What to Expect from the First Therapy Appointment (and What You Can Do to Prepare)
If you’re new to therapy, chances are you’re feeling some degree of nerves before the first appointment. It can be anxiety-provoking to start something new… especially when that “something new” involves talking about deep-rooted emotions, thoughts, and/or trauma with a stranger. There are very few (if any) accurate representations of therapy in the media, which adds to the uncertainty of what to expect.
My goal for this post is to demystify the process by outlining what you can expect, and some tangible steps you can take to feel ready.
The initial appointment is often referred to as an “intake” appointment.
The intake is typically more structured than a regular therapy appointment, in that your therapist will ask a series of open-ended questions to understand the concerns that are bringing you into therapy, your background/history, relevant life experiences, and what you’d like to see different in your life.
In other words, your therapist will be “taking in” information during the intake.
Follow-up sessions tend to be more conversational (back-and-forth), though this can depend on the modality of treatment your therapist will be using.
You’ll be asked to fill some paperwork out ahead of time.
If you’re meeting with your therapist online, you’ll most likely be sent the paperwork at the time you schedule the appointment. If you’re meeting your therapist in person, you might be able to complete the forms in-person by arriving 15-20 minutes early.
The paperwork will include things such as:
Consent form which outlines the risks and benefits of therapy, cost, limits of confidentiality, and other important items
Practice policies form which outlines things such as the cancelation/no-show policy
Questionnaires on current symptoms, medical history, etc
It might feel like a lot, yet each form has a purpose and important information to review. Take your time and ask questions as needed if something feels unclear.
The first few minutes will include reviewing logistical information and answering questions.
At the beginning of the session, your therapist will highlight some important aspects of the consent and policy forms, and invite you to ask any questions that came up on the paperwork.
They’ll also give you a brief outline of what to expect from the appointment, including how long the appointment will take.
Expect lots of questions.
Your therapist will ask questions to understand your concerns, history, and goals for therapy:
The nature of the problem bringing you into therapy, and how long it’s been going on
Times the problem is better/worse
What you’ve tried to do already to help with the problem
Past mental health treatment
Childhood history
Relationship/family history
Educational and work history
Medical history
Family mental health history
Risk concerns (suicidal thoughts or thoughts of harming others)
Alcohol, marijuana, or other substance use (past/current)
Cultural identity
Religious/spiritual beliefs, if applicable
Legal history
Goals for therapy (what you’d like to work on changing)
It’s a lot! If it feels overwhelming, just know that the full intake process can actually take several sessions total. You’ll probably not get to everything in the first visit.
If you’re drawing a blank on goals, no worries. Your therapist will help you formulate these. The information below might also help you put together some ideas.
You also are in control of how much you choose to share — if something feels difficult to talk about, let your therapist know you’d like to skip that one for now.
You can also ask questions at any time.
At the end of the appointment, your therapist may share initial ideas for the treatment plan.
This could include reviewing what approach(es) they recommend for treatment based on your concerns, history, and goals. They will also share a little about what you can expect from sessions moving forward, including the next session. You can ask questions or give feedback as needed.
You’ll then make a plan for the next appointment, if you choose to move forward.
In some cases, it might become clear during the intake that your therapist may not be the best fit for your specific concern. If this happens, they will talk with you about next steps and offer referrals to another provider, if applicable.
Likewise, if you feel unsure if the therapist is the right fit for you or need more time to consider your options, there’s no pressure to set up a follow-up visit.
What you can do to prepare for the intake.
1) Come up with some ideas for therapy goals.
A place to begin is to ask yourself, “what does better look like?” For example, if you’re struggling with depression, you might set a goal of “feeling less depressed,” which isn’t particularly specific.
What would you be doing differently if you felt less depressed?
Would you be re-engaging with friends or hobbies?
Would you be less distracted by negative thoughts?
Spend a little time brainstorming before the appointment, and take some notes. Bring these into your session.
2) Take some notes on what’s been going on.
Everything blurs together when you’re feeling overwhelmed, down, and anxious. It can be helpful to think back to when the problem started, what else was going on around that time, and any other relevant details.
3) Write down questions for your therapist.
If you’re new to therapy and not sure what to expect, just know that you are allowed to ask as many questions as you need!
Here are some questions you can ask in the first appointment:
What will sessions look like moving forward?
How frequently should we meet?
How many sessions do you think I might need for this concern?
What’s your experience treating XYZ issue?
Will I be asked to do anything in between appointments?
4) Give yourself some decompression time after the appointment.
You might feel “emotionally hungover” after the initial appointment, and that’s normal. Talking about painful emotions, thoughts, or experiences can stir up a lot. If you can swing it, it can be helpful to plan some buffer time for yourself in between the appointment and whatever else you have on your schedule.
Let yourself decompress and burn off some of that anxious energy in a way that feels good to you — go for a walk or run, chat with your best friend, watch silly TikTok videos, whatever works.
You also might find yourself replaying what you shared or questioning if you shared “too much.” Just know these thoughts are normal, and it’s just your brain’s way of processing and integrating a new life experience.
You just took a big step towards improving your wellness, and that deserves some celebration!
5) If you realize you forgot to talk about XYZ, just bring it in next time
This happens a lot - clients often come into session two saying, “I can’t believe I forgot to mention XYZ!”
If this happens, just make a note for yourself and bring it into the next appointment.
