-lit space where you can sit comfortably and face your screen. We’re not trying to be fussy, but we do rely on what we can see—your posture, your expressions, how you shift or look away. If you’re in a car or lying in bed in the dark, we can still work—but it’s harder to track those cues.

Starting the Session

Most first sessions start with logistics: confidentiality, payment, scheduling, cancellation policies. You might sign a consent form. It’s not just paperwork—it’s part of creating a container where you can feel safe.

Confidentiality is central to that. What you share stays private, with a few exceptions—like if someone’s in danger or if a judge demands records. Your therapist will walk through this clearly. Ask questions. That’s part of the job too.

Boundaries in therapy aren’t walls. They’re the scaffolding. They protect your space and allow things to unfold with clarity and steadiness.

“What Brings You In?”

Sooner or later, we’ll ask something like that. Not because there’s a right answer. Just because it helps us get started.

You might tell a story. You might say, “I’m not sure.” You might feel embarrassed. That’s all fine. We’re listening for what matters—what’s hard to say, what feels stuck, what lights up when you talk. We notice your tone, your rhythm, where you linger or pull back.

Some therapists ask structured questions about family or history. Others just follow the thread. Neither is better. It’s about what helps you get in touch with yourself.

A Note on Fit

As you talk, you’re also getting a feel for us. Some therapists feel warm and chatty. Others are more reserved. Some are expressive; some say very little.

Fit doesn’t mean instant comfort. But it does mean something about you feels met. And if something feels off, say so. “That didn’t land,” or “I felt a little shut down when you said that.” That kind of honesty helps. It’s not criticism—it’s data.

I’ve had four therapists over my life. One was a big-hearted guy with a vaudevillian sense of humor. One was so reserved I spent weeks wondering if she liked me. One quoted Žižek and had the air of someone who hadn’t slept in three days. Looking back, each one had the exact presence I needed—or maybe I just grew into what they offered. Either way, they were all very different. And they all helped.

The Relationship Is the Work

Therapists are trained in techniques—but the relationship is what often makes the biggest difference. When you feel safe and understood, you're more likely to explore what’s painful. That’s when therapy gets traction.

Of course, therapy is also a bit weird. You may talk about your deepest fears with someone who reveals almost nothing personal. That imbalance is by design—it keeps the focus on you. But it can feel odd. That’s okay to name too.

Eventually, the therapy relationship becomes a kind of mirror. The way you feel about us often says something about how you feel in other relationships. Bringing that into the conversation can be one of the most powerful parts of the work.

After the Session

Ending the first session can feel a little surreal. Like walking out of a movie theater into bright daylight. One moment you’re deep in something tender, the next you’re checking your parking meter or clicking over to your inbox.

I once saw a therapist on my lunch breaks. Fifty minutes talking about heartbreak, then back to spreadsheets and meetings. No one tells you how jarring that can be. But it’s normal. If you can, give yourself a moment to transition—take a walk, sit quietly, breathe. Let yourself catch up.

What Happens Next

After you’ve acclimated to regular life again, pay attention to how you feel when you think about going back. Are you looking forward to working with your therapist? Are you indifferent? Are you wondering if it’s not the right fit? Again, no wrong answers. That response is part of the process.

This is your time. You get to decide if you want to continue.

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Thinking About Starting?

If you live in California and you’re considering therapy, I offer a free 15-minute phone consultation. It’s a chance to share what you're looking for, ask questions, and get a sense of fit. You’re welcome to come with questions—or none at all. This is your time. I’m happy to meet you wherever you are.