Questions About Therapy:
First Therapy Consultation: What to Expect
For newcomers to therapy, the first therapy consultation can seem a bit daunting — especially if you don’t know what to expect. Like, what will you do? What are the unspoken norms in this situation? Do you just walk through the door, recline on a chaise lounge, and immediately start spilling your guts to a therapist? What should you say?
Truthfully, the first therapy appointment is easy. It’s a high level, very basic conversation to start to get to know a prospective therapist. The goal is not to jump in and start talking about why you need therapy — the goal is to see how you feel with the prospective therapist, and make sure that you feel comfortable with them. You don’t need to know what you’re going to say before you get there. A good professional therapist will make you feel safe, comfortable, and understood, and they will lead the conversation in a structured and appropriate way. And you get to decide if you want to take it further.
It’s also important to know that you’re not going to dive into the deep end of the pool right away. Of course you’re there to talk about important things, but how therapy works is much more about building a genuine relationship with a professional therapist, and much less about lying back and getting analyzed. It takes time to build a therapeutic relationship, and your first therapy session is just the initial step in that process.
It’s incredibly anxiety-provoking when you feel like you need to know what’s going to happen in a new situation in order to prepare, and there isn’t a lot good information to guide you. So I put together this article in order to help you gain clarity and feel more at ease about what the experience in a first therapy consultation, and the beginning stages of therapy are actually like.
Getting started: How to find a therapist
Before you can meet with a therapist, you’ll first need to find someone you’re interested in working with. (If you’re thinking, “How do I get a therapist?” check out this article on how to find a good therapist.) You may search for a therapist online, get a list from your insurance company, or call a practice with multiple clinicians and get matched with a counselor.
At Growing Self, we have dozens of carefully vetted, qualified, and compassionate experts specializing in evidence based, growth-oriented therapy to help you find the best possible fit. Our process is for our client services team to get enough information about what your goals are for therapy in order to determine which expert or experts would be most helpful to you. Then we present you with a few options. You can read through their bios to lean more about them, and schedule a free therapy consultation meeting with the one you think you like the best.
Whether you’re searching online, through your insurance company, or getting matched with a therapist at a counseling practice, look for someone whose areas of expertise align with the issues you’re hoping to resolve. If you’re dealing with a mental health condition like depression, relationship problems, grief and loss, or another specialized issue, seek out a therapist with training and experience helping clients with that particular problem. You can read more about what type of therapist to work with here: What Kind of Therapist Do I Need?
Having a good relationship with your therapist is important. In fact, research shows that the quality of the relationship between client and therapist is the single most important factor in whether or not the therapy will be successful. For this reason, finding a therapist who offers a free consultation is a good idea. This will allow you to begin getting to know your therapist and assessing their personality before choosing to work together.
When you meet with a new therapist for the first time in a private practice setting, it will be in a therapy consultation session — not an actual therapy session. What is a consultation? It’s not much different from meeting anyone else — you’ll simply begin to get a feel for each other and to talk about why you’re there and what your work together would look like.
You can meet for a first therapy consultation by phone, by online video, or in person at their office. At the end of the consultation session, you should have an idea about how this therapist could help you and whether the relationship feels like a good fit. If so, you can then schedule your first therapy appointment and get to work.
During the consultation, your therapist should discuss legal matters with you, such as confidentiality and the narrow set of circumstances that would force them to break it. You’ll also discuss the cost of therapy, whether or not you can use insurance to pay for therapy, and how often you plan to meet. Most clients start with once-per-week sessions, but may taper off to bi-weekly or monthly sessions as their symptoms improve or the things they’re struggling with evolve.
Your prospective therapist should ask about what problems you’re experiencing and what goals you have for therapy. If you’re struggling with something outside their scope of competence, or outside the parameters of their training and background, an ethical therapist will tell you they won’t be able to work with you, and may offer a referral to someone better equipped to help.
A first therapy consultation is not therapy, and you won’t be expected (or likely permitted) to begin “doing the work,” or talking through any deep-seated issues yet. Instead, this is the time to ask your potential therapist questions about their qualifications, whether they use an evidence-based approach, and how they’ve helped clients like you in the past.
In some settings, such as community health centers or at social service agencies, a consultation is called an “intake appointment.” During an intake appointment, you’ll likely be filling out a questionnaire about mental health symptoms, substance abuse, and other issues, rather than actually meeting with your therapist.
