What to Expect During Your First Therapy & Counseling Session

Maybe you’ve never participated in mental health counseling before and you’re unsure about what it will be like. In such situations, when we don’t know what to expect, it’s typically far too easy for our minds to imagine all sort of stories as we’re trying to fill in the blanks.

But counseling needn’t be some mysterious or anxiety provoking thing.

Therapy, to very succinctly summarize, is a process wherein you sit with someone who is non-judgmental and who is entirely preoccupied with helping you be healthy and happy. It’s unlike any relationship you’ve ever experienced. The focus will be wholly on assisting you with your personal goals, so it’s far more one-sided than your average interaction. Also, rather than giving you advice or telling you what you should do, like a friend or family member might, the therapist is there to help you grow your own personal ability to make decisions for yourself, ones you’re confident of and feel good about. This encourages you to move ahead in your life with greater clarity and assuredness. It helps you become more independently capable.

The therapist will, too, do a number of other things during your time together including making you aware of the things you might otherwise be unaware of, as well as helping you develop resources and coping skills with which to better navigate your life.

Therapy is an opportunity to heal, to learn about your thoughts and feelings (and how to best manage them so you’re able to function well), and a chance to positively shift your perspective. Counseling can change you, your life, and your relationships. It’s a chance to learn how to leave maladaptive behaviors behind and it can propel you towards living the life you once thought wouldn’t exist beyond your daydreams.

With that said, what exactly can you expect at your first counseling appointment?

The therapist will ask a lot of questions

The first counseling session, often referred to as an initial assessment or an intake, is when the therapist is able to begin to really get to know you.

Some people enter their first therapy session and they are overflowing with things to say. However, others find it difficult to talk. Whichever one describes you, it’s all okay. As a therapist, I am prepared for each type of person and I seek to meet you wherever you’re at. If you’re comfortable getting right into it, the appointment might feel like a freely flowing conversation. If you have no idea what to say, and are feeling uneasy, no worries - I am prepared to guide you forward and the session will run like more of a formal, structured interview.

In each case, there are lots of questions to be answered, from open-ended to closed-ended. So expect to do more talking than listening. Know that there are never any right or wrong answers. This is all about you and your individual perspective.

Every question is deliberate and intentional. This means I am not needlessly asking you things just to be nosy or fill the time. Instead, there is always a reason for each question. For example, if I ask you how much caffeine you typically drink, I am trying to determine if that is the reason you feel jittery and anxious, or if that’s why you’re having so much trouble sleeping. Or, too, I might ask you about something that you know has nothing to do with you. In this case, I’d be ruling that out for you. Each question is purposeful, even if, on the surface, it might seem irrelevant. Sometimes, the things which seem inconsequential and extraneous ultimately lead us in the right direction.

Rather than giving you advice or telling you what you should do, like a friend or family member might, a therapist is there to help you grow your own personal ability to make decisions for yourself, ones you’re confident of and feel good about.

There can be so many questions during our first therapy session (and also during follow up appointments, particularly the early first few) that it might, at times, seem more like an interrogation than counseling. The reason for so many questions is simply that I need to come to a much deeper understanding of you and your life in order to determine what’s truly happening and how to best address all of it. In the beginning, there is more of an emphasis on gathering facts and details, as opposed to, say, any deep processing of feelings (that sort of thing comes later).

Be aware that while there are many question, none will be especially invasive at this early stage (unless there is a clear reason and it’s directly related to something you’re wanting to work on).

You might feel nervous about starting counseling

With your first therapy session scheduled and booked, you might feel a mixture of emotions.

You might perhaps feel hopeful. It’s natural to feel this way. After all, you’ve finally located a counselor who really seems to be a good fit for you and you’re excited to begin finally making positive changes. It can really be exhilarating to imagine having your goals finally be realized.

But this can, too, be coupled with apprehension. Any change, even a seemingly small one that we know is good for us, can trigger uneasiness and fear. So you might have differing levels of nervousness. You might experience worried thoughts and may even feel some related physical sensations, perhaps some butterflies in your belly. It’s normal and common for this to happen. If you’ve never attended counseling before then you’re likely unsure as to what you can expect - you thus have good reason to be nervous. When we face an unknown it’s natural to feel tense, uneasy, and on edge a bit. But, even if you have been in therapy before, you might still be nervous. You’re still embarking on a new journey and you’re meeting with an unfamiliar-to-you counselor - so, essentially, also very good reasons to encounter some nervous feelings.

Therapists know people tend to be somewhat anxious when coming into their initial appointment. I, for example, know I’m asking you to sit with me, someone you don’t know, and asking you to share deeply personal details about yourself and your life. That would make anyone feel a little tense!

With this in mind, I do my best to ease you into things. So yes, I’ll ask you questions during the first appointment. But I’m very mindful of the awkwardness of the situation and of your natural, very human hesitancy to share.

Trust takes time to build. So, my goal is to begin to gather details, but I seek to do so slowly and with gentle compassion. In fact, I expect brief answers, particularly with certain topics, and won’t push you to share more than you’re comfortable with. I remain on alert, noticing whether or not any questions are resulting in stress for you – because my intent is to understand you better, not overwhelm you.

