The Mystery of What Actually Happens

There's something uniquely nerve-wracking about walking into your first counselling session. You've seen therapy depicted on television—someone lying on a couch whilst a bearded analyst takes notes—but what actually happens when you close that door and sit down with a real therapist?

The honest answer: it depends. Every therapist works slightly differently, and every client brings unique needs. But there's also a reassuring structure to most counselling sessions, whether it's your first or your fiftieth. Understanding this framework can ease that pre-session anxiety considerably.

This guide walks you through what typically happens in a counselling session, from the moment you arrive to how sessions end, so you know exactly what you're stepping into.

Before You Arrive: The Practical Bits

Timing

Most therapy sessions last 50 minutes. This isn't random—it's long enough for meaningful work but short enough that your therapist can take notes, use the loo, and prepare mentally before their next client.

Plan to arrive about five minutes early, particularly for your first session. You might need to find the room, sort out payment details, or simply sit quietly and prepare yourself mentally.

Location

In-person sessions happen in various settings. Some therapists work from dedicated therapy rooms with comfortable chairs, soft lighting, and carefully chosen art. Others use consulting rooms in shared buildings that feel more clinical. A growing number work from home offices (completely separate from their living space, with separate entrances for privacy).

For video sessions, you'll receive a link beforehand. Test your technology 10 minutes early—there's nothing like fumbling with camera settings to spike your anxiety right before therapy.

What to Bring

For in-person sessions: just yourself. You don't need to bring notes or homework unless your therapist has specifically asked. Some people like having water, which therapists usually provide, but feel free to bring your own if you prefer.

For online sessions: water, tissues, and perhaps a blanket if sitting still makes you chilly. Make sure you're in a private space where you won't be interrupted.

The First Few Minutes: Arrival and Settling

The Greeting

Your therapist will likely meet you in a waiting area or at the door. Expect a warm hello, maybe a handshake if that's comfortable for both of you, and a short walk to the therapy room.

This bit can feel awkward. Do you make small talk? Comment on the weather? Most therapists will lead the way here, often keeping it simple: "Did you find the place okay?" or "Can I get you some water?"

Getting Comfortable

Once in the room, your therapist will indicate where you should sit. Usually there are two chairs facing each other, sometimes at a slight angle rather than head-on. The slight angle actually helps—direct eye contact for 50 minutes is intense, and having the option to look away occasionally feels more natural.

Take a moment to settle. Put your bag down, remove your coat if you like, find a comfortable position. Your therapist isn't judging how you sit or where you put your hands. They're simply waiting until you're ready.

The Opening: How Sessions Begin

First Session vs Ongoing Sessions

The very first session looks different from regular ongoing sessions.

In your first session, expect:

More questions from your therapist about your background, what's brought you to therapy, and what you're hoping to address
Discussion of practical matters (confidentiality, how often you'll meet, fees, cancellation policy)
Some therapists will provide a brief explanation of how they work
Goal-setting or "contracting"—agreeing what you both want to achieve together

In ongoing sessions, the opening is usually simpler:

"How's your week been?"
"What would be useful to focus on today?"
"You mentioned last week you were worried about X—how did that go?"

Some people arrive with a clear agenda: "I need to talk about what happened with my boss on Tuesday." Others sit down with no idea where to start. Both are completely fine.

The Sacred Silence

Here's something that surprises many first-time therapy clients: silences are allowed. Expected, even.

If you sit down and don't immediately know what to say, that's not a problem you need to fix. Your therapist will sit comfortably with the quiet until you're ready, or they might offer a gentle prompt: "Take your time. There's no rush."

This is profoundly different from normal conversation, where silence feels awkward and someone rushes to fill it. In therapy, silence can be productive. It gives you space to find the right words, or to sit with feelings that are hard to articulate.

The Middle: The Actual Therapeutic Work

This is where the real substance happens, and it varies enormously depending on your therapist's approach and your needs.

The Talking Part

Most people imagine therapy involves a lot of talking, and generally, yes. You might:

Describe events from your week
Explore patterns you've noticed in your relationships or behaviour
Revisit past experiences that feel relevant to current struggles
Work through difficult emotions

But here's what TV gets wrong: it's not usually a monologue. Your therapist won't sit silently taking notes whilst you perform an emotional soliloquy. It's more like a particular kind of conversation.

