What To Expect in Therapy

Have you been feeling down lately or like your brain has "checked out" and is on autopilot? Not feeling like yourself or notice that things that once brought you joy no longer do? Overwhelmed by stress or anxiety? Finding it difficult to connect with the people close to you? Having marital problems or considering divorce? If you are reading this, chances are that you are not feeling at your best and are considering counseling or therapy (these terms are often used interchangeably) to help you through this difficult time.

Counseling is an effective process that can help you make significant changes in your life and experience relief. It can be intimidating to not only meet someone new but to open up about personal details of your life that you may not even want to share with friends or loved ones. Below are a few things to expect in your first session.

Picking your Counselor

Aside from you showing up, your relationship to your counselor is the most important element for change. This relationship is often referred to as the therapeutic alliance, which conveys that your counselor is on your side, working together with you. When looking for a counselor, it is essential to assess that they are licensed, competent, and specialize in the issue at hand but be sure to also evaluate how you think you might relate to the person. Many counselors offer free phone consultations. Take advantage of this! This is an excellent time to test if you feel comfortable talking to this person. 

Keep in mind your preferences regarding where the counselor is located. Maybe you'd like a counselor close to your home or work for convenience or perhaps you'd like to keep this a private matter and are willing to travel a little to your sessions. Make sure to choose a counselor within your budget, as well. Some take insurance but some do not. If you are considering using insurance, keep in mind that they often require a copay, which can be almost as much as paying privately. Talk with the counselor about this during your consultation!

the first session

You found a counselor that you can relate to, has the right location, and is the right price. That's wonderful! Now comes the first session, which can have people feeling a little nervous. Do I lay down on a couch? Is my counselor going to ask about my relationship with my mother? Will it be 50 minutes of pointing out what I'm doing wrong?

Take a deep breath. A majority of counselors have a normal couch or chair and will ask you to sit, make yourself comfortable. The counselor is there to help guide the session.


During your first session, you should be presented with forms including a notice of privacy practices, confidentiality forms, and consent to treatment. Some counselors might have more paperwork for you to fill out or go over together, which is typical and varies depending on the counselor's preferences. Your counselor may ask you to arrive 15-30 minutes early for your session to allow time to for this so it doesn't eat into your session.

getting to know you:

After the paperwork is complete, now is the time that you have probably been simultaneously excited for and most nervous about: explaining what brought you to therapy. Your counselor will likely give you lots of room in the session to do this and get out into the open what has been in your head. Expect your counselor to ask some open-ended questions to get a better sense of the issue at hand, such as how long it's been going on and what you may have tried in the past to resolve it. This shouldn't feel like a questionnaire but more like a conversation, a dialogue. 

the relationship:

Remember that important therapeutic alliance mentioned earlier? By the end of the session, you should begin to feel that starting to develop. You should feel as though your counselor has genuine interest in what you are discussing, empathizes with you, and you should feel that trust is growing (or at least that trust is a possibility down the road). If you get a sense that the counselor is cold or disconnected from you, this may not be the right fit. This is okay and can happen when trying out a new counselor. Don't get discouraged. Some people work better together than others and this just means you need to give someone else on your list a try. 

what now?:

As the session comes to a close, this is the time your counselor will likely explain to you his or her approach to therapy or personal style. The counselor might also describe how he or she can be of help, what future sessions will look like, and how often you should come to sessions. 

the space between:

It is very common for counselors to ask you to work on something in between sessions. This could be anything from giving thought to a new perspective, trying out a new technique, doing an activity, or filling out worksheets. What the work between sessions is will depend largely on the style of your counselor, the issue at hand, and your personal goals. It's very important that you put genuine effort behind doing this work outside the session, as it will boost the effectiveness of each session, solidify new information you learned, and ultimately give you the most bang for your therapy buck! Working hard between sessions often means needing fewer total sessions in the long-run. 


Before you leave the first session, your counselor will ask about scheduling for the next one. If you're still unsure about continuing, either with counseling in general or that counselor in particular, you have the option of scheduling the appointment later on when you are more sure of things. 

Still Worried?

It's okay to still be nervous about starting counseling. One thing you can do to decrease that feeling is write down a list of your concerns or points to discuss so you can be sure you don't forget anything. If the counselor you chose doesn't explicitly offer a free phone consultation, request one from them to talk about some of your initial worries. 

Most importantly, begin considering what your life could look like if things could change and you could learn to look at things from a fresh perspective! Have hope. Therapy can help!