Once you’ve made the brave step of making an appointment with a therapist, you may wonder, “what am I setting myself up for?” Knowing what to expect can help alleviate any anticipatory anxiety and prepare you for your first session. 

Here’s what to expect at your first appointment and some quick tips to get the most out of it. 

You Might Feel Nervous

Whether it’s your first appointment or meeting your new therapist for the first time, it’s normal to be nervous. Opening up about your deepest thoughts and feelings is difficult, especially in a new environment with someone you’ve never met before. So, if these feelings come up, know that they are a normal part of the process and will likely go away with time.

You can also try some strategies for managing therapy anxiety, such as:

• Opening up to your therapist about your anxiety
• Setting aside your preconceptions about psychotherapy
• Focusing on your therapist’s experience and desire to help
• Recognizing your strength and bravery

They’ll Ask Some Tough Questions

Your therapist will spend much of your first session trying to get to know you better. Before your appointment, you’ll fill out an intake form with questions about your background, mental health history, and more. During the session, your therapist will review these questions and follow up with a few others.

Their goal is to assess your mental health, determine whether they’re the best provider to help you on your journey to mental wellness, and begin designing your treatment plan. Some examples of the types of questions your therapist may ask include the following:

• What brings you to therapy?
• Have you attended therapy before? If so, what was that experience like?
• How do you cope with stress?
• Do you have a family history of mental illness?
• What do you hope to get out of therapy?
• What are your strengths?
• How are your relationships with others in your life?

Take Your Time

While these questions may seem simple enough, they can be difficult to answer on the spot. One way to get around this is to work on your answers before your session. Go for a walk and think carefully about why you’re going to therapy and what you hope to get out of it. Consider your stressors and focus on your strengths. The more accurate and thorough your answers, the better your therapist can help.

If you aren’t able to answer the questions right away, that’s okay too. Your therapist can work with you slowly over several sessions to learn more about you and how they can help. 

Remember, It’s Just a Conversation

Femi Olukoya LPC, an Austin, Texas-based therapist at Heading Health, shares a helpful tip for reframing therapy discussions in a way that makes them seem more casual and less intimidating. He says:

It doesn’t have to be that you’re sharing your deepest thoughts on your vulnerabilities. […] It’s more like having a conversation with a friend in a coffee shop or a bar, and the therapist is doing the work in the back end.

In other words, you don’t have to view your sessions as a rigid discussion with a detached profession. They are far more akin to talking with a warm, compassionate friend whose got some special therapy skills to help you address what’s bringing you down. 

Confidentiality

One reason you might be worried about talking about your mental health is privacy. While this worry is understandable, it’s important to remember that almost anything you say during a therapy session is confidential. While the exact details vary by state, generally, a therapist can only breach confidentiality if a client poses an imminent threat to themselves, the therapist, or a third party. 

Of course, you are never obligated to respond to your therapist’s questions. You are in complete control of what information you provide and withhold. 

They’ll Lay Out Your Treatment Plan

After learning a little about your background and mental health needs, your provider may discuss a tentative treatment plan. Often they will mention the psychotherapeutic technique they’ll be using, of which there are many. Some of the main therapies include:

• Cognitive-behavioral therapy (CBT): This therapy helps you become aware of inaccurate or unhelpful ways of thinking and offers healthier thought patterns. 
• Dialectical-behavioral therapy (DBT): Rather than changing the way you think, DBT aims to help people be more mindful of their emotions, cope with stress, and improve their social relationships
• Acceptance-commitment therapy (ACT): ACT helps individuals learn how to accept and sit with challenging emotions rather than avoid, deny or struggle with them
• Psychoanalysis and psychodynamic therapies: Based on the theories developed by Sigmund Freud, psychoanalysis tries to uncover unconscious thoughts, feelings, and desires that are at the heart of a patient’s psychological struggles. 

Your therapist may also discuss the treatment timeline and what it will require from you, both in and outside of your appointments. 

If you are uncomfortable with their chosen approach or have any follow-up questions, be sure to ask them. Often, the most effective treatment is the one the patient feels best about, so it’s important to voice your preferences and concerns if you have any.

You’ll Get to Know Your Therapist Too

“New patients should see every appointment as a conversation. This is your time to talk and allow me to know who you are,” shares Andrew Neal LPC, another one of our therapists here at Heading. 

Your first appointment isn’t just an opportunity for your therapist to get to know you; it’s also a chance for you to learn more about them. This can help you assess whether they are a good fit, align with your goals, and are equipped to address your concerns and mental health needs. 

Here are a few examples:

• What got you interested in therapy?
• How much experience do you have treating issues similar to mine?
• How long will therapy last?
• Is medication an option?
• How will I know if therapy is working?
• Are you available in case of a crisis or after business hours?

Crispin Feliciano LPC highlights how specific questions may be crucial for members of marginalized or disenfranchised communities. When discussing the LGBTQ+ community, he states:

Many members of the LGBTQ+ community may try to find therapists with a shared aspect of their identity to help reduce anxieties. It’s also helpful to consider other important factors […] such as the issues surrounding sexuality, gender expression, coming out, or other challenges that affect the community. It may also be important to know if the therapist is working from a sex-positive framework, as people are often seeking a space to explore their sexuality and gender without judgment or shame.

In general, it’s important to consider whether your therapist has experience with and can relate to important parts of your background and identity. 

What’s Next?

After talking about your mental health, everyday stressors, treatment plans, and more, you might feel a little overwhelmed. Remind yourself that this is totally normal. Feeling anxious after an appointment is common, and it’s not a sign that you have made the wrong choice or that therapy won’t work for you. Take some time to decompress and let any post-session anxiety drift away. 

After you’ve come down from your first session, you may have a bit of homework to do. Therapy doesn’t just happen within the walls of your therapist’s office, and they may want to get you started before your next session. This will likely involve something light at first. You may be asked to try practicing mindfulness or write some quick journal entries when you encounter something that triggers anxiety or low mood. 

Subsequent appointments will look a little different. While your therapist will continue asking questions during each session, the goal will shift towards helping you get better and applying the strategies your therapist has decided will most effectively alleviate your symptoms.