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  • Writer's pictureCollin Pearman, LPC

How to Prepare for Your First Therapy Session: A Step-by-Step Guide

Updated: Feb 10

two people sitting with their hands in their laps, reflecting the uncertainty, the questions, and the hesitation many clients feel when seeking out or beginning therapy with a new therapist. The therapist, off-screen, is matching body language with the client, evidence that they're paying attention to the common factors responsible for change across all counseling theories or modalities

Starting therapy can feel like a significant step, one filled with both anticipation and uncertainty. However, being well-prepared for your initial session can greatly enhance its effectiveness and set a positive tone for your therapeutic journey. Here's a step-by-step guide to help you navigate your first therapy appointment with confidence:

Understand Common Factors while you Research Different Providers and Treatment Modalities:

Before you’ve even found a counselor, many people get bogged down with the idea of trying to find the “right” one. But how do you do that? Do you pay attention to the therapist credentials? Experience? Their treatment modality or theories of how change works? Or is it more about who the therapist is as a person? So, like millions of other people every year, you hit up the internet and begin typing. You come across a seemingly-endless number of therapists who all have their own treatment styles, theories, and modalities. It can be overwhelming, and many people stop before they’ve really started.

So what can we do about this? As you explore different therapy providers and treatment modalities, it's essential to understand the common factors that contribute to positive therapeutic outcomes. According to Barry Duncan, a leading figure in psychotherapy outcomes research, these common factors include the therapeutic alliance, therapist factors, and client factors. “Research has shown that personal therapy (meaning the therapist spending time getting their own therapy to become a better therapist) has nothing to do with outcome; there are no therapeutic approaches, strategies or interventions shown to be better than any other; professional training and discipline do not matter much to outcome; there is no evidence to show that continuing professional education will improve effectiveness; and, although it defies common sense, experience does not improve outcomes either.”

While professional experience and licenses and training do matter, in that I wouldn’t be very likely to get “counseling” from an unlicensed person in a back alley, research indicates that the therapist’s training matters far less than building a strong therapeutic alliance with their clients. “In reality,” Duncan states, rather than rigidly adhering to a specific model, “it’s a far more interactive and changing process that we engage in with clients as we try to figure out what will work best with them.”

“In reality, it’s a far more interactive and changing process that we engage in with clients as we try to figure out what will work best with them.” -Barry Duncan


The therapeutic alliance refers to the collaborative relationship between therapist and client, characterized by trust, empathy, and mutual respect. Therapist factors encompass the therapist's personal qualities, skills, and approach to therapy, while client factors include the individual's motivation, readiness for change, and ability to engage in the therapeutic process.

When seeking a therapist, go ahead and look for someone who has experience working with clients with similar presenting symptoms, struggles, or experiences. Look for someone who’s theories on change line up with yours or are attractive to you. But as you’re searching, remember that it's crucial to find a therapist who makes you feel comfortable, welcomes your feedback, and adapts their approach to meet your needs, rather than rigidly adhering to a predetermined program.


Reach Out for a Discovery Call/Consultation:

For those residing in Missouri who might want to work with me, or for anyone anywhere looking for a counselor, typically the next step after narrowing you’re your list of potential counselors is to reach out to them for a Discovery Call/Consultation with a therapist. Many therapists offer this service for free. I know I wouldn’t want to pay for a consultation, so I definitely don’t charge for them. You deserve to evaluate therapists and get a feel for what it would really be like to work together without an initial investment of anything more than you’re valuable time. This initial conversation allows you to learn more about the therapist's approach, ask any questions you may have, and ultimately determine if it's the right fit for you before committing to an appointment. No worries though, you can always change your mind later. Any therapist worth their salt is going to help you out the best they can, even if that means giving you a referral for another therapist who might be a better fit.


