What to Expect in Your First Therapy Session
Starting therapy takes courage, and knowing what to expect can ease some of the natural anxiety about that first appointment. As a Seattle therapist with over 15 years of experience, I want to help you feel prepared and empowered as you take this important step. Here's a detailed guide to what happens in a first therapy session and how to make the most of it.
Before You Arrive
The Free Consultation
In my practice, we always start with a complimentary 20-minute phone or video consultation. This allows us to:
Get a sense of each other
Discuss what brings you to therapy
Explore whether we're a good fit
Answer your initial questions
Schedule the first full session if we both feel positive
This consultation takes pressure off the first full session, we've already connected, so you're not meeting a complete stranger.
Practical Preparations
Paperwork Most therapists, including myself, will send intake forms before your first session:
Basic contact and demographic information
Health history and current medications
Previous therapy experience
Current symptoms and concerns
Consent forms and office policies
Completing these in advance saves time and helps me prepare for our meeting.
Insurance Considerations If you plan to use out-of-network benefits:
Verify your coverage before the session
Understand your deductible and reimbursement rate
Know the CPT codes (90791 for initial evaluation)
Prepare questions about superbills
Logistics
Confirm the location 5306 Ballard Ave NW
Plan for parking or transit. Note i have easy street parking!
Arrive 5-10 minutes early
Silence your phone
Mental and Emotional Preparation
It's Normal to Feel:
Nervous or anxious
Uncertain about what to share
Hopeful yet skeptical
Exhausted at the thought
Relief that you're finally doing this
Helpful Mindsets:
You don't have to share everything immediately
There's no "right" way to do therapy
Your pace is respected
Questions are welcome
You're interviewing me too
The Structure of Session One
Opening and Introductions (5-10 minutes)
I'll greet you in the waiting area and guide you to my office. The first few minutes involve:
Getting comfortable in the space
Brief introduction beyond our consultation
Reviewing confidentiality and its limits
Discussing any immediate concerns
Setting the frame for our work
Understanding Your Story (30-40 minutes)
The bulk of our first session involves me learning about you:
What Brings You Here I'll ask open-ended questions like:
"What has you seeking therapy now?"
"What would you like to be different?"
"How have these issues impacted your life?"
"What are your hopes for therapy?"
Your History Depending on your comfort, we might explore:
Family background and relationships
Previous therapy experiences
Significant life events
Current life circumstances
Coping strategies you've tried
Current Symptoms I'll gently assess:
How you're sleeping and eating
Anxiety or depression symptoms
Any safety concerns
Substance use if relevant
Physical health impacts
My Clinical Impressions (5-10 minutes)
Toward the end, I'll share:
Initial thoughts about your concerns
How I might approach treatment
Which of my specializations apply
Potential treatment timeline
Any immediate recommendations
This isn't a formal diagnosis—it's collaborative exploration.
Planning Next Steps (5-10 minutes)
We'll discuss:
Whether we both feel it's a good fit
Session frequency (usually weekly initially)
Any between-session suggestions
Questions you have
Scheduling our next appointment
What Makes My First Sessions Unique
Integration from the Start
With my diverse training, I'm assessing multiple levels:
Trauma history and nervous system regulation
Attachment patterns and relational style
Body awareness and somatic symptoms
Cognitive patterns and beliefs
Meaning-making and spiritual dimensions
This comprehensive view helps me understand how to best help you.
Collaborative Approach
Unlike more traditional therapy:
I share my observations transparently
We discuss treatment options together
Your preferences guide our approach
I explain my clinical thinking
We create goals collaboratively
Hope with Realism
Having specialized in helping "stuck" clients:
I acknowledge past therapy challenges
I'm realistic about timelines
I identify what might be different this time
I balance hope with honesty
I respect your skepticism
Common First Session Concerns
"What If I Cry?"
Tears are welcome and normal. I have tissues ready and see crying as:
A healthy release
A sign of trust
Important information
Part of healing
Nothing to apologize for
"What If I Don't Know What to Say?"
There's no script to follow. If you're unsure:
I'll guide with gentle questions
Silence is okay too
We can start wherever feels comfortable
Stream of consciousness works
"I don't know" is a valid answer
"What If I Overshare?"
You can't "overshare" in therapy. However:
You control the pace
We can slow down anytime
I'll help contain if needed
Everything is workable
Your comfort matters most
"What If We're Not a Good Fit?"
This is important to assess:
Trust your instincts
It's okay to not continue
I can provide referrals
No hard feelings
Your needs come first
"What If I Feel Worse After?"
It's normal to feel drained after a first session because:
You've shared vulnerable material
Your nervous system is activated
Change is beginning
Defenses are softening
Plan for gentle self-care afterward.
What I'm Noticing in Session One
While you're sharing, I'm tracking:
Verbal Content
Your story and concerns
Patterns and themes
Strengths and resources
Areas of stuckness
Readiness for different interventions
Nonverbal Communication
Body language and posture
Emotional regulation
Eye contact patterns
Nervous system state
Comfort with connection
Relational Dynamics
How you relate to me
Trust and safety levels
Attachment style indicators
Defensive strategies
Openness to support
This multi-level attention informs my approach.
Making the Most of Your First Session
Be Honest About:
Previous therapy experiences
What hasn't worked
Your fears about therapy
What you hope for
Any concerns about me
Ask Questions:
About my experience with your issues
How I typically work
What therapy will involve
Timeline expectations
Anything that would help you feel safe
Trust Your Instincts:
Notice how you feel with me
Pay attention to safety signals
Honor your pace
Speak up about needs
Value your gut feelings
After the Session
Immediate Aftermath
Plan for:
Potential emotional vulnerability
Need for alone time or support
Gentle activities
Good self-care
Processing time
Between Sessions
I might suggest:
Simple awareness exercises
Journaling prompts
Self-care practices
Resource building
Nothing at all—just being
Making Your Decision
Take time to consider:
How you felt during session
Your sense of hope
Comfort with my approach
Practical considerations
Overall fit
The Bigger Picture
Remember, the first session is just the beginning. It's about:
Planting seeds for trust
Opening the door to healing
Starting to be truly seen
Beginning important work
Taking a courageous step
You don't need to be perfect, prepared, or put-together. Come as you are.
Your First Session Awaits
If you're ready to take this step, I offer:
Safe, judgment-free space
Comprehensive assessment
Clear treatment planning
Multiple approach options
Genuine care for your wellbeing
The hardest part is often just beginning. Once you're here, we'll navigate together.
