Therapy First Session: A Guide For The Nervous & Curious

You’re going to do great, because there is no wrong way to do therapy! 

A lot of the time when I first see a client in therapy there is some kind of emotion that they’re feeling…nervous, anxiety, ready, excited, neutral. 

For those feeling antsy about starting, I want to give you a guide about the your first therapy sessions so you feel a little less nervous for meeting with your therapist for the first time. 

Before your first session: 

Consultation Call

You mostly likely had a quick chat with your therapist about why you are thinking about coming to therapy. Sometimes people have remaining questions or things they needed from the call. You can ask those questions at your first session. 

Paperwork

Your therapist is required to have you fill out paperwork before sessions start. Usually, they are emailed to you beforehand. Just like going to the doctor, you have a bunch of forms to fill out.

In general, these are the forms you will fill out: 

Intake Form/Questionnaire

This helps therapists gather information about you, your family, and your mental health

Questions Can Include:

• What brings you to therapy

• What are your goals for therapy

• Any mental health diagnosis

• History of mental illness (yourself and family)

• Medications

• If you have been hospitalized for mental illness

• Do you drink or use drugs or have history of substance use

• Have you experienced trauma

• Do you have suicidal thoughts (currently or in past) 

• Have you attempted suicide 

• What your relationships are like 

• What are your living arrangements

• What do you do for work

• Have you been to therapy before

Assessments

Demographics

Informed Consent

Practice Policies

Notice of Privacy Practices

Consent for Telehealth

How to prepare for your first therapy session

• If you have to bring in paperwork, bring it in! We can’t start without it

• Write down any questions you may have

• If you’re comfortable, tell your support people you’re starting therapy. Ask them to check in on how it went, if you want them to. 

• Be ready to talk about what’s going on with you, but know you can say you need more time to share about certain things

Things I want clients to know before they come in 

• It’s okay to feel however you’re feeling about starting therapy

• I are not here to judge you for why you’re coming to therapy

• I’m anticipating that you might be nervous/anxious 

• I won’t make you deep dive into the hard stuff asap

• I think you’re awesome for taking steps to help yourself in coming to therapy

• There’s no wrong way to do therapy

• I am a stronger. It will take time to build trust and comfortability with sharing your life

• I don’t expect you to: show up as your best self, put on a show, be perfect at therapy

• I also don't expect you to know the answers

• I don't care if you word vomit bits and pieces of info at me

• No apologies necessary

What is the first therapy session like?

Sometimes, depending on the therapist, the first session doesn’t feel like therapy. Which is disappointing for some, because you really want relief and to dive in!

Therapists need to gather more info about you, so the first session will be them asking you a lot of nosy questions about the information you gave on your intake paperwork. There will be additional questions as well, but, sometimes, it can feel repetitive. 

As therapists we are trying to determine:

• First, that you’re keeping yourself and others safe

• Where your mental health is at (SOS status, struggling but ok, doing ok for the most part, etc.)

• How many days/weeks/months/years something has been impacting you

• How long feelings/experiences last (ex: panic attack for 3 hours twice a week)

• How frequently you experience these feelings

• What coping skills you use

• Who is your social support

We try to create a safe, understanding, and empathetic environment for you from the beginning. But, the first session(s) we may or may not have fun or engaging conversations because we are getting info about you. I promise after a few sessions it gets more interesting.

Tips for first therapy session

• Expect that the first session is more a question and answer about you and less therapy

• Be as honest/open as you can or are comfortable with

• You don’t have to share everything at once. We have time to learn it all about you

• It may feel uncomfortable/awkward at the beginning, because we may ask a lot of questions about what’s happening, how you respond, who knows, etc.

• Frankly, it can seem like we’re grilling you for why you're in therapy, but we really are just trying to get to know you and pepper in some lighthearted, caring conversation. 

• You may get interrupted by us. Sometimes clients come in and, for the first time, share ALL their life's stories. We may interrupt to get necessary information about you, but it doesn’t mean we don’t want to hear those stories at some point

• Ask us questions

• Know we cannot read your mind. We try to piece information together, but we will ask what you mean about something instead of assuming or jumping to conclusions

• Be patient. The initial “getting to know you” period can take a few sessions 

• There is no quick fix to emotions and life (I wish ice cream fixed everything, but it’s only temporary goodness)

I think of therapy as trying to put together about five different puzzles at the same time, but all the pieces to these 5 puzzles are in the same box. It takes some sorting and arranging for us to understand how you think and feel. Over time we put pieces together and you start to see what the picture is, which is really fucking dazzling for a therapist to watch unfold.

Jessica Miller, LMFT

About the author: Jessica Miller is a licensed therapist in the state of California. Her background is in domestic violence, self-esteem, anxiety, trauma, and somatic experiencing. She believes that life is messy and sometimes we need someone to understand that we don't know wtf we're doing.

If I made therapy less intimidating...reach out to schedule a consult!