I know it will take time for comfort and rapport to develop. During the first counseling session, there is no expectation for diving too deeply into anything. We can explore things more comprehensively later – we’ll likely revisit subjects repeatedly as we unpack topics and keep digging in deeper. The purpose on that first day is just for me to begin to get to know you better. In other words, this is a process that requires patience. Growth takes time. It’s a bit like growing a garden in your yard. You may plant the seeds in one afternoon, but you know that it will take time for the garden to blossom.

Also, too, if you find there is something we don’t talk about on day one, know that there will be time later for more discussion. And this goes both ways. Often, I think about you throughout the week, or I will make note of something at the end of our session time that I think you’d benefit from looking at more, and so I will hold the thoughts for our next session.

It might help you to know that at no point during therapy are you required to share or speak about anything you don’t want to. Even if I ask you a question about something, you’re never obligated to reply. You can simply say that you aren’t ready to talk about it. I won’t ever force you.

That said, keep in mind that, as your therapist, I can never help you with the things you keep hidden, the things you never discuss with me. It’s really hard for me to genuinely understand your experiences when I don’t have all the information. So, I encourage you to be willing to open up and be vulnerable.

Being more transparent generally makes therapy far more productive for you in the long run. People tend to hold back “secrets” - sometimes for weeks, sometimes for months. When they eventually do disclose, they tend to feel much better and therapy can take a newer, usually more constructive turn.

Often, the very things we want to talk about the least are the things we need to talk about the most. So, if you find yourself consistently resisting a certain topic, consider why and whether that really is helping you in the long run.

Talking about hard and uncomfortable stuff certainly isn’t easy to do, but the effort to speak can be valuably meaningful. And, if your hesitancy to share is feeling a bit too much, we can simply discuss that. We can just talk about your fear of exposing the parts of yourself you’ve never shared. It takes bravery to do just that alone and the payoff can be immense. Overall, try to remember that a therapist, although highly trained in psychology and counseling, is not a mind reader! I can do many things, but I will never know what’s going on in your head unless you talk to me about it.

You might feel all sorts of emotions when your first therapy appointment is over

You might feel some relief, and hope, when the session has ended. Many people report that sharing their problems and worries with a therapist feels like having a heavy weight lifted off of them. If you’ve never been able to have a therapeutic conversation with anyone about what’s been happening, it can feel like releasing a weighty burden which you’ve been secretly carrying around. It feels good to be able to get things out of your head.

Also, you could feel frustrated. Mental health counseling doesn’t work like other medical care does. A doctor, for example, can look at an x-ray and give you a quick, concise answer about what is wrong and what can be done to fix it. However, counseling is more complex and requires more time. We don’t have the same diagnostic tools. There is no blood test I can run to assess your emotions. Therapy is a little bit science mixed with a little bit of art. This means you might not have a diagnosis right away (if you’re looking for one) and your symptoms won’t disappear quickly.

Further, because we are often exploring deep, hidden wounds within ourselves during the counseling process, and because you might have become accustomed to being numb to your emotions, to tucking them discreetly away from view, it’s normal to sometimes feel worse before you begin to feel better. We’re potentially exposing a lot of stuff that you’ve kept under tight wraps and have never spoken about. So speaking about that stuff could make you feel upset, sad, embarrassed, angry, anxious, guilty, etc.

Remember that a problem brought you to therapy, so when we begin talking about it then it really is virtually inevitable that you’ll feel uncomfortable. That can cause symptoms to increase a bit. But the direction we’re moving in is to help you better tolerate distress and help you learn coping mechanisms which are more effective. The avoidance, as you well know, doesn’t solve anything - it usually just makes things worse, the more time goes by.

Many people report that sharing their problems and worries with a therapist feels like having a heavy weight lifted off of them. If you’ve never been able to have a therapeutic conversation with anyone about what’s been happening, it can feel like releasing a weighty burden which you’ve been secretly carrying around. It feels good to be able to get things out of your head.

Be aware that any potential breakthroughs don’t happen right at first, but the commitment to the therapy process does yield results. You might not ever have a tremendous “ah-ha!” moment, but instead could experience more of a slow yet steady drip of results. How long will all of this take for you? There are lots of variables to consider so this isn’t an easy question to answer. One consideration to be mindful of is the length of time you’ve been struggling. If you’ve been dealing with an issue for decades, it likely won’t resolve in just a few weeks.

We can all benefit from the support provided in mental health counseling

There will come a time in all our lives where we need extra help and support. Oftentimes, our family and friends, while well-meaning, cannot meet all of our needs. It’s wonderful to have these individuals to share with, and their insights can be meaningful and helpful. However, it is much harder for them to be neutral and objective since they know you personally.

In counseling you have the rare opportunity to speak freely - you won’t be judged or criticized, and you don’t have to worry about hurting anyone’s feelings. It’s one of the only times in your life where you are free to say whatever it is you really want to say.

If you find yourself wanting or needing to make changes, in yourself and in your life, therapy and counseling could be an option worth considering. Therapy certainly isn’t the quick or even easy solution. Yet, quick fixes tend to have results which dissipate equally as fast as they came. Counseling, however, tends to have more sticking power. Therapy is a thing which methodically unfolds over time.

Mental health therapy and counseling can facilitate a powerful, lasting transformation. It could be worth a try - keep an open mind and try a few sessions. There’s very little to lose and potentially a whole lot to gain.