They'll ask questions:

"What was that like for you?"
"What did you notice happening in your body when they said that?"
"How does that connect to what you mentioned last week about your mum?"

They might offer observations:

"I'm noticing you smile when you talk about something quite painful."
"You've mentioned feeling 'fine' three times in two minutes."

They'll reflect back what they hear:

"It sounds like part of you wants to leave this job, but another part feels guilty about disappointing people."

Different Therapeutic Approaches in Action

What happens in the middle portion depends significantly on your therapist's approach:

Person-Centred therapists typically follow your lead, offering empathy and understanding but letting you direct where the session goes.

CBT therapists might work with you to identify unhelpful thought patterns, challenge them, and develop alternative ways of thinking. They might suggest homework or worksheets.

Psychodynamic therapists help you explore unconscious patterns and how past relationships influence present ones. They might point out patterns they notice between your descriptions of different people in your life.

Transactional Analysis therapists (like me) might explore which "ego state" (Parent, Adult, or Child) you're operating from in different situations, helping you understand patterns in how you communicate and relate.

Many therapists integrate multiple approaches, adapting to what you need in that particular session.

The Emotional Bit

Crying in therapy is common and completely acceptable. Your therapist will have tissues ready and won't be remotely bothered by tears.

But sessions aren't all heavy emotion. Sometimes therapy involves:

Problem-solving practical challenges
Celebrating progress
Gentle humour (yes, therapy can include laughter)
Quiet reflection
Simply feeling heard and understood

Some sessions end with you feeling lighter, relieved, hopeful. Others finish with you feeling raw, tired, or stirred up. Both are okay—therapy isn't meant to feel good every week; it's meant to be useful.

Time Awareness: The 10-Minute Warning

Around 40 minutes in, good therapists begin tracking time. This doesn't mean the session suddenly becomes superficial, but your therapist will be mindful not to open up huge new topics five minutes before you need to leave.

If you've been exploring something difficult, your therapist might:

Begin to gently bring things to a close
Help you ground yourself again before you leave
Check whether what you've discussed today feels manageable or if you need some support sorting through it

Some therapists explicitly say "We have about 10 minutes left" so you're aware. Others manage the transition more subtly.

The Ending: How Sessions Close

Wrapping Up

The last 5-10 minutes usually involve:

Summarising: Your therapist might briefly recap what you've covered—"So today we've talked about your difficulty setting boundaries with your sister, and we've started exploring where that pattern might have come from."
Checking in: "How are you feeling about finishing up?"
Practical planning: "Same time next week?" or "Is there anything you want to make sure we focus on next time?"

Homework (Sometimes)

Some therapeutic approaches involve between-session tasks:

CBT therapists might suggest keeping a thought diary
You might agree to try a particular behaviour (like saying "no" once this week)
Some people choose to journal about what came up in the session

But many therapists, particularly humanistic ones, don't assign homework. The work happens in the room, and your week unfolds however it does.

The Transition Back to Life

Leaving therapy and immediately returning to your normal life can feel jarring. You've just spent 50 minutes in an unusually intimate, honest conversation, and now you're walking to your car or logging off to make dinner.

Give yourself transition time if you can:

A brief walk before getting in the car
Ten minutes sitting in a café
A few moments of quiet before diving into emails

What Doesn't Happen in Therapy Sessions

It's worth clearing up some myths:

Your therapist won't give you all the answers. They're not there to tell you what to do about your relationship, your job, or your life. They help you find your own clarity.

You won't be hypnotised or analysed without your knowledge. Therapy requires your active participation. You're in control of what you share and how deep you go.

It's not like talking to a friend. Friends commiserate, give advice, share their own experiences. Therapists maintain boundaries and keep the focus on you.

You won't be judged or criticised. Even when therapists gently challenge you or point out patterns, it's done with care and respect, not judgment.

It doesn't work instantly. Rarely does one session fix everything. Therapy is more like going to the gym—the benefits accumulate over time.

