The [……]’s Guide to Getting a Therapist: Your First Session

Fun fact: searching around for creative commons licensed couches results in lots of couches on fire. Is this a Thing?

Note: For decreasing the amount of language confusion in this post, I’m using ‘therapist’ as a blanket term to mean ‘someone who practices therapy’. In fact, this is not precisely accurate, though it seems to be colloquial use. For sorting between psychiatrist, psychologist, and therapist, take a look at the Terms section in Part I.

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Part III: In which couches are sat upon, forms are filled out, and intake is had.

I am not a therapist! However, lots of people ask me a lot of the time about getting therapy, and are often willing to keep me updated on what worked and what didn’t. This four-part guide, which is essentially the sum total of every bit of advice I could think of, and a few I didn’t come up with (thank you, proofreaders and feedback-givers!) aims to make the therapist-getting part less mysterious and more accessible. 


Your first session:

The first session is an extension of the “Do you want to tango?” testing-each-other thing. The therapist wants to know if they can help your particular case, and you want to know if you feel comfortable/matched with them. It’s a first ‘date’ and if they’re metaphorically rude to the waiter, or you just don’t click, it’s okay not to start a relationship.

You might have to fill out some forms. This can vary a lot from place to place, but generally forms can include:

-acknowledgement of the confidentiality policy: therapists will keep nearly everything confidential, but they are bound by law and ethics in some very specific circumstances. If you want an idea ahead of time, here’s the gist.
-if you have medical or other psychiatric information that they might want or need, there’s a potential for signing releases to allow them to have this information. I’ve signed releases so that my medical info was accessible to my therapist and releases to allow therapists to have my previous therapists’ files on me. I was glad I did both these things, but you aren’t required to do so.
-In larger establishments like a health services center or such, it’s common for there to be initial diagnostic questionnaires, like a depression measure.

This session will likely involve very little Classic Therapy ™. Your therapist will be trying to get a feel for your issues and circumstances and might asks things like “Can you tell me what brought you here?” and ask about your previous mental health history.  I’ve also been asked if I was suicidal or had a history of suicidality and whether or not I had a history of being sexually assaulted or raped. The latter might be as a result of where I was seeking therapy—a women’s center, but I’m not certain.

The therapist should tell you about their approach and training. The American Psychological Association has a list of questions your therapist should be able to answer in your first session here—I highly encourage you to seek this information (and take it as a great sign when said therapist provides it without me asking.)

Therapies can also look quite different from practitioner to practitioner–one might be very structured and use lots of forms and worksheets (not necessarily a downside–I like these!), while another might be more informal or conversational. You can ask things like “What does [X therapy] look like in practice?” to get a better sense of this.


Some thoughts on the experience of getting therapy for the first time:

Intake–the first session or the pre-first session–is exhausting. It’s telling all of what makes you need therapy and answering a fair number of invasive questions. I strongly recommend that people plan something relaxing and low stress (if you’re introverted, something that does not involve human interaction) for afterwards. Even thought I usually know what intake should feel like and have done it multiple times, I have to spend ~3 hours decompressing afterwards.

Most of the rest of therapy is not like this, but in order to have the relevant information, the therapist needs to have lots of starting knowledge about you. This is well worth it, but if at all possible, do not put your first therapy session between other scheduled and important actions.


Some things to notice:

Does the medium therapist communicates with you in align well with how you prefer communication? I had phone-phobia for a while–therapists who didn’t use email weren’t worth it, because I’d never be able to get around the ugh field to call them and reschedule.

Does the therapist let you direct the session or do they initiate most angles or discussion? There’s not a One True Way. I prefer therapist-initiated angles of conversation (though I will sometimes point out that I’d like to focus on something time-sensitive), some people prefer the opposite. Noticing what you prefer here can improve future therapy.


Next post: Miscellania
<< Previous post: Reaching Out

I am actively looking for things I’ve left out, so if upon reading any section, you have unanswered questions–even if you think they are trivial or might mean you’ve missed something, please let me know. I would much rather spend time responding with “no, that’s in paragraph two” than have a whole subset of people think they didn’t read properly and not tell me I was unclear. Further, many thanks to Rita Messer for checking over the advice within. 


  1. says

    I agree that it’s OK not to start a relationship.

    I’m dubious about any first session that contains very little classic therapy. In my experience, therapists who fill the first session with form-filling and history-taking are usually the therapists who aren’t very good at therapeutic alliance, and then many sessions later you’ve got nowhere and are looking for another therapist.

    As for finding out about the therapist’s approach and training, that should be done before you even consent to attend the first session.

    I disagree that the therapist needs to have lots of starting knowledge about you. A therapist who overdoses on information is evading getting to know you as you, evading the therapeutic alliance. If you find that happening, don’t go back.

    • Kate Donovan says

      I’m not comfortable with the idea of expecting therapy in a first session. Many therapists who work through health services centers *have* to do those forms, and they can be quite extensive. Or, what you could be expecting to be your intro session could be the time the center calls you in to fill out forms. Going in and expecting to feel better via therapy can mean setting yourself up for disappointment, and I’m trying to avoid that.

      Secondly, can you please operationalist “overdoses on information”? If you’re warning readers away from that, I think you’d need to define what that would even look like, and how one would be able to tell if they haven’t been in therapy before.

  2. Gregg says

    I’m in the process of shopping for a therapist now after my old one has informed me she’s moving, and one thing I’m curious about is views on how many “first sessions” or significant phone contacts should be made before choosing one to go with. Is it advisable to speak to a bunch first, before scheduling intake and trying one on for size in a full session (many are willing to at least speak on the phone, which has revealed a lot to me, while some only are willing to talk in person for a fee, and I find this somewhat off-putting)? Or should one try “serial monogamy” with therapists; just do the research, go to one, and try it for a while?

    Also, one CBT-oriented therapist offered me a heuristic for judging how to judge whether a therapist is worth continuing to see; one session should be sufficient to see if we ‘click,’ 3 sessions should bring about minor change, and 8 sessions should result in significant, noticeable improvement. Does this sound like an accurate heuristic? How should can one tell early on in a therapeutic relationship if one should continue with that therapist or look for a new one?

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