Your first session

Starting therapy is a big step. To put yourself at ease, there are things you can do to prepare and help make the most of your first session and any ones that follow.

What should I expect?

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:

  • You may feel strong emotions. This is totally normal, and it helps your therapist understand how you’re feeling, so try not to hold back. It’s also OK if you don’t experience this. If you feel blocked or out of touch with your emotions, you can explore this with your therapist, too. The important thing is talking about it.
  • You’ll need to look inward. Therapists usually guide you to reflect on your thoughts and feelings to become more self-aware. You will begin to notice things you might never have noticed before about yourself, and that can feel scary, but it also helps you grow.
  • You’ll learn to help yourself. Therapists won’t solve your problems for you, but they’ll help you understand how you react to them and can suggest new ways of dealing with what you’re feeling and going through.
  • You might have “homework.” Your therapist might ask you to journal, try out new coping strategies, or make observations between sessions. These are common and effective methods that therapists who use cognitive-behavioral therapy (CBT) or dialectical behavioral therapy (DBT) approaches may use. These assignments should be realistic for you to actually do, so speak up if you think it is too much or not feasible. 
  • You might not know what to talk about sometimes. You might feel like you don’t have much to say, and you may feel tempted to cancel. Instead, be honest with your therapist about this (“I honestly almost canceled today because I feel like I have nothing to say.”). Together, you can help figure out how to spend your session time and might even delve into something you shelved from a past session.
  • You might feel worse before you feel better. You might notice that the strong emotions that come up in therapy, also start to come up between sessions. This happens sometimes, especially in therapies like trauma therapies. But, you have to go through it to get through it, and that is expected. Talk to your therapist about this.
  • You may feel impatient. It can take around 10 sessions to judge the fit and progress with a (new) therapist, so give therapy time to work. You are working on changing behaviors or coping with things in your life, and that takes time.

How should I prepare?

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.

For following sessions, there are some good habits you can develop to make the most of your time together:

  • Reflect on and revisit the goals you set early on with your therapist.
  • Set aside a few minutes before the session to gather your thoughts (or if you’re meeting by video or phone, find a good quiet location to get set up and remove distractions).
  • Note topics you’d like to cover in advance, so when the session starts you’re both aligned on how to make the most of your time together. Taking notes between visits can be helpful.
  • Do assignments if you are in a therapy that incorporates them. If you struggle doing them, talk about it with your therapist, as that is important, too.
  • If you have a disagreement or do not like something, or do not feel you are progressing, talk about it with your therapist. It can sometimes feel easier to just stop going, or to participate less, but that isn’t helpful. Speaking some of these things out loud can help significantly. 
  • Make sure to set realistic expectations about your progress—change takes time and effort. Be kind to yourself along the way.

Learn more about different types of therapy

What if my therapist recommends medication?

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. 

How long and how often should I go to therapy?

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:

  • Your symptoms improve: While it varies by person, research suggests half of folks with mental health symptoms need 15 to 20 sessions to see symptoms subside. More serious conditions could require 12 to 18 months.1
  • You achieve your goals: Setting clear goals up front and regularly discussing progress can make it easier to realize when you’ve reached this point. It’s usually a good sign if you feel like you’re able to effectively manage the challenges that brought you to therapy, or you feel like you no longer need therapy for growth. 

The choice is always yours. Even if you achieve your goals, you might want to keep seeing a therapist for regular self-care or on an as-needed basis. If you feel progress isn’t being made, you can talk to your therapist about changing approach, switching to a new therapist, or ending therapy.

How do I know therapy is working?

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.

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  1. American Psychological Association. Length of Treatment for PTSD