The night before my very first therapy session as a client, I couldn't sleep. My mind raced with questions: What if I cry? What if I don't cry and they think I'm not trying hard enough? What if I can't think of anything to say? What if I say too much? What if they judge me? What if I'm wasting their time?

Now, as a therapist, I hear these same anxieties almost daily from new clients. The unknown is uncomfortable, and walking into a room (or logging into a video call) to talk about vulnerable things with a stranger feels genuinely daunting.

This guide demystifies what actually happens in that first counselling session. I'll walk you through the entire process—from the moment you arrive to what happens after you leave—so you can focus on getting the support you need rather than worrying about logistics.

Before You Arrive: The Practical Stuff

Booking and Admin

Most therapists will ask you to complete some paperwork before your first session. This might include:

A brief intake form asking about:

Your reason for seeking therapy
Current symptoms or difficulties
Previous mental health treatment
Current medication
Emergency contact details
Medical history relevant to mental health

Consent forms covering:

Privacy and confidentiality policies
Limits to confidentiality (harm to self/others, safeguarding concerns)
Data protection
Cancellation policy

Some therapists send this digitally beforehand; others provide it when you arrive. Either way, it's not a test—there are no wrong answers.

What to Bring

For in-person sessions:

Payment (if paying session-by-session)
Water if you like to have a drink available
Tissues (though therapists always have these)
Nothing else required—you don't need to prepare notes or bring documentation unless you want to

For online sessions:

A private, comfortable space where you won't be interrupted
Headphones (optional but can help with privacy)
A glass of water
Tissues nearby

Timing

Arrive about 5 minutes early for in-person sessions. This gives you time to use the bathroom, settle yourself, and not feel rushed.

For online sessions, log in a minute or two early to check your connection.

The First Few Minutes: Settling In

The Greeting

Your therapist will greet you warmly but professionally. We're trained to read the room—if you seem nervous, we'll move gently. If you seem ready to dive in, we'll follow your lead.

There might be a brief moment of small talk ("Did you find the place okay?" "How's the weather?" "Can you see and hear me clearly?") but this isn't empty chatter—it's helping you transition from the outside world into the therapeutic space.

The Environment

In-person: Most therapy rooms are deliberately calming—comfortable seating, soft lighting, minimal distractions. You'll typically have a choice of seats. There's no "correct" seat; choose what feels comfortable.

Online: The therapist's background will usually be neutral or professional. They should have good lighting and clear audio.

Setting the Frame

In the first few minutes, your therapist will likely explain:

Session structure:

Length (usually 50 minutes)
Frequency recommendation (weekly, fortnightly)
How sessions typically flow

Confidentiality:

What stays private
Legal limits (risk to self/others, safeguarding issues, court orders)
Note-keeping practices

Practical boundaries:

Cancellation policy
Contact between sessions (if any)
Payment arrangements

This might feel formal, but it's creating safety. You need to know the rules of engagement before you can relax into vulnerability.

The Core of the First Session: Getting to Know You

The Opening Question

Most therapists begin with some version of: "What's brought you here?" or "What made you decide to seek therapy now?"

This is deliberately open-ended. You can start wherever feels right:

The specific crisis that prompted you to book
A general sense of struggling
A pattern you've noticed
Something recommended by a friend or GP

There's no need to tell your entire life story in chronological order. Start with what feels most pressing.

What Your Therapist Is Trying to Understand

While you talk, your therapist is gently gathering information to understand:

Your presenting concern:

What's bothering you most right now?
How long has this been going on?
What impact is it having on your life?

Your context:

Living situation and relationships
Work or study
Support network
Any significant life events or transitions

Your goals:

What would be different if therapy helped?
What does "better" look like for you?
Are there specific things you want to work on?

Your strengths and resources:

How have you been coping so far?
What's helped in the past?
What matters to you?

Safety and risk:

Are you in immediate danger?
Thoughts of self-harm or suicide?
Substance use?
Eating or sleeping significantly disrupted?