Frequency and Consistency

Most people attend weekly sessions, though this varies. Some people see their therapist fortnightly or monthly; others (during intensive periods) meet multiple times per week.

Consistency matters more than frequency. Your brain needs time to process what comes up in sessions. Weekly sessions seem to hit a sweet spot—frequent enough to maintain momentum but spaced enough for you to try new things between appointments.

Confidentiality: What Gets Shared?

What you say in your session stays between you and your therapist, with rare exceptions:

You disclose serious risk to yourself or someone else
You reveal information about child abuse
Your records are requested by a court (unusual)

Otherwise, your therapist won't:

Tell your partner what you said
Discuss you with friends or family
Share specifics with other professionals without your permission

This confidentiality creates the safety needed for honest, vulnerable conversation.

What Makes a Good Session?

This varies for everyone, but generally:

You feel heard and understood
Something shifts, even slightly, in how you view a situation
You leave with more clarity, even if you don't have solutions yet
The time felt useful, even if it wasn't comfortable

Not every session will be brilliant. Sometimes you'll leave thinking "that was a waste of time." That's normal. Overall patterns matter more than individual sessions.

When Sessions Feel Difficult

Some sessions are hard work:

You can't articulate what you're feeling
Everything feels stuck or circular
You're talking about surface stuff and avoiding the real issues
The chemistry with your therapist feels off

When this happens more than occasionally:

Tell your therapist. "I'm struggling to connect today" or "I feel like we're going in circles" are valid things to say.
Consider whether you need a different approach or therapist. Fit matters enormously.

After Your Session

Many people find it helpful to briefly jot down anything significant that came up, though this isn't required. Some insights that feel crystal-clear in session become fuzzy by evening.

You might feel:

Energised and hopeful
Raw and emotional—like a wound has been cleaned but is still tender
Confused—sitting with new perspectives that haven't settled yet
Tired—therapy is work, and emotional work exhausts differently than physical exertion

All normal.

The Cumulative Nature of Regular Sessions

Individual sessions have value, but therapy's real power emerges over time. Your therapist begins to know you deeply. They spot patterns you haven't noticed. They remember the seemingly small detail you mentioned weeks ago that turns out to be significant.

This is why "just give it a few sessions" is genuine advice, not a sales pitch. The first session introduces you to the process, but sessions 4, 7, 15 are where deeper work often happens, because you've built trust and safety.

Virtual vs In-Person: Does It Change What Happens?

Online sessions follow the same structure and principles as in-person work. The therapeutic process—the talking, the exploring, the reflecting—translates remarkably well to video.

Small differences:

You're in your own space, which some people find comforting and others find difficult
Eye contact works differently through screens
You need to be more explicit about what you're experiencing physically: "I'm noticing tension in my shoulders" rather than your therapist observing your posture

But the essentials—being seen, heard, understood, and supported—work just as well online for most people.

Your Part in Making Sessions Useful

Therapy is collaborative. Your therapist creates the structure and safety, but you bring:

Honesty: Even when it's hard
Curiosity: About yourself and your patterns
Willingness: To sit with discomfort sometimes
Engagement: Showing up, even on weeks you don't feel like it

You don't have to be perfectly articulate or emotionally intelligent. You just have to be genuinely present.

What to Do If You're Still Nervous

If understanding the structure hasn't completely settled your anxiety about that first session:

Remember that your therapist knows you're nervous. They expect it.
You can literally say "I don't know what to talk about" or "I feel really awkward"—that's a perfectly valid way to start.
Nothing dramatic has to happen in your first session. You're simply meeting someone and beginning a conversation.
You're allowed to decide after one or two sessions that this particular therapist isn't right for you. You're interviewing them as much as they're assessing how to help.

About the Author: The Kicks Therapy content team creates accessible, honest mental health resources based on clinical experience and current research. Our practice offers integrative therapy combining Person-Centred, Gestalt, and Transactional Analysis approaches.

Ready to experience what a counselling session is actually like? Book an initial consultation in South West London or via video call. Sessions run for 50 minutes and cost £80, with block discounts available.

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