What should I expect at my first counseling session? What happens at my intake appointment?

What to expect from your first therapy session

The first session is all about building a foundation, so it’s unlikely you’ll get into the deep stuff right away. “An initial session is more of an intake and information-gathering conversation, laying the groundwork for future therapeutic intervention,” says Jami Dumler, LCSW, director of clinical programs at Thriveworks.

Your first session typically follows this order:

Step 1: Getting to know each other

“Your relationship with your therapist—along with your engagement in the process—is one of the most important factors in therapy success,” Dumler says. This time is about understanding what brought you here and what you’re hoping to change.

Your therapist will ask what made you seek therapy now (not six months ago, not next year—why today?). This is what therapists call your “presenting concerns,” and it helps them understand how best to support you. They’ll also share their background, specialties, and therapeutic approach, so you understand how they work and whether it resonates with you.

“The goal is for you to share your perspective on what challenges you’re facing, and for me to help you understand my approach and what working together will look like,” Dumler says.

Step 2: The paperwork conversation

Your therapist has an ethical responsibility to make sure you understand the legal aspects of therapy. They’ll walk you through what’s confidential (almost everything you discuss), what’s not (if you’re in imminent danger of hurting yourself or others, or if there’s suspected child abuse), and their role as a mandated reporter. This is what’s known as “informed consent.”

“This is also when we discuss practical expectations,” Dumler says, “like attendance, billing methods, insurance, and what happens if you need to cancel.” Even if you’ve already signed forms online, therapists review this in person so you can ask questions and move forward feeling informed and comfortable.

Step 3: Understanding your full picture

Your therapist will ask about your daily life, relationships, family history, past mental health treatment, current symptoms, and what’s working or not working in your life right now. This isn’t them being nosy. It’s how they figure out what kind of support will actually help. Therapists call this a “biopsychosocial assessment,” and it allows them to better understand your full experience and begin shaping care around what matters most to you.

“Your provider might also guide you through questionnaires like the PHQ-9 for depression or GAD-7 for anxiety to establish a baseline for some of the more common mental health conditions,” Dumler says. “These may be revisited throughout treatment to help track your progress.”

Step 4: Setting goals together

Therapy works best when you and your therapist establish clear goals together. You’ll start talking about what you’d like your treatment to focus on, what challenges you want to address, and what areas of your life need the most attention.

“Collaborating on a plan ensures we’re aligned on what progress looks like and how we’ll work toward meaningful improvement over time,” Dumler says.

Step 5: Scheduling your next sessions

Finally, you’ll figure out a regular meeting schedule that works for both of you.

“Creating a plan for when and how we’ll meet helps ensure momentum,” Dumler says. “It makes it easier for both you and your therapist to prioritize sessions and begin working toward your goals.” Most people meet weekly or every other week, though frequency depends on your needs, schedule, and what your therapist recommends.

How to prepare for your first therapy session

There isn’t much practical preparation needed for a first session, but there are some simple ways to make the most of your time.

1. Block off real time and space.

For in-person sessions, factor in travel time so you can arrive five to 10 minutes early and not feel rushed. For virtual sessions, find a private space where you won’t be interrupted—not your car in a parking lot during lunch, not your bedroom while your partner watches TV in the next room.

Test your internet connection beforehand and make sure your device is fully charged. “Having dedicated space and time for your sessions helps ensure focus, allowing you to get the most out of your time,” Dumler says.

2. Think about what you want to focus on.

Spend 10 minutes before your session reflecting on what led you here. Is it a specific event? A pattern you keep noticing? A feeling that won’t go away?

“Coming to the first session with even a rough idea of what they want to focus on helps my clients maximize their time and arrive with more clarity, confidence, and direction,” says Alexandra Cromer, LPC, a therapist at Thriveworks.

If you’re struggling to pinpoint specific goals, don’t worry: Your therapist will talk through your challenges with you and help you establish some together. Even a general sense of what you’d like support with is a great place to start.

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3. Fill out intake forms ahead of time.

Many practices ask clients to complete intake forms before the first session, things like consent forms, medical history, and background information. Taking care of these in advance removes administrative barriers and allows your time together to focus on you and your care.