This isn't interrogation—it's collaborative exploration. A good therapist will weave these questions naturally into conversation rather than firing them like a checklist.

Assessment (But Not the School Kind)

The first session is partly assessment, but this isn't about judging whether you're "bad enough" for therapy. It's about understanding:

Whether the therapist has relevant experience with your concerns
Whether their approach suits your needs
Whether you're a good match
What kind of support would be most helpful

Some therapists use formal questionnaires (like PHQ-9 for depression or GAD-7 for anxiety). These aren't diagnostic tools—they're snapshots to track progress over time.

How Much to Share

A common worry: "Do I have to tell them everything in the first session?"

Absolutely not. You share what feels safe to share. Therapy is a process of gradually building trust.

It's completely fine to say:

"I'm not ready to talk about that yet"
"Can we come back to this another time?"
"I need to know you better before I go into detail"

A good therapist will respect your pace and never push you into overwhelm.

If You Get Emotional

Many people worry about crying in therapy. Here's the truth: therapists are completely comfortable with emotions.

We have tissues. We have time. We don't need you to apologize for crying, laughing nervously, or sitting in silence while you gather yourself.

Equally, if you don't cry, that's also completely fine. Some people process through talking, others through tears, others through thoughtful silence. All are valid.

Understanding the Therapist's Approach

Explaining How They Work

At some point in the first session, your therapist should explain their therapeutic approach in accessible language.

For example, I might say: "I work integratively, which means I draw from different approaches depending on what you need. My foundation is humanistic therapy—this means I see you as the expert on your own life, and my role is to help you explore what's going on and find your own answers. I also use techniques from transactional analysis to understand patterns and person-centred therapy to create a really safe, non-judgmental space."

They might also explain:

Whether they give homework or exercises
How directive vs exploratory they are
What a typical ongoing session might look like
How they measure progress

Questions Are Encouraged

This is your opportunity to ask:

"How long does therapy usually take for [issue]?"
"What's your experience with [specific concern]?"
"How do you know if therapy is working?"
"What happens if I feel worse before I feel better?"

If they use jargon you don't understand, ask for clarification. Therapy should be transparent, not mysterious.

Practical Arrangements

Scheduling Ongoing Sessions

If both you and the therapist think it's a good fit, you'll discuss:

Frequency: Weekly is standard for building momentum; fortnightly works for some people
Day and time: Regular slot (same time each week helps establish routine)
Duration of commitment: Some people book 6 sessions initially; others commit to 3 months; some prefer open-ended

Payment

Your therapist will confirm:

Session fee
Payment method (bank transfer, card, cash)
When payment is due (usually same day or within 24 hours)
Any block booking discounts available

Cancellation Policy

Most therapists require 24-48 hours notice to cancel without charge. This protects both your time and theirs.

Some therapists charge for late cancellations; others work on a trust basis. Make sure you understand the policy.

How the Session Ends

Winding Down

A good therapist will manage time so the session doesn't end abruptly mid-topic. About 10 minutes before the end, they might say something like: "We have about 10 minutes left—is there anything else important we should touch on today?"

This isn't cutting you off; it's making sure you're not walking out the door in a heightened emotional state.

Summarizing and Next Steps

Before you leave, your therapist might:

Briefly reflect on what they've heard
Suggest some initial directions for future sessions
Ask how the session felt for you
Confirm the next appointment

How You'll Feel Afterward

Everyone responds differently to their first session:

Common reactions:

Emotional exhaustion (talking about difficult things is tiring)
Relief ("Finally, someone understands")
Vulnerability ("Did I share too much?")
Uncertainty ("Was that helpful?")
Hope ("This might actually help")
Disappointment ("I thought I'd feel instantly better")

All of these are normal. One session is just the beginning—like reading the first chapter of a book.

Some people feel worse after the first session because they've opened up things they'd been pushing down. This usually settles as therapy continues and you develop tools to process what's coming up.

