If you’ve never been to therapy before, the lead-up to your first session can feel bigger than the session itself. You might be rehearsing what to say, worrying you’ll be judged, or wondering if you even have a “real enough” problem to bring. As a therapist who works from an integrative, trauma-informed approach, drawing on Acceptance and Commitment Therapy, Narrative Therapy, Dialectical Behaviour Therapy, EMDR, and attachment theory, I want to walk you through what a first session with me actually looks like, so you can walk in knowing what to expect.
I work with adults navigating anxiety, depression, relationship trauma, relationship challenges, life transitions, grief, and questions around gender and sexuality. While every therapist’s process is a little different, here’s an honest look at how I structure that first hour, and what I wish more people knew going in.
Reviewing Informed Consent Together
Before we get into anything personal, we review informed consent together. This isn’t a formality I rush through. I want you to actually understand things like confidentiality, its limits, how sessions work, and what you can expect from me as your therapist. I always leave room here for questions. This is your chance to get a feel for how I communicate and to make sure you feel informed and in control before we go any further.
Exploring Why You’re Here Now
From there, we move into exploring what’s brought you to therapy at this particular point in your life. I’m curious about what’s happening currently that made you decide to seek support now, what symptoms you’re experiencing, and how those symptoms are interfering with your day to day life.
This isn’t about getting your whole life story in one sitting. It’s about understanding the shape of what you’re carrying and why it’s surfaced as something worth addressing today.
Setting Goals That Are Allowed to Change
This is one of my favourite parts of the first session. I ask: if therapy was working, what would be different in your life? How would you know, based not just on how you’d feel, but on how you’d actually act?
This question often catches people off guard in a good way. It shifts the focus from fixing something abstract to imagining concrete, lived change.
I also want to be clear about something important. Goals in therapy aren’t static. As we work together and new information surfaces about your history, your patterns, your relationships, those goals can and often do shift. That’s not a sign anything went wrong. It’s a sign therapy is doing what it’s supposed to do.
Talking Through a Possible Treatment Approach
Based on everything you’ve shared, I’ll usually offer some initial thoughts on what an approach to working together might look like, and which of my modalities might be relevant to what you’re bringing. That could be EMDR for trauma processing, DBT skills for emotional regulation, ACT for values based living, or narrative work for re-authoring difficult life stories.
This is a starting point, not a contract. Therapy is responsive, and so is this plan. The first few sessions are connecting sessions. Their job is to build a therapeutic relationship and a sense of safety that will support the deeper work later on. If session one feels more like getting to know you than breakthrough, that’s not a failure. That’s exactly how it should feel.
Misconceptions I Hear Often
I Need to Have It All Figured Out Before I Come
Also not true, and honestly, the opposite of the point. Therapy is a space for exploring your inner world, not presenting a finished, tidy version of it.
The Therapist Is Going to Tell Me What to Do
This one comes up a lot, and I always want to gently correct it. My role isn’t to hand you a life plan. You are the expert in your own life. My role is to offer skills, guidance, and a space to pause and reflect, to help you get clearer on what’s meaningful to you and what behaviours will actually work for the life you want.
My Honest Take: It’s Okay to Feel Awkward
Here’s something I don’t think gets said enough. Meeting a new person, especially in a context as vulnerable as therapy, can be genuinely awkward, intimidating, and uncomfortable. Most articles gloss over this or promise you’ll feel instantly comfortable. I won’t promise that.
What I will say is this: it’s okay to walk away from a first session feeling like it was a little strange, or like you didn’t totally click yet, or like you’re not sure what to make of it. I’d actually invite you to bring that feeling back into the room, either in the moment if you notice it during the session, or at our next appointment. That kind of real time feedback is how we learn about each other and make adjustments as we go. The relationship is allowed to be a work in progress. That’s not a red flag. It’s the process working as intended.
The Bottom Line
A first therapy session isn’t about diagnosis, deep breakthroughs, or having the right words ready. It’s about orientation, to me, to the process, and to yourself. If you walk in expecting consent and questions, some history taking, a conversation about goals, and an honest acknowledgment that it might feel a little awkward at first, you’ll likely find that first session is far more manageable than you imagined.
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