What to Expect from Your First Therapy Appointment

You’ve done your research, found a therapist, and set up an appointment (and, by the way, we’re totally proud of you for taking the first step and being open to therapy in the first place). But as the slotted date and time edges closer, you’re starting to feel a little nervous about what you’re getting yourself into. As another writer eloquently put it, therapy is ironically hard to talk about — and that stigma leads to an air of mystery when it comes to what happens behind closed doors.

Plus, sometimes it’s hard to talk with even your best friends about the emotional gymnastics going on in your brain — let alone revealing your full history of poor relationships or family drama to a complete stranger, in 60 minutes or less.

what to expect from your first therapy appointment

The first step to being comfortable with your therapist is to be comfortable with the process of going to therapy, and part of that is knowing what to expect from your first appointment. We’re here to reveal the man behind the curtain and take away some of the uncertainty that comes with being new to therapy. We’re of the mind that building your mental and emotional muscles is just as important as getting in a workout, and that whether you’re in a time of crisis or cruising along through life, therapy can benefit you in at least some small way.

Here’s what you should know before your first therapy appointment.

Before you show up, think about your goals for therapy

Dr. Paula Freedman, a licensed clinical psychologist at Interaction Dynamics in Chicago, notes that many people come to their first therapy appointment with the vague but hopeful goal of “feeling better.” However, your psychologist is probably going to need you to be a little more specific than that.

“I’ll usually ask, ‘how will we know this is working?'” she says, so she knows what changes and what outcomes to keep an eye out for. Examples might include not getting overwhelmed easily, or not lashing out at a partner during a bad day, or having a more peaceful relationship with food.

Another thing to consider: if you’ve had therapy before, contact your past therapist to request what’s called a treatment summary.

Explains Dr. Kendra Kubala, “[A treatment summary] will include a write-up of your time in treatment with the previous provider. You may choose to sign a release of information so that the two professionals may communicate. You can also jump right in; an informed and competent therapist will ask for clarification when needed.”

Know what’s probably on the agenda for your first appointment

Your first session, says Dr. Camila Williams of Living Well CBT, is almost always for information-gathering.

“The first therapy session is almost always an intake,” she explains. “This is an information gathering session. The therapist wants to know your “presenting concerns” aka what brought you to therapy, what’s going on? They want some background – any significant events in your past that affect your coping, and regarding prior mental health treatment, what helped versus what didn’t.”

While it varies from doctor to doctor, Dr. Freedman notes that she’s paying attention to a few different things during an initial session. In addition to information gathering, she’s mentally conducting a risk assessment to make sure her client isn’t in any immediate danger, while simultaneously judging whether her office setting is the right amount of support for the client.

Beyond that, your therapist wants to see if the two of you hit it off personality-wise and if there’s a possibility to build a solid relationship. To that end, your therapist is likely considering whether her therapy style is going to be a good fit for you and your goals.

Finally, your therapist will begin to outline a treatment plan and set some initial goals for your sessions. That way, you’re working together to build a road map to stronger mental health, which will guide your next sessions instead of leaving you aimlessly talking.

You might be surprised to know this…

…but according to Dr. Freedman, your first therapy appointment is probably going to be way more chill than you expected it to be.

People expect therapy to be really unpleasant, and they’re pleasantly surprised that it’s not,” she explains. “They tend to think it’s going to be really serious and uncomfortable, or that they’ll have to put out raw feelings right away and they’re going to cry right away. But not every session is super intense — it can be fun!”

Here’s how you should decide if it’s worth a second appointment

Of course, if you hit it off right away with your therapist and can’t wait to come back, there’s no need to shop around any more. But what if you just had a kind of average first appointment?

In this case, Dr. Freedman recommends going back to the same therapist at least two more times.

“If you’re on the fence and there’s not a glaring red flag, go for a second or third date,” she advises.

A good barometer, she goes on to explain, is to ask yourself whether you feel hope at the end of the session.

“You should feel like you’re going to get somewhere,” she shares. “At the same time, therapy gets harder before it gets easier, especially if you’re talking about something intense for the first time. It can be overwhelming or intense at first. Don’t give up right away, and give it a chance.”

Dr. Fawn McNeil-Haber of Brave Minds Psychological Services agrees that therapy can be overwhelming at first, adding “You should leave the office feeling understood and with hope that things can improve.  You may also leave feeling a little vulnerable, which makes sense —  you’ve just shared intimate information.”

And if you need to take a few days, or even weeks, to decide if you want to come back, that’s absolutely fine, and a good psychologist won’t be bothered by that at all. Dr. Freedman noted that she’s had clients who went to a first appointment and then didn’t schedule a second one until months later.

“You won’t hurt our feelings!” she laughs, noting that it’s just part of the job.

Remember, it’s a process

At the end of the day, your first therapy appointment isn’t going to be the one hour in which all your mental health issues are magically cured — and that’s okay.

People want to feel good,” muses Dr. Freedman, “and there’s a false idea that feeling good means never feeling sad, nervous scared, any unpleasant emotion for the rest of your life. That doesn’t exist, and that’s not what it means to handle emotions in a healthy way. In therapy, you’ll learn to not let emotions suck you into a black hole of terribleness while recognizing that life comes with sadness and pain.”

If you’re looking for a therapist, we wrote this post about how to find a therapist. This tool from Psychology Today is a good place to start too.



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About Kristen Geil

A native of Lexington, Kentucky, Kristen moved to Chicago in 2011 and received her MA in Writing, Rhetoric, and Discourse from DePaul while trying to maintain her southern accent. Kristen grew up playing sports, and since moving to Chicago, she’s fallen in love with the lakefront running path and the lively group fitness scene. Now, as a currently retired marathoner and sweat junkie, you can usually find her trying new workouts around the city and meticulously crafting Instagram-friendly smoothie bowls. Kristen came on to A Sweat Life full-time in 2018 as Editor-in-Chief, and she spends her days managing writers, building content strategy, and fighting for the Oxford comma.