Questions to ask a new therapist
Look for a therapist who freely offers information about their educational background, licenses, and areas of expertise. If they don’t volunteer this information themselves, don’t be afraid to ask questions, and if they aren’t happy to answer, that’s likely a sign to look elsewhere.
Before working with a new therapist, you may want to ask:
- What degrees do you hold? From where?
- Where are you licensed to practice?
- How can you help me resolve the particular issues I’m dealing with (depression, anxiety, breakup recovery, stress, etc.)?
- What issues do you specialize in treating?
- What forms of therapy do you practice? Are they evidence based?
- How will we know when our work together is done?
Keep in mind that the answers to some of these questions might not be clear cut. For instance, most counselors have an integrative approach to therapy, drawing on various schools of psychological research to help different clients with their particular needs. Just be sure that the types of therapy they draw on are evidence based approaches, and that the therapist is able to provide you with an understanding of what the path forward will look like for you, as well as how therapy works.
Your prospective new therapist should be transparent about their skills and background, and about their plan for helping you. Remember, you are driving the car at every stage of the therapeutic process. Your therapist is like the map, there to offer gentle guidance and support along your journey of healing and self-love. Who you choose to work with will have a huge impact on how effective therapy is for you, so don’t hesitate to ask questions and get all the information you need to make the best choice.
At the end of the consultation, it’s time to ask yourself some questions. Did your potential new therapist seem professional? Were they happy to answer your questions, or did they seem irritated or impatient? Does this feel like someone you would be comfortable talking to about difficult topics?
If all goes well, you’re ready to set up your first therapy appointment.
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Preparing for your first therapy appointment
Before your first therapy appointment, you’ll want to spend some time thinking through what you’d like to talk about. What are the issues bringing you to therapy? It could be anything from dealing with trust issues and low self-esteem, not sleeping well due to anxiety or depression, creating boundaries in relationships, and more. How long have you been struggling with them? Are they part of a larger pattern? What are your goals for working with your therapist?
The point of considering these questions isn’t to have everything rehearsed and planned out before you arrive at the first appointment. What you talk about in each session will unfold organically, and your therapist will probe topics and ask questions that you hadn’t thought to ask yourself.
But taking a little time before your session to think or journal about what you’d like to discuss can give you and your therapist some direction and help you make the best use of your time together, not only at your first session but as you move forward. Some clients like to keep a running note on their phones with thoughts and feelings that come up between sessions that they’d like to talk about at their next appointment.
First therapy session: What to expect
Once you’re at the appointment and talking with your therapist, they’ll begin conducting a basic assessment in order to understand how best to support your personal growth process. Your counselor will ask about what brought you in, whether you’ve been to therapy before, and what you’re hoping to get out of the process. If you’re seeking therapy for mental health treatment, they’ll likely ask about any symptoms you may be experiencing, and how those symptoms are affecting your day-to-day life. They may ask about your family history, work status, and about any significant relationships in your life.
The purpose of these questions is to give your new therapist a baseline idea of what’s going on with you, any protective factors helping you cope (like a supportive family, work you love, or financial resources), and any vulnerabilities making things worse (like depression, a lack of close relationships, or financial stress).
Your therapist will also be asking you questions about the current “pain points” in your life, and what you hope might change for you as a result of therapy. You can talk about anything you like: disappointing relationships, feelings of insecurity, trust issues, sexuality, low self esteem, or just generally feeling stuck in life. All are fair game, and appropriate things to talk about in therapy.
Your therapist should receive what you share with understanding, empathy, and without judgment. This allows you to begin to build trust and a sense of emotional safety, laying the foundation for future conversations that may probe more difficult topics.
Like all relationships, the relationship you’ll have with your therapist will begin on a more surface level and deepen as you get more comfortable with each other. You won’t be expected to share your deepest darkest secrets the moment you walk through the door (or ever, if you don’t want to), and you’re always allowed to say “I’m not ready to talk about that” if a topic makes you uncomfortable.
The first therapy session is also a good time to ask your therapist any questions you didn’t get to ask during your consultation. You can even ask them appropriate personal questions, like where they’re from or whether they have kids. While the point of therapy is to talk about your own life, not your counselor’s, it’s only natural that you’d want to spend a little time getting to know the person sitting across from you, listening to the intimate details of your life.
Your therapist should feel like a helpful, trustworthy, emotionally safe person. They should be on your side, working with you to heal, grow, and create a happier, healthier life for yourself. If you attend a few sessions and you’re not feeling this way, it may be time to look elsewhere.
