Starting Therapy: What to Expect in Your First Therapy Session - A Therapist's Guide

The decision to start therapy is a significant one. If you've taken the step to book your first session, you've already done something courageous – you've acknowledged that you want something to change, and you're willing to explore that with another person.

But I know that the time between booking that first appointment and actually showing up can be filled with anxiety. What will we talk about? What if I don't know what to say? What if the therapist judges me?

As a therapist working in Walthamstow, I've sat with hundreds of people in their first session. I want to share what actually happens, so you can walk in feeling a little more prepared and knowing what to expect.

Before You Arrive

You don't need to prepare anything specific. There's no homework, no list of topics you must cover, no right or wrong way to begin. Some people arrive with pages of notes they want to share. Others come with nothing but a vague sense that something isn't working. Both are completely valid starting points.

The First Few Minutes

When you first sit down, there's often a moment of uncertainty. Where do I begin? This is entirely normal. I usually start by explaining a few practical things – how long sessions last, confidentiality, and what happens if you need to cancel. This gives you time to settle into the space.

Then, quite simply, I'll ask what's brought you here. You can share as much or as little as feels comfortable. There's no pressure to reveal everything immediately – or ever. Therapy unfolds at your pace.

What We Actually Talk About

In a first session, we're beginning to build a picture together. I might ask about:

• What's happening in your life right now

• How you've been feeling recently

• Whether anything specific triggered your decision to seek therapy

• What you're hoping might be different
  

But this isn't an interrogation. It's a conversation. And importantly, I'm not just listening to gather information – I'm listening to begin understanding your world from your perspective.

The Therapist Isn't Going to Judge You

I think this is the biggest fear people carry into their first session. What if they think I'm weak? What if my problems seem trivial? What if I say something that shocks them?

Here's the truth: there's very little that would surprise a therapist. We've heard about affairs, addictions, violent thoughts, shameful secrets, and the quieter pain of simply feeling empty or stuck. Our job is not to judge but to understand.

The therapeutic space is perhaps one of the few places in life where you can be completely honest without social consequences. You don't need to manage my feelings or worry about burdening me, although that may well happen. The chances are that if you have worries of managing my feelings, you may well feel this quite intensely in your relationships too, and so it becomes a feeling replicated in the therapeutic relationship and one that we can work through in the moment.

You Don't Have to Commit Immediately

A first session is partly an assessment – but not just of you. It's also your chance to assess whether this therapist is right for you. Do you feel heard? Does the space feel safe enough? Can you imagine opening up more over time?

If something doesn't feel right, that's important information and one that I encourage clients to speak about in the therapy. Not every therapist suits every client, and finding the right fit matters more than just finding any therapist. Equally it is important to understand what it means when we say the relationship doesn't feel right or it's not the right fit? What is it about the relationship that doesn't fit? Will this feeling allow us to understand your current relationships in the same way?

What Happens Next

At the end of the first session, we'll usually discuss whether you'd like to continue. If we agree to work together, we'll find a regular time that works for both of us. Weekly sessions are standard – this rhythm allows momentum to build while giving you time to reflect between sessions.

Some people know immediately that they want to continue. Others need a few sessions before they're sure. There's no wrong answer.

A Final Thought

Starting therapy takes courage. Not the loud, dramatic kind – but the quieter courage of admitting you don't have all the answers and being willing to explore that uncertainty with someone else.

If you're considering starting therapy but haven't booked that first therapy session yet, perhaps this is your sign. And if you've already booked, know that the hardest part is already done. You've made the decision. Now you just have to show up.

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Max Chainey is a BACP-registered integrative therapist practising in Walthamstow, East London. He offers both in-person and online therapy for individuals experiencing anxiety, depression, relationship difficulties, and other challenges. 

Get in touch to book a session