What to expect in your first therapy session

It is normal to feel nervous

Starting therapy can feel like a big step. The American Psychological Association notes that it is normal to feel a little anxious in the first few sessions^{Source [1]}. Reaching out is already part of the work, and you do not have to know exactly what to say.

What happens in the first session

At the first session, the therapist usually gathers information about you and your needs, and you may be asked to fill out forms about your physical and emotional health^{Source [2]}. Psychotherapy, also called talk therapy, aims to help you identify and change troubling emotions, thoughts, and behaviors^{Source [3]}.

At Choosing Hope, the first session is an intake assessment. We talk about what brings you to therapy, your background, and your goals, so that follow-up sessions can focus on what matters most to you.

You will likely also cover practical matters, such as how to schedule or cancel, fees, and confidentiality^{Source [1]}. Counselors are expected to review your rights and responsibilities with you, in writing and in conversation, as part of informed consent^{Source [4]}.

Questions you might be asked

The first session can feel like a lot of questions. That is by design: it helps the therapist understand your situation. You might hear questions like these:

• What brought you here today?
• What has been going on, and when did it start?
• How is it affecting your sleep, work, school, or relationships?
• What have you tried so far, and what has helped?
• What would you like to be different?

You set the pace

It is okay to say that you are not ready to talk about something yet^{Source [1]}. It can take a few sessions for a therapist to fully understand your situation^{Source [2]}, so there is no need to cover everything on the first day.

Confidentiality and its limits

Except in rare cases, conversations with your therapist are confidential^{Source [2]}. Your therapist should explain the limits of confidentiality at the start^{Source [4]}. In general, the exceptions involve protecting you or someone else from serious harm, and situations where the law requires it, such as suspected abuse or neglect of a child or a vulnerable adult^{Source [1]}.

Questions you can ask the therapist

The first session is also your chance to interview the therapist^{Source [2]}. The National Institute of Mental Health suggests asking questions like these^{Source [3]}:

• What are your credentials and experience?
• What approach do you use, and how will we set goals?
• How long might treatment take, and how will we know it is working?
• Are our conversations confidential, and what are the limits?

How to prepare

You do not need to prepare much, but a few steps can help^{Source [5]}:

• Write down what you want to talk about and any questions you have.
• Note when your concerns started, how often they happen, and how strong they feel.
• List any medications you take.
• Think about what you would like to be different.

If your first session is online

Choose a quiet place where you can talk openly, test your technology, and sign on a few minutes early^{Source [6]}. Our article on whether online therapy is effective covers more tips and what the research says about video sessions.

How to tell if the fit is right

The relationship with your therapist matters. A review that combined 295 studies found that a stronger working alliance between client and therapist is linked to better outcomes, both in person and online^{Source [7]}.

After the first session, ask yourself whether you felt listened to, respected, and not judged. Feeling fully comfortable can take a few sessions, and results do not happen overnight^{Source [2]}. If something does not feel right, it is okay to say so. A good therapist will welcome that conversation.

How we can help

At Choosing Hope, we offer a warm, judgment-free space, in English or in Spanish. Every session takes place online on a secure video platform, so you can start from home anywhere in New York State. You need to be physically located in New York State during each session.

We work with adults, couples, and families on concerns such as anxiety, depression, grief, and life transitions. If you have questions before your first session, including about rates or our sliding scale, call us or fill out our short contact form, and we will help you figure out what fits.

Common questions

References

1. American Psychological Association (2023). Understanding psychotherapy and how it works
2. Mayo Clinic (2023). Psychotherapy
3. National Institute of Mental Health (2024). Psychotherapies
4. American Counseling Association (2014). 2014 ACA Code of Ethics
5. National Institute of Mental Health (2022). Tips for Talking With a Health Care Provider About Your Mental Health
6. U.S. Department of Health and Human Services, Telehealth.HHS.gov (2025). What should I know before my telehealth visit?
7. Flückiger C, Del Re AC, Wampold BE, Horvath AO. Psychotherapy (2018). The alliance in adult psychotherapy: A meta-analytic synthesis