What Happens in a First Therapy Session
The first hour is mostly about getting oriented, and you do not need to have the right words ready.
A first session is a conversation with a purpose: understanding what brings you in and deciding together where to begin. Here is what it usually involves.
On This Page
Guide
The short answer
In a first therapy session, you and your therapist talk about what brought you in, what has been happening recently and what you would like to be different. The therapist asks questions about your history, your health, your work and relationships, and how you have been coping. By the end, you should have a clearer sense of the main concern and a rough idea of how you might work on it together.
It is not a test and there is no wrong way to do it. Many people arrive unsure how to describe what is going on. That is normal. Part of my job in a first session is to help you put words to it, one question at a time.
The first session is also a chance for you to decide whether the fit feels right. You are learning about me as much as I am learning about you.
If you have been in therapy before, the first session with someone new is still worth treating as a fresh start. It helps to mention what was useful last time and what was not. That gives me a sense of what to build on and what to do differently, so you do not have to repeat an approach that did not fit.
- What brings you in
- Recent history and context
- What you want to change
- Practical details
- Questions for me
The practical side before you begin
Before the first appointment, there is usually some paperwork. That typically includes consent forms, a privacy notice, contact information and insurance details if you plan to use your benefits. With my practice, appointments are requested through a secure client portal, and forms are completed there as well.
Because I work only by secure video, it helps to plan where you will be. Choose a private space where you can speak freely, check your internet connection and have a phone, tablet or computer with a camera and microphone. You need to be physically located in Connecticut, New York or Massachusetts during each session, since those are the states where I am licensed.
We will also review the practical agreements: how scheduling works, how to reach me between sessions for administrative questions and the cancellation policy. In my practice, appointments canceled with less than 24 hours' notice are subject to a $100 fee. Knowing these things up front removes guesswork later.
If you plan to pay privately, we go over fees before your first session. If you plan to use insurance, it helps to confirm your behavioral health benefits with your insurer ahead of time.
What we actually talk about
Most first sessions follow the shape of your concern rather than a script. I will ask what prompted you to reach out now, since the timing often says something important. I may ask how long things have felt this way, what you have already tried and what has helped even a little.
I will also ask about the wider picture: sleep, physical health, work, the people around you and your use of alcohol or other substances. These questions are routine. They help me understand what might be feeding the problem and what strengths you already bring. You can always say you would rather come back to something later.
Toward the end, I usually offer a first impression of what seems to be going on and a few ideas about how we could approach it. That might involve practical tools from Cognitive Behavioral Therapy, room to sort out mixed feelings through Motivational Interviewing, DBT skills for strong emotions or solution-focused questions about what already works. I explain what I am suggesting and why, so the plan makes sense to you.
I will also ask about safety in a straightforward way, including whether you have had thoughts of harming yourself. This is a standard part of a careful first session, not an assumption about you. If something urgent comes up, we make a plan together. For immediate crisis support at any time, call or text 988, or call 911 in an emergency.
How you might feel afterward
People leave a first session feeling many different ways. Some feel lighter simply from saying things out loud. Others feel tired or a little raw, especially if they talked about something they have been holding for a long time. Both are common and neither means the session went wrong.
It can help to leave a few minutes after the appointment before jumping into the next task. You may notice thoughts or memories surfacing over the following days. You are welcome to bring those to the next session.
If something in the first session did not sit right, say so next time. A good therapeutic relationship can handle honest feedback, and adjusting the approach is part of the work.
Between the first and second sessions, some people jot down a few notes about what stood out, what they forgot to mention or questions that came to mind. This is optional. It can simply make the next conversation feel easier to start.
Deciding whether it is a good fit
Research on therapy has generally found that the relationship between client and therapist matters a great deal. After a first session, ask yourself whether you felt heard, whether the questions made sense and whether you could imagine being honest with this person over time. You do not need to feel completely comfortable yet, but you should feel respected.
My style is warm and direct. I listen closely, ask practical questions and keep our conversations connected to your daily life. Some people want exactly that. Others want a different pace or style, and that is a legitimate reason to look elsewhere.
If you are an adult in Connecticut, New York or Massachusetts and want to see how this might feel, you can start with a free consultation. Visit the Work With Me page to request an appointment through the secure client portal.
Common Questions
Questions People Ask
Do I need to know exactly what to talk about in a first session?
No. Many people arrive unsure how to describe what is happening. I ask questions to help clarify the concern, and we can decide together where to begin.
Will I have to talk about things I am not ready to discuss?
No. You set the pace. I may ask about many areas of life so I understand the context, but you can always say you would rather return to something later.
How is a first telehealth session different from an in-person one?
The conversation is the same. The main difference is preparation: choose a private space, check your connection and device, and make sure you are physically located in Connecticut, New York or Massachusetts during the session.
When You’re Ready
Let’s talk about what would help.
Begin with a free consultation. We will discuss what brings you here and whether working together feels like a good fit.
Request an Appointment