Spending a few minutes on paperwork beforehand helps optimize your first session, giving you more time to get to know your therapist and make sure everything is set up according to your needs.

How to get the most from your first session

1. Show up willing to try new things.

Therapy might feel awkward at first. That’s normal. The techniques your therapist suggests—like tracking your thoughts, trying breathing exercises, or examining relationship patterns—might seem strange or too simple to actually work.

“One of the most effective mindsets you can have during your first session is being open, flexible, and willing to receive feedback,” Cromer says. “The approaches and concepts of therapy may not make complete sense right away, but as long as you stay open to trying new strategies, you keep yourself open to growth.”

Staying open-minded and showing up with intention is a key part of seeing meaningful results from therapy, Dumler adds. “It allows me to build a framework for care and also helps build trust, laying the groundwork for future sessions.”

2. Give your therapist the full context.

Try to be as specific as possible. Instead of saying “I want to be better in relationships,” explain why that’s a goal and what’s behind it. What patterns keep showing up? Do you always date the same type of person? Do you panic when someone gets too close? Did a past relationship leave you guarded?

“Think of examples, context, or anything else that can help your provider understand what you’re struggling with,” Cromer says. “Say you want to improve your relationships. What experiences or emotions might be driving those issues? Are there patterns or insecurities tied to these challenges? Are there past life events that may have played into them? Providing that context allows me to get a full picture, making it easier to assess the situation and find appropriate treatment strategies.”

​​3. Speak up about what’s working and what’s not.

Therapy is largely client-led, which means honesty is essential. You don’t have to get into everything right away—most therapists want to start with the basics and won’t begin deeper processing until later sessions.

But it’s still important to be honest about what you’d like to address, how you’re feeling in the moment, and your thoughts about the direction of treatment.

“If something feels too vulnerable or scary to answer in the moment, let your provider know and they can help guide you through it,” Cromer says. “Your therapist takes their cues from you, so don’t be afraid to voice your thoughts.”

This kind of honesty allows you and your therapist to figure out what strategies and approaches will work best for you personally.

4. Keep a running record of what you discuss.

In the first session and beyond, it can be helpful to have a record of what’s been covered. “One of the best practices you can have after your session to help adjust to the therapeutic process is to create a brief summary of the visit, either in your head or written down,” Cromer says.

Dumler also encourages clients to keep notes between sessions. “These notes or journal entries might include practices you want to try, what you noticed after doing them, and new topics you’d like to bring into the next session,” she says. “This kind of active participation between sessions helps create a bridge that keeps progress moving forward, ensuring key goals and insights don’t get lost in the busy day-to-day flow of life.”

“I encourage clients to work with their provider to find the best way to carry therapy content beyond the session. Many therapists are open to sharing brief recaps of each session, offering additional resources aligned with session themes, and more.”

The bottom line

Your first therapy session is mostly about gathering information, understanding each other’s communication styles, and figuring out if you’re a good fit. The deep therapeutic work comes later.

If something doesn’t feel right—your therapist’s approach, the way they communicate, the dynamic between you—that’s valuable information. You don’t need to force a connection or do anything that makes you feel uncomfortable.

“I encourage clients to be kind to themselves and give the therapy process time to do its work,” Dumler says. “Adjustments will always need to be made based on your unique concerns, so don’t worry if things don’t feel right immediately. As long as you continue to be vulnerable, discuss your thoughts with your provider, and redirect when needed, progress is possible.”

Frequently asked questions

How long does a first therapy session usually last?

Most first sessions last 50 to 60 minutes, though some therapists offer shorter 30-minute intakes depending on their practice and your needs.

Do I have to talk about everything right away?

No, you don’t have to talk about everything right away. The first session focuses on intake processes, goal-setting, and discussing possible approaches. The real therapeutic work happens in later sessions. Therapy also moves at your pace, so nothing has to be brought up or processed before you feel comfortable talking about it.

What if I don’t click with my therapist?

It may take a few sessions to build rapport, so give it two or three sessions before making a decision. If you’re still not feeling a connection, consider bringing it up directly with your therapist or exploring other providers.

Your current therapist might be able to adjust their approach to better suit your needs, but if the necessary rapport isn’t there, it’s worth finding someone who’s a better fit. Not every therapist works well with every client, and that’s completely normal.