What to Expect in a First Therapy Session

Starting therapy for the first time, or returning to therapy after a break, can feel really daunting. As a therapist, I often think that the work I do feels draped in a cloak of mystery and uncertainty. I commonly hear people asking – What actually happens in therapy? What will a therapist ask me? Will I feel overwhelmed by therapy? What if I become upset during a session? What if I don’t like my therapist? What if they don’t get me? And when I think back, I recognise these questions as having swum around the whirlpool of my mind when I waited for my first-ever therapy session many years ago.  

When I work with new clients, I always try to welcome questions and uncertainty into the room. Clients can arrive at first sessions feeling a whole range of emotions – anxiety, scepticism, apprehension, excitement, motivation or even relief to have arranged the session itself. Not forgetting that more often than not, these feelings will overlap and co-occur, or might change from one moment to the next.

Some clients may feel they can express how they’re feeling about being in the session to me there and then – I welcome this, and often think it creates a window of opportunity for me to support them in a way that’s closely tailored to their needs. However, many clients are likely to hold these feelings close – after all, despite all warmth and good intention, I am still a stranger – and it’s only human to feel hesitance towards sharing with someone who feels so ‘unknown’.

Trust is earned, and relationships take time to grow – I know this. I often think about the great responsibility therapists hold in forming and nurturing a trusting relationship with their clients. This is hugely important to my practice.

In this blog, I outline a few key things to expect or consider when seeing a new therapist for the first time, reflecting on my practical experience of working with clients for counselling and therapy.

The Agreement or ‘Contract’

Prior to a first therapy session with me, I send my clients a copy of my ‘contract’ – this is a document that outlines how sessions will work and what a client can expect from me and our work together. It will include logistical things like how to contact me, or what to do if you need to cancel a session – as well as covering practical and legal aspects of our work, for example, how confidentiality works, and the instances in which this confidentiality would need to be extended. My contract also accounts for situations such as ‘what happens if we see each other out in public?’ – so clients can be as clear as possible about what to expect if they start working with me.

My written contract is signed by both the client and myself ahead of our first session – then in session, I will go over a few of the most important things, as well as a few extras, before we start. I often acknowledge to clients that the initial arrangements for therapy can feel like a lot of reading…but I find giving my contract to clients in this way allows them to digest the information and bring any questions they may have to a session. For this reason, it is common for a portion of a first session to include talking through any questions and clarifying key points.

Over the course of our work together, clients may have new questions about elements of the contract; I am open to these at any time. 

Will my Therapist Assess Me?

When it comes to first sessions and assessment, different therapists will have their own approach to whether or not some kind of assessment or questionnaire is their ‘standard practice’. With me as your therapist, I do not use formal assessments at any point during my process.

For me as a practitioner, I believe that many assessments commonly used by counselling or therapeutic services (e.g. Core 10, Core 34, GAD 7) often generate a vague, general sense of what’s going on for a person – or sometimes, result in what the client is actually feeling being totally missed. I don’t want to form an initial sense of my client through a formulaic questionnaire; I want to hear about how they’re feeling, from them, at their own pace, in their own way.

What Does a Therapist Ask?

As a person-centred therapist, I believe that each of my clients is the only possible ‘expert’ in their own world. This means I like to invite clients to bring whatever feels most relevant or ‘present in their mind’ to a session on a given day. This might mean any two sessions could feel very different – but they meet the needs of the client on a given day.

Within some other therapeutic approaches, there may be a set agenda for each session, or a structure that sessions follow – I prefer my sessions to be free-flowing. I often invite clients to ‘paint me a picture’ of what’s going on right now. And as they explore – I will reflect, clarify, and ask questions that both assist my understanding and offer my honest sense of how I am hearing what is being shared.

This does not mean that I am ‘passive’ – and will not offer challenge or new considerations. It instead reflects that I see therapy as a journey we make together, where I move alongside you, offering my senses of your world – without making assumptions or approaching your situation as something to be ‘worked on’. 

Can I Ask my Therapist Questions?

As I mentioned at the beginning, asking questions can sometimes feel difficult for clients, especially earlier on in the therapy process. Despite this – I always remind clients that I am open to questions about my work or my thoughts.

Of course, depending on the question, I always use my own professional discretion when offering answers – but primarily view questions as an opportunity to clarify feelings, and create greater trust and understanding within the therapeutic relationship.

A ‘Good Fit’?

After a first session with a new therapist, you might start to notice whether working with them feels comfortable, or ‘right’. For some, this might take several sessions to decide – while others might only need one session (or even an initial call) to sense if someone is the right therapist for them. I always like to acknowledge that not booking another session, or even expressing that you feel uncertain, is just as welcome as choosing to book again. In many ways, I like to think of therapy as an opportunity to ‘practice’ giving voice to your true feelings, and being able to feel empowered in personal agency and decision-making.

As a person-centred therapist, I believe that the therapeutic relationship is the most important piece to the therapy ‘puzzle’ – and that a therapeutic dynamic in which a client can feel heard, understood, and appropriately challenged, while connecting with another human, can act as a really impactful tool for therapeutic change.

Online Therapy with Becky Mellor Psychotherapy

I’m Becky, a person-centred therapist, registered with the BACP. I gained my clinical experience in the NHS, working with clients for counselling at Macmillan Cancer Support. I currently work online with clients across the UK, offering 1/1 counselling sessions that last up to 50 minutes.

 I currently offer clients the option of a free 15-minute phone call to help them gain a sense of whether I might be the right therapist for them.

If, as you have read, you’ve found yourself connecting with my approach, my perspectives, or the idea of working with me as your therapist, contact me today. To learn more about me and my practice, including session rates, explore my website.

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