6 things to know before your first therapy session

Tips and advice on how to prepare and what to know before you go to your first therapy session. Includes what to bring, privacy policies, and developing trust in your therapist or counselor.

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Aug 24, 2021 UPDATED
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You did it. You’ve found a therapist. You’ve scheduled your first visit. So now what? Here are six things to keep in mind to help prepare you for that first visit. 

1. Everything is confidential

Trust is at the center of every therapist-patient relationship. Key to that trust is knowing that everything you share in a session is confidential. It will take time to feel completely comfortable sharing your innermost thoughts, feelings, and concerns, but it should help know that the therapy session is a safe space, whether it takes place in person, via a telehealth platform, or on the phone. 

Therapists are required to abide by a strict code of conduct and social workers by a code of ethics in which trust, integrity, and confidentiality are paramount. Before your first session, your therapist should share a privacy statement that details their privacy policies, how your information is recorded and/or stored, and the (rare!) instances that your information may be shared with anyone else. 

These very limited exceptions to therapist-patient confidentiality include if a dangerous crime has been committed, or your therapist deems that someone is at risk of harm or self-harm. Exceptions also apply with minors or those in the care of proxies or guardians. Even in that case, your therapist will require advance written permission from you to disclose anything to your designated health care proxy, be it a parent, partner, or other legal guardian. 

So while you might not divulge any serious secrets in your first session, knowing that you are in a safe space and that anything you do share will be treated with compassion and confidentiality is a first step towards not only building a healthy rapport with your therapist, but also towards a happier, healthier life.

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2. Have a goal/outcome in mind

Reaching out to a therapist likely means there’s something you’d like to work out or work on in your life, your relationships, your mental health, or career. While the reasons for seeking help are myriad, whatever your reason, it helps to have a specific outcome in mind. What is your goal for therapy? Do you want to stop taking work stress personally? Do you want to figure out a way to communicate with an estranged family member? Maybe you’re trying to work through a loss or a disappointment. 

Your reason for seeking therapy can be broad (“I’m having trouble sleeping”) or acute (“I think I may be addicted to alcohol”) but it’s important to articulate these reasons as specifically as you can. Whatever the reason, be prepared to tell your therapist why you are seeking therapy, and what you hope to get out of the relationship. 

Of course, the outcome you hope for likely will not happen overnight. But there are tools that your therapist can suggest to improve your daily interactions and the way you respond to difficult or disappointing situations. With time, you should expect to check-in with your therapist on how you are progressing towards the initial goal or outcome you set at the beginning of treatment, and to adjust or update it as needed.

3. Limit distractions

If you’re meeting with your therapist in person, it’s easier to remember to leave your cell phone off (or on silent). On a telehealth platform, limiting distractions can be a bit trickier. Try to make sure you’re somewhere quiet, private, and comfortable (your therapist will likely want to be sure you’re in a safe space, too). Any stress or anxiety about your vulnerability will only be exacerbated if you’re tired or hungry, so try to get a good night's sleep the night before and ensure that you’ve eaten or had a snack in advance. 

When meeting via telehealth, it’s normal that your cat may jump into your lap, your neighbor’s dog may bark in the background, or your own child may interrupt looking for a snack of their own. This is totally okay, just know that the more time you spend apologizing for the interruption or going into an explanation, the less time you have to focus on the important stuff. Acknowledge the disruption, and move on—it’s not a big deal. 

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4. Bring a notebook and a pen/pencil (be prepared to both share AND to listen)

Many people think of a therapist as a kind of sounding board who will listen to their problems. Less obvious to many is that therapists also use their own training—and judgement—to suggest solutions. Sometimes this is a new way of thinking about problems or responding to situations via exercises to “retrain” your brain, such as those used in Cognitive-Behavioral Therapy (CBT)

Your therapist may also suggest additional reading materials or even give you homework. Homework could be simply paying attention to the situations that cause your most vexing symptoms, and those that bring you joy. Write these “assignments” down in your notebook so you can remember later; this will also help you to focus your attention in the moment on what your therapist might have to say. 

5. It doesn’t have to be weird

While it’s totally normal to be nervous when meeting a therapist for the first time, know that going to therapy is not unusual. In a recent SimplePractice survey, 59% of people over the age of 18 have seen a counselor or therapist. It can be a comfort to know that you’re not alone in seeking help. If you are feeling nervous, or awkward, try to commend yourself for having the courage to seek advice, counsel, or treatment. Taking the time to center yourself before the session by focusing on your breath for a few moments—either in your car, the waiting room, or, if the session is via phone or telehealth, in a quiet solitary place in your home—can go a long way in helping to calm any nerves and focus your attention on being as present as possible during the session. 

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6. Give it at least a few visits before deciding if it’s the right fit 

The first therapy session is typically part-administrative to review privacy policies, billing procedures, part-just getting to know one another. Just like any relationship, it takes time for trust to develop, so it’s typical that your therapist will keep things light for the first few sessions. You’re not likely to achieve your desired outcome right away, but you should start to feel a sense of relief that you are taking proactive steps towards feeling better overall. 

Deciding to find help with a therapist is no small matter; you’ve already jumped the tallest hurdle. Preparing yourself for what’s next is smart, but at the end of the day, there are no wrong moves. You got this. 

Article originally published Mar 30, 2021. Updated Aug 24, 2021.

American Psychological Association (APA). (2017). Ethical principles of psychologists and code of conduct (2002, amended effective June 1, 2010, and January 1, 2017). Retrieved from https://www.apa.org/ethics/code/

National Association of Social Workers (NASW). (2018). NASW code of ethics. NASW. Retrieved from https://www.socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English 

APA Div. 12 (Society of Clinical Psychology). (2017). What is cognitive behavioral therapy? American Psychological Association (APA). Retrieved from https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral 

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