The Arc of Therapy
Your therapist will likely spend the first two or three sessions doing a lot of listening, asking occasional questions, but not offering much specific feedback or guidance. That’s because they’re just getting to know you and your situation, and they don’t know enough yet to jump in and begin making recommendations. Don’t worry, this doesn’t mean therapy will always feel like talking to someone who never weighs in — once your therapist is more familiar with your personality and your needs, they’ll begin to give more feedback and take a more active role in steering the conversation if they feel that would be helpful to you.
Within two or three sessions, your therapist should develop a game plan for how they can help you. If they haven’t shared their treatment plan with you at this stage, don’t be afraid to ask. How long therapy takes to help you will depend on what you’re struggling with and on the types of therapy they practice, but studies show you should be experiencing at least some growth from counseling within eight to ten sessions, if the current approach is right for you.
It may also be the case that after conducting an assessment and getting to know you better, your therapist might make recommendations about a particular approach that would be most helpful to you. For example, your therapist may determine that couples therapy or discernment counseling would be more beneficial than individual therapy, if your relationship problems are causing the majority of your distress.
A therapist who provides life coaching or solution sessions in addition to therapy might determine that you’re less in need of mental health treatment (aka, therapy) than you are of an action oriented coaching approach that helps you create clarity, self-awareness, and a strategy to create positive change. (Learn more about the differences between life coaching and counseling here).
Lastly, your therapist may provide you with recommendations about a specific kind of therapy that would be especially useful to you. For example, if you’re struggling with depression they may recommend cognitive behavioral therapy. If you have generalized anxiety disorder, they might recommend an approach that emphasizes mindfulness and emotional self-care. People dealing with the long-term legacy of trauma often require a trauma-focused approach to heal. People facing the hard work of grief can often benefit from a gentle, non-directive talk therapy approach.
No matter the type of therapy you need, your therapist should be able to explain to you why the approach they’re suggesting would be helpful to you in a way that makes sense to you.
Therapists Need Feedback From You
If you’re not feeling like you’re making some progress after eight to ten sessions, share that with your therapist so you can pivot to something more helpful. Therapists often have many ways of being helpful, and know that different people benefit from different approaches. You are not a cookie: A good therapist should never use a cookie-cutter approach that is the same for every person.
Sometimes people feel uncomfortable telling a therapist how they feel about therapy, especially if it doesn’t feel helpful. Some people will even drop out of therapy rather than having that conversation with their therapist! Please know that providing your therapist with feedback and being an active, empowered “co-creator” of your therapeutic process is how therapy works.
A good therapist will be checking in with you often to see how therapy feels for you, and will always listen to your feedback and make adjustments if needed. If you tell your therapist that you’d like to try a different approach and they become defensive or refuse to alter course, that could be a warning sign that you’re with the wrong therapist.
How often should you go to therapy?
Therapy should begin with the end in mind, meaning you should know going in what changes will indicate your work with in therapy has been successful. You may be waiting until you feel more secure in your relationship, or until the symptoms of depression ease off, or until you’ve passed through an especially difficult time in your life. Keeping the end in mind not only ensures therapy doesn’t drag on past the point that it’s helpful, it gives you a measuring stick to judge your progress by.
In the beginning stages of therapy it can be most helpful to attend therapy weekly, in order to establish a strong working relationship with your therapist, and to begin making progress. Once you’re moving forward, have gained self awareness, and have learned the new ways of thinking, feeling and behaving that will help you, it can be appropriate to start cutting back the frequency of therapy sessions. Learn more about how therapy works here.
Once you reach the more stable, happier place you’re aiming for, you can either continue checking in with your therapist for occasional sessions, transition to more growth-oriented work in coaching, or just be done. Whatever you choose, you can feel proud of your work in therapy, the important insights you’ve gained, and the positive changes you were able to make.
I hope this article answers some of your therapy questions, and gave you a sense of what to expect when meeting your new therapist, so that you can go into the experience prepared and relaxed. A first therapy session is no big deal, but taking the first step toward a happier, healthier life certainly is.
Your first therapy session can be a little intimidating, but once you find the right counselor and get to work, you’ll wonder why you didn’t do it sooner.
Your partner in growth,
Dr. Lisa Marie Bobby is the founder and clinical director of Growing Self. She is a licensed psychologist, a licensed marriage and family therapist, and a board-certified coach, as well as the author of “Exaholics: Breaking Your Addiction to Your Ex Love,” and the host of The Love, Happiness & Success Podcast.
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