The first session is not therapy. It's a mutual interview. The therapist figures out whether they can help, and you figure out whether you want to work with them. Both jobs matter.
Before the session
- Write down the three things you'd most like to talk about, in order. You'll forget one in the room otherwise.
- Note any medications you're currently on, including supplements. Your therapist will ask.
- If you've seen a therapist before, note who and how long — you don't have to share everything, but the fact of previous therapy is useful context.
- Book somewhere quiet where you won't be interrupted for 90 minutes (first sessions often run long).
What your therapist will ask
- What brought you in today?
- How long has this been going on?
- How is it affecting your day-to-day (work, sleep, relationships)?
- Any history of mental health issues in yourself or your family?
- Ever thought about hurting yourself?
That last question is universal and standard. Being asked doesn't mean the therapist thinks you're at risk — it's baseline due diligence. Answer honestly.
Green flags — a therapist who's a good fit
- Listens more than they talk in the first session.
- Explains their approach clearly when you ask ("I mostly use CBT for anxiety; here's what that means").
- Doesn't make big promises. Anyone who guarantees to "fix" you in a set number of sessions is oversimplifying.
- Sets the frame — how often they'd want to meet, roughly how long treatment tends to run, what their cancellation policy is.
Red flags — book elsewhere
- Interrupts you or talks about themselves in ways that don't relate to your issue.
- Diagnoses you in the first 20 minutes.
- Recommends a modality you've never heard of without explaining why.
- Makes you feel judged rather than understood.
After the session
Give yourself an hour before you decide whether to book a second session. First sessions can leave you tired or emotional and both of those cloud judgement. If, after that hour, you feel it was useful and you can imagine building on it — book. If not, tell the therapist honestly. Good therapists appreciate feedback and can refer you to someone else.