Review Paperwork and Intake Forms:

So, you’ve narrowed down to one therapist that you got a good feeling from. They “passed the vibe check,” you might say. Whatever it was that gave you the internal green light to schedule you’re first session, congratulations! You’ve taken your first step in a messy, but hopefully beautiful, direction. Once you've scheduled your first session, take the time to carefully review any paperwork or intake forms provided by the therapist. While filling out these forms may seem daunting, providing detailed information about your concerns, history, and goals can significantly aid the therapist in understanding your needs from the outset, thus facilitating a more tailored and effective treatment plan. At Home and Community Counseling you can bet on this, that if you write me a book in your intake form, I will read that book. I love it when my clients give me a richly-detailed account of their life story. It tells me so much about you; how you think and feel, what you believe about yourself, about others, about the nature of reality, about why we’re all here. I do not take it for granted that my clients are being vulnerable and opening up their worlds to me. So, I read every word in preparation for the first session. Consider slowing down, and taking the time on this that it really needs, and that you really deserve. You are worth your own effort.


Consider Practice Policies:

Familiarize yourself with the policies of the therapist's practice, including procedures for cancellations, late arrivals, and missed appointments. Understanding and adhering to these guidelines not only ensures a smoother therapeutic process but also demonstrates respect for both your progress and the therapist's practice. While it might not be easy to talk about, recognize that how you handle potentially difficult conversations (finances, respect for yours and the therapist’s time, etc.) is actually part of the therapy process and your therapist is working through these things with you for your benefit. The thoughts, feelings, and bodily states that come up for you in the midst of these conversations are things that may indicate useful areas for exploration. So no worries, your therapist is not going to judge you if these conversations ever feel awkward. They might feel a little awkward for them, too, because every therapist I’ve ever known has also been, well, human.


Prepare Questions:

Take some time to reflect on any questions you may have about the therapeutic process, the therapist's approach, or how progress will be measured. Clarifying these points beforehand can help set clear expectations and foster a collaborative therapeutic relationship from the start. This is something that you’ll hopefully do before your consultations with potential therapists, but it’s also a process that continues throughout the entire course of treatment once you’ve actually selected a therapist and started in on the process. When you, your therapist, or collaboratively you’ve decided on an assignment, ask questions about it. How will this help me? What might I expect to gain from this? What will the challenges be? How will we measure success? How will we know if this isn’t working? How will we handle setbacks? These questions will not offend your therapist, quite the contrary. We therapists want to work with people who are taking an active role in their treatment. We know not everyone will have had prior experiences with therapy and that you might not know what to ask or expect. We want you to ask.


Document Recent and Historical Symptoms and Attempts to Manage Them:

Before your session, make a note of the symptoms you're experiencing, how long you’ve been dealing with them, how they're impacting your life, and any previous attempts you've made to manage them. To be clear, whether or not you think you’re managing them well, something must have been working to help you make it through, or else you would not have arrived at this present moment. Even less healthy methods of coping do something for you. What do they do for you? How do they help? Do they have any drawbacks? Where do your symptoms show up? Where are these symptoms mysteriously absent from your life? You will likely have covered some of this in your intake paperwork, but if not, spending time thinking about and writing these things down provides valuable insights for your therapist and serves as a starting point for exploring potential treatment strategies.


Bring Necessary Items and Have a Plan for Potential Distractions:

On the day of your appointment, ensure you have all necessary items with you, such as a journal or notebook, water, and tissues. Having these items on hand can help enhance your focus and comfort during the session, allowing you to fully engage in the therapeutic process. Bringing a journal allows you to really get the most out of the therapeutic process. Write down things that you talked about, emotions that came up for you during the session, things it made you think about, and any assignments for how to take what you got from the sessions out into your every day life. Not everyone naturally thinks about journaling, and you don’t have to start a regular habit of keeping a journal or diary, but humans have limited capacity to retain information during moments of stress, and therapy can be a stressful process. A good one, but stressful nonetheless. Recording information can help us bypass these human limitations so that we can get better, faster.

One of the benefits of telehealth therapy is that you’re hopefully in a comfortable environment with all the things you need to be present and focused in on the discussion so you can get the most out of it. To be fair though, this also comes with potential drawbacks. Distractions from your everyday life. Make your best efforts to rