What to Expect in Your First Therapy Session: A Complete Guide
- Jenna Miles
- 10 minutes ago
- 8 min read
You've made the decision. You've found a therapist. You've scheduled your first appointment.
And now you're wondering: What the hell happens in a first therapy session?
If you're feeling nervous, know that is completely normal. Almost everyone feels some anxiety before their first therapy appointment. Will they judge me? What if I cry? What if I don't know what to say? What if we just stare at each other in awkward silence?
Here's the good news: your therapist has done this hundreds (maybe thousands) of times. They know you're nervous (and often they are a little bit too). They expect the nerves. And they're not going to throw you into the deep end.
At Mile by Miles Counseling, we want your first session to feel as comfortable as possible. So, let's walk through exactly what to expect from the moment you walk in (or log on) to the moment you leave.
Paperwork (Yes, There's Paperwork):
Most therapy practices—including ours—will ask you to fill out intake forms before your first session. This typically includes:
Basic information: Name, address, contact info, emergency contact
Insurance information: If you're using insurance
Medical history: Current medications, past mental health treatment
Consent forms: HIPAA privacy notice, informed consent for treatment
What brings you to therapy: A brief overview of what you're hoping to work on
Questions to Think About (But Don't Stress Over)
Your therapist will ask you questions to get to know you, but it can help to think about:
What made you decide to try therapy now?
What are you hoping to get out of therapy?
Have you been to therapy before? If so, what was helpful (or unhelpful)?
Are there specific issues you want to work on? (Anxiety, relationship problems, trauma, life transitions, etc.)
You don't need perfect answers. "I don't really know, I just know something needs to change" is a completely valid response.
What to Bring
A water bottle (it's okay to get emotional, and hydration helps)
An open mind (seriously—that's the most important thing)
It's really that simple.
The First Few Minutes: Getting Comfortable
If You're Coming In-Person:
When you arrive at our practice, you will just have seat in the waiting room. We have snacks, coffee/tea, and water for you. It's cozy, not clinical. We want you to feel comfortable and not like you're sitting in a doctor's office. This is way more chill than that.
Your therapist will come out to meet you, introduce themselves, and bring you back to their office. Most therapy offices are designed to feel warm and inviting—comfortable chairs, soft lighting, maybe some plants or calming artwork.
If You're Doing a Virtual Session:
You'll receive a secure video link before your appointment. Log on a few minutes early to make sure your camera and audio are working. Find a private, comfortable space where you won't be interrupted (we know this is not always a guarantee, if there is an interruption that is okay). Grab some water, maybe a blanket or pillow—whatever helps you feel at ease. If home doesn’t feel like the right place for you to have your session, many people drive to a park or park in a parking lot and have their session from there. Whatever and wherever makes you feel safe and comfortable is what we want for you.
Your therapist will join the call, introduce themselves, and make sure you can see and hear each other clearly.
The Vibe Check
Here's what most people don't realize: the first session is as much for you to evaluate the therapist as it is for them to evaluate you.
Pay attention to how you feel. Do they seem warm and approachable? Do you feel judged, or do you feel heard? Do they explain things clearly? Not every therapist is the right fit for every person, and that's okay. A good therapist will actually encourage you to find someone who feels right—even if that's not them.
What Your Therapist Will Ask You
Your first session is mostly about gathering information and getting to know you. Here's what your therapist will likely ask:
1. "What brings you to therapy?"
This is the big one. Your therapist wants to understand what's going on in your life right now and what you're hoping therapy will help with. Maybe you're dealing with anxiety, depression, or panic attacks. Maybe you're going through a breakup, a career change, or a family conflict. Maybe you experienced trauma—recent or from years ago—and it's affecting you now. Or maybe you can't quite put your finger on it. You just know something feels off. All of these are valid reasons to be in therapy.
There's no "right" answer.
2. "Have you been to therapy before?"
If you have, your therapist will want to know what worked (or didn't work) for you. This helps them tailor their approach. If you haven't, that's totally fine. Your therapist will explain how therapy works and what you can expect moving forward.
3. "What's your support system like?"
Your therapist will ask about the people in your life—family, friends, partners. Not because they're nosy, but because understanding your relationships helps them understand you. This is also where you might talk about cultural background, identity, and community. At Mile by Miles Counseling, we recognize that your culture, race, sexual orientation, and life experiences shape your mental health. We want to understand the full context of your life so we can best support you.
4. "Are you experiencing any safety concerns?"
If you are struggling with suicidal thoughts, your therapist will work with you to create a safety plan. Therapy is a judgment-free zone, and your therapist's job is to keep you safe.
5. "What are your goals for therapy?"
Some people have crystal-clear goals: "I want to stop having panic attacks" or "I want to save my marriage." Others have vague goals: "I just want to feel better" or "I want to figure out why I keep sabotaging myself." Both are fine. Your therapist will help you clarify and refine your goals as you go.
Questions You Can Ask Your Therapist
Remember: the first session is an interview that goes both ways. Here are some questions you might want to ask:
"What's your approach to therapy?" (CBT, EMDR, psychodynamic, etc.)
