Your first session

If you’ve never worked with a therapist, you might be wondering what to expect. It can vary by therapist and type of therapy, but a few things are usually the same.

The first session usually involves your therapist getting to know you and setting expectations. They’ll ask about your life experiences, if you’ve gone to therapy in the past—and if you have, what worked and didn’t work for you—what’s bringing you to therapy now, how you’re currently managing any challenges you’re facing, and more. This session is question-heavy and therapist-talking-heavy, so be prepared for that. 

After that, depending on how often you meet, sessions might begin by discussing what happened since your last session, and then going deeper on something important to you. Topics that come up in therapy could include: your childhood; past and current relationships; difficult situations you’ve gone through or are going through; and your thoughts, feelings, and behaviors in different circumstances. Your therapist might also point out things they notice in the therapy setting or in your relationship with them, as your relationship with them is probably similar to your relationship in the world.

Here are a few things you might expect to feel or experience:

Your therapist will guide your first session and all future sessions, and will give you an idea of what to expect each time. That being said, there are things you can do to help you get the best results.

For your first full session:

• Be ready to share why you’re seeking therapy (including specific symptoms or challenges) and what you hope to achieve over the course of treatment to help define goals with your therapist. This can be hard, and might evolve over time, but try to be as specific as possible.
• If you have past experience with therapy, think about what worked well and what didn’t, so you can share this with your therapist. It can help to talk about what, if anything, you struggled with in the relationship with that therapist (speaking up, setting goals).
• If you are coming in to talk about a feeling, like sadness, or a stressor, like family, it can help to bring in specific things you want to be sure to cover on those topics (and write them down throughout the weeks leading up to your visit). For example, for sadness, you might want to notice how often you are sad and what seems to trigger it. What concerns you about it? What symptoms are you noticing other than sadness?
• Review your past and current medications and family medical history so you can share this information on office forms or in discussion. This might mean looking back at your pharmacy or your medical records and talking to family members about their histories.
• Be prepared to do a lot of talking to help your therapist get to know you, and try not to get too frustrated with clarifying questions and silence–this is all part of the process. Try to plan for some rest after the session.

Your therapist might bring up the topic of medication—whether as-needed for relief in specific situations or on a regular basis to help with an ongoing condition. If your therapist suggests that you try it, they may refer you to a psychiatrist. Your primary care doctor can also prescribe and manage medication for mental health conditions, depending on their comfort and the severity of your symptoms, and might be a good place to start.

Sometimes medication comes up because they notice your symptoms aren’t improving with therapy alone. Or, they may notice your symptoms might be interfering with your ability to process and participate in therapy.

While taking medication is common and a well-proven part of treatment, it’s completely normal if you feel nervous or have questions about medication. You should feel comfortable asking questions, expressing your concerns, and even waiting and thinking about it.

The length and frequency of sessions, as well as how long therapy lasts will vary based on your reasons for therapy, the type of therapy, and your goals. 

Session length: Sessions are typically 45-55 minutes. It may seem weird that they always start and end on time, but actually this is part of the safety in the appointments: You always know what to expect. For more intensive treatment or group therapy, sessions will likely be 80-85 minutes. 

Session frequency: Sessions tend to be every other week or weekly, especially at the beginning. For more serious situations or specific kinds of therapies (like trauma), they may be multiple days each week. Over time, you might meet less often. 

There’s no standard rule, but people generally stop attending therapy when:

One clear way to tell if therapy is “working” is by reviewing progress toward your goals—whether those involve reducing symptoms of a condition, overcoming difficult emotions, or coping with a challenge.

Recognizing change within yourself is one indicator of progress. When you begin feeling a sense of relief or hope, that suggests you may be thinking and feeling differently. You might also be sleeping better, or functioning better day to day at work and in your relationships.

You can also regularly check in on progress with your therapist, or talk to loved ones about what changes they observe (if that feels comfortable for you). Sometimes they notice changes before you, and that can be helpful.

Seeing results from therapy takes time, but the results can be life-changing and long-lasting when you stick with it. Remember that even though it might take time to find the right fit, and it may feel uncomfortable and even hard to talk about yourself at first, therapy is worth it.

1. American Psychological Association. Length of Treatment for PTSD