Common First-Session Worries (Addressed)

"What if I can't think of what to say?"

Your therapist is trained to help with this. If you go blank, they'll ask gentle questions. Silence is also okay—sometimes the most important work happens in quiet moments.

"What if I talk the whole time and don't let them speak?"

Therapy isn't a normal conversation. It's absolutely fine (even ideal) for you to do most of the talking. Your therapist will interject when it's helpful.

"What if they think my problems aren't serious enough?"

A good therapist will never make you feel this way. If something is affecting your quality of life, it matters. There's no suffering Olympics in therapy.

"What if I don't like them?"

Therapeutic fit matters immensely. If you don't feel comfortable after the first session, it's completely acceptable to:

Try one more session to see if initial nerves settle
Politely say it's not the right fit and look elsewhere
Ask them to recommend someone else who might suit you better

"What if they judge me?"

Therapists are trained to be non-judgmental. We've heard it all. Truly. The things you're ashamed of are probably things we've worked with many times.

If you feel judged, that's valuable information—either your therapist needs feedback (good ones welcome this), or it's not the right fit.

"What if I cry uncontrollably?"

You won't. And if you do get very emotional, your therapist will help you regulate. We can slow things down, use grounding techniques, or simply sit with you until the intensity passes.

Red Flags in a First Session

While most therapists are skilled and ethical, watch out for:

They talk a lot about themselves rather than focusing on you
They push for long-term commitments before you're ready
They promise quick fixes or guaranteed outcomes
They make you feel judged or uncomfortable
They breach boundaries (overly personal questions, unclear about confidentiality)
They don't explain their approach or answer your questions clearly

Trust your gut. You deserve a therapist who makes you feel safe, respected, and heard.

Preparing for Your First Session

You don't need to do extensive preparation, but if it helps to think ahead:

Reflect on:

What's brought you to therapy now (not necessarily the whole history, but what's prompted this decision)
What you're hoping might change
Any previous therapy experiences (good or bad)
Anything that feels particularly important to mention

Consider writing down:

Questions you want to ask
Things you're worried you'll forget to mention

Avoid:

Rehearsing exactly what you'll say (therapy is a conversation, not a performance)
Expecting to "fix" everything in one session
Drinking alcohol beforehand to calm nerves (it dulls your ability to engage meaningfully)

After the First Session

Give It Time

One session is a beginning, not a complete picture. Some therapeutic relationships click immediately; others take a few sessions to warm up.

Generally, by session 3-4, you should have a sense of:

Whether you feel comfortable with this person
Whether their approach suits you
Whether you're starting to gain insights or feel any shifts

Self-Care

After your first session:

Give yourself time if possible (don't rush into back-to-back meetings)
Be gentle with yourself emotionally
Drink water and eat something nourishing
Notice how you feel, but don't over-analyze

Follow-Up Questions

It's absolutely fine to email your therapist between sessions if:

You have logistical questions (appointment times, fees)
You want to clarify something said in the session
You're unsure about next steps

Most therapists will clarify their between-session contact policy in the first meeting.

Final Thoughts

Your first counselling session is the beginning of a unique relationship—one focused entirely on your wellbeing, growth, and healing. It might feel strange at first (when else do you have someone's complete, undivided attention for 50 minutes?), but that strangeness often gives way to profound relief.

You don't need to be the perfect client. You don't need to have everything figured out. You just need to show up, be as honest as you can in that moment, and be willing to explore.

The therapist's job is to make the process as safe and helpful as possible. Your job is simply to be present.

If you're in London and looking for a humanistic, integrative therapist who works with anxiety, depression, relationship issues, and life transitions, I offer both in-person sessions in Fulham and online therapy. I provide a free 15-minute consultation call before your first session, so you can get a sense of whether we might work well together before committing.

The hardest part is often just making that first appointment. But you've already taken the step of learning what to expect—and that means you're ready.

What Happens in Your First Counselling Session? A Therapist's Inside Guide