"Have you worked with people dealing with [your specific issue] before?"
"How long does therapy typically take?" (There's no one-size-fits-all answer, but they can give you a general idea)
"How often should we meet?"
"What should I do if I need support between sessions?"
"Do you have experience working with [your identity/community]?" (e.g., veterans, LGBTQ+ individuals, people of color)
We want you to feel empowered to ask questions. A good therapist will answer openly and help you feel confident in your decision to work with them.
Things That Might Surprise You About Your First Session
You Might Not Dive Deep Right Away
Some people expect to unload their entire life story in the first session. And you can, if you want to! But you don't have to. First sessions are often more surface-level—getting to know each other, understanding the basics, setting goals. The deep work comes later, once you've built trust.
It's Okay to Cry (But You Don't Have To)
Some people cry in their first session. Some people don't cry until their tenth session. Some people never cry at all. All of these are normal. Your therapist has seen it all, and they won't judge you either way.
You Might Feel Worse Before You Feel Better
Therapy can stir up emotions you've been avoiding. It's normal to feel a little raw or drained after your first few sessions. This doesn't mean therapy isn't working—it means it is working. You're starting to process things you've been pushing down.
You're in Control
If your therapist asks a question you're not ready to answer, you can say, "I'm not ready to talk about that yet." If something doesn't feel right, you can speak up.
Therapy is a collaborative process. You're not a passive patient. You're an active participant.
After Your First Session: What Happens Next?
At the end of your first session, your therapist will usually:
Summarize what you talked about and reflect back what they heard
Discuss next steps—how often you'll meet, what you'll work on, etc.
Schedule your next appointment (weekly is common, but it depends on your needs and availability)
Answer any final questions
You'll leave with a clearer sense of what therapy will look like moving forward and hopefully, a sense of relief that you've taken the first step.
Common First-Session Worries (And Why They're Not a Big Deal)
"What if I don't know what to say?"
Your therapist will guide the conversation. They're trained to ask questions and help you open up. Awkward silences happen sometimes, and that's okay.
"What if I cry the whole time?"
Crying is welcome in therapy. Your therapist will hand you tissues, give you space to feel your feelings, and not rush you.
"What if I don't like my therapist?"
Then you find a different therapist. Seriously. Fit matters, and a good therapist will understand if you want to see someone else.
"What if my problems aren't 'bad enough' for therapy?"
There's no threshold for "bad enough." If something is bothering you, it's worth working on. Therapy isn't just for people in crisis. it's for anyone who wants support, growth, or change or just someone outside of their world to talk to.
"What if I'm judged?"
Therapists are trained to be nonjudgmental. That's literally part of the job. Whatever you're dealing with, your therapist has probably heard something similar (or more intense) before. If you feel judged, it may not be a great fit.
Special Considerations for Different Communities
We recognize that starting therapy can feel different depending on your background and identity.
For Veterans and Military Families:
You might be wondering if your therapist understands military culture. Our therapist, Jacquie Shires, is a military spouse who specializes in working with veterans and military families. She gets the unique challenges you face—and she offers EMDR therapy, which is highly effective for PTSD and doesn't require you to relive traumatic details.
For the Black Community and People of Color:
Finding a therapist who understands your cultural context isn't just a preference, it's essential for effective therapy. Our therapist, Kyi Sterling, is a Black therapist with extensive community mental health experience. She creates a space where you can show up as your full self without having to explain or translate your experiences.
For Mothers Everywhere:
Sometimes you might want to meet with a therapist who you know understands the nuances of motherhood, the identity shifts, the sacrifices, the struggles. Our therapists, Lauren Shaulis and Eloise McCorkle, are both moms themselves as well as having taken specialized training in supporting moms. They get it.
For LGBTQ+ Individuals and Couples:
You deserve a therapist who affirms your identity and relationships. Our practice is LGBTQ+ affirming, and we specialize in working with queer individuals and couples. Jenna Miles has additional professional training in supporting the LGBTQ+ community as well as couples in both monogamous and consensual non-monogamous relationships.
What If You're Still Nervous?
That's completely normal. Here's what helps:
Remind yourself why you're doing this. You're taking a brave step toward feeling better.
Give yourself permission to take it slow. You don't have to spill your deepest secrets in the first session.
Remember: your therapist is on your team. They genuinely want to help you.
Trust the process. It might feel awkward or uncomfortable at first, but it gets easier.
Your journey starts with a single session.
Ready to Take the First Step?
At Mile by Mile Counseling, we make starting therapy as easy as possible. Whether you're dealing with anxiety, depression, trauma, relationship issues, or just feeling stuck, we're here to help.
We offer:
In-person therapy in Ashland, VA
Virtual therapy throughout Virginia
Specialized care for veterans, military families, LGBTQ+ individuals, people of color, and couples
Insurance accepted (Anthem BCBS, Healthkeepers, Sentara, Aetna)
Evidence-based approaches including EMDR, CBT, and culturally competent care
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