What to Expect in Your First Therapy Session
Being uncertain about what will actually happen in session is one of the primary reasons people hold off on starting therapy. Here are some things to consider before we get started.
What happens before the first session? Paperwork.
Intake paperwork will be sent to you ahead of time through a secure client portal. You can expect to fill out:
Basic contact info
A history form covering your background and current concerns
Basic screening tools to help me understand where we’re starting from
Consent forms and a summary of confidentiality (and its limits, such as safety concerns)
Payment info
Filling these out in advance means less time spent on logistics and more time spent on what’s bringing you in once we’re in the room together. If this feels like too much you can always opt to fill out the paperwork together in session but the consent, privacy info (HIPAA), and practice policies are a must-do before you come in.
What will we talk about during the first session?
The first part of therapy is establishing some level of safety and trust. To me, that means de-centering a specific list of questions I need answered and centering what you’re bringing in. If you have questions for me, I welcome them. If you aren’t sure where to start, it can be more conversational and I’ll ask you some questions. If you’ve been holding things in for way too long and just need to get some of it out, we’ll start there. The goal from the get-go is creating a space that feels like a safe haven, not an interrogation room. Beyond understanding and implementing theory and ethics (which is on me), you call the shots on what’s right or wrong for you in the therapy room. What do you want to talk about?
It may feel awkward.
Talking to a stranger about deeply personal things may feel a little strange at first, even when it’s going well. Feeling self-conscious, over-explaining, or going quiet doesn’t mean therapy isn’t working or that the fit is off. If you’re reaching session 3-4 and still feeling that way, it’s something we should explore together but my hope is that you’ll feel safe from the start.
Not every first session leads to an ongoing fit and that’s a normal part of the process, not a failure on your part. If something felt off, it is worth naming that or deciding if it’s time to look elsewhere.
How to prepare, practically.
Find a private, quiet space if the session is via telehealth
Have a general sense of what you want to talk about
Bring a list of current medications, if relevant
And when possible, give yourself a few minutes after the session before jumping into the rest of your day. First sessions can bring up more than people expect.
Frequently Asked Questions
How long is a first therapy session?
Intake sessions are typically 1.5 hours.
Will I have to talk about my whole life story in the first session?
No, and we couldn’t cover it all if we tried. I’ll learn about you over time.
What if I cry or get emotional in the first session?
Whether you do or don’t, it’s normal. Tears are an important part of the process and if you’re crying, we’re probably on the right track.
Do I need to know exactly what's wrong before I go?
No. Many people start with only a general sense that something feels off and that’s a valid starting point.
Is the first session confidential?
Yes, with standard limits that any therapist should explain clearly, generally involving imminent safety concerns or specific legal requirements.
Have more questions? Just ask!
info@knotandthreadpsychotherapy.com or (917) 970-7890
