How to Prepare for Your First Therapy Session (Without the Stress)

Sarah
Sep 29
5 min read

Starting therapy is a big, brave step. Whether you’ve been thinking about it for months or you booked your first session on a wave of courage, you might be feeling a mix of hope and nerves. That’s completely normal. Most people walk into their first therapy appointment unsure of what to expect, what to say, or even if they’re “doing it right.”

The good news is this: you don’t have to have it all figured out. Your therapist doesn’t expect perfection from you, I promise! They expect honesty, uncertainty, and a little bit of anxiety. This guide will walk you through what usually happens in a first therapy session, common questions your therapist might ask you, and the questions you can (and should!) ask them. The goal is to help you feel more prepared and empowered as you begin your therapy journey.

Why Starting Therapy Feels Nerve-Wracking

It’s worth acknowledging the emotional weight of starting therapy before diving into logistics. Many people are surprised at just how anxious they feel before that first appointment. There are a few reasons for this:

The unknown factor. You don’t know what the therapist will be like, what they’ll ask, or how much you’ll be expected to share. Anytime we step into unfamiliar territory, our nervous system ramps up.
Vulnerability. Therapy is a place where you’ll eventually share thoughts and feelings you might not even admit to yourself. Even though you don’t have to tell your whole life story in session one, just the possibility can feel overwhelming.
Fear of judgment. Many people wonder: What if my problems sound silly? What if I say the wrong thing? A core part of the therapist’s job, though, is maintaining a judgment-free space.
Pressure to “get it right.” Some clients feel they have to prove they’re “sick enough” for therapy, or that they need to explain themselves perfectly. But the goal of therapy isn’t to pass some test! Show up just as you are today, ready to learn more about yourself and start getting relief.

If you notice your heart racing or your mind going blank on the way to your appointment, remember this: therapists know first sessions can feel scary. It’s their job to guide you through and help you feel safe.

What Typically Happens in a First Therapy Session

While each therapist has their own style, most first sessions follow a general structure. Knowing this ahead of time can help reduce some of the unknowns.

Introductions. Your therapist will start by welcoming you, introducing themselves, and explaining their role. They’ll often review confidentiality (what they can and cannot share) so you know what’s private and what has limits, like if someone is in danger.

Paperwork and logistics. Before or during your session, you’ll likely review intake forms. These often include consent for treatment, practice policies, and sometimes questionnaires about your history or current concerns.

Getting to know you. A first session is usually about gathering information. The therapist may ask why you’re seeking therapy now, what’s been going on in your life, and what goals you hope to work toward. They may also ask about your history with mental health, medical conditions, or important relationships.

Your chance to share. You don’t have to tell your life story in perfect detail. Many people start with the biggest struggle they’re facing, while others don’t know where to begin. Either way is okay. A good therapist will help guide the conversation without pushing you too far, too fast.

Collaboration. Therapy is not a lecture or a one-sided interrogation. Your therapist wants to understand your perspective and create a plan with you. You might leave with a few goals or simply a sense of relief that you’ve taken the first step.

And most importantly: you don’t have to have it all figured out in the first session. Think of it as putting on your tennis shoes, not running the whole marathon.

Questions Your Therapist Might Ask You

Knowing some of the questions you might be asked can also help ease first-session nerves. These questions aren’t designed to trip you up. They’re meant to help your therapist understand you better. Some examples include:

What brought you to therapy right now?
What are your main concerns or goals?
Have you been in therapy before? If so, what was helpful or unhelpful?
What’s your support system like? Friends, family, community?
How are you coping currently? What strategies do you use when things get hard?
Do you have any medical conditions, or are you taking medications that might affect your mood?
What does a “better” version of life look like to you?

Some of these might feel big and hard to answer. That’s okay. A simple “I’m not sure yet” is an acceptable response. Therapy is a process of discovery, and your therapist doesn’t expect you to have all the answers on day one.

Questions You Can Ask Your Therapist

It’s easy to forget that the first session isn’t just about your therapist learning about you, but it’s also about you learning about your therapist. Therapy is a deeply personal relationship, and you deserve to feel safe and informed. Here are some good questions to consider asking:

What’s your approach or style as a therapist? (They might say CBT, psychodynamic, trauma-informed, etc.)
Have you worked with clients who share my concerns?
What does a typical session look like with you?
How long do people usually stay in therapy? (This varies, but the answer can give you a sense of their philosophy.)
How do you measure progress?
What are your policies around cancellations or emergencies?
If I don’t feel comfortable with something in therapy, how should I bring that up?

Asking these questions is practical and it also helps you gauge whether this therapist feels like the right fit. You are allowed to be curious and to take an active role in your own care.

Tips for Making the Most of Your First Session

To help you feel more grounded, here are a few practical steps you can take:

Jot down a few notes beforehand. Think of 2–3 things you’d like to mention, such as “anxiety at work” or “grief since losing my parent.” This helps if your mind goes blank under pressure.
Remember that emotions are welcome. It’s okay to cry, laugh, feel awkward, or sit in silence. Therapy is a safe place for whatever comes up.
No perfect story required. You don’t need to explain everything chronologically. Share what feels most pressing, and the rest will come with time.
It’s okay to say “I don’t know where to start.” Many people begin therapy this way. It’s an honest and perfectly acceptable opening.
Reflect afterward. After your session, take a few minutes to write down how you felt about the therapist, what you noticed about yourself, and anything you want to bring up next time.

When to Reevaluate Fit

It’s important to know that you don’t have to stick with the first therapist you meet if something doesn’t feel right. Some questions to ask yourself after a few sessions:

Do I feel heard and respected?
Does my therapist create a safe space for me to be myself?
Do I feel judged, or do I feel supported?
Am I starting to notice small shifts, even if subtle?

If the answer is consistently “no,” it’s okay to look for another therapist. Therapy works best when you feel comfortable and connected.

Your first therapy session is the very beginning, not the final destination. Feeling anxious is normal, but remember: you don’t have to show up polished or with everything figured out. You only have to show up as you are.

In that room, you’ll find someone trained to listen without judgment, help you untangle your struggles, and support you in building a healthier, more grounded life. And you’ll find that over time, the initial nerves give way to trust, connection, and genuine growth.

So take a deep breath. You’ve already done the hardest part: deciding to begin.

If you’re reading this and feel ready to start therapy, but haven’t found the right fit, reach out to us and we’ll schedule a free consultation to talk about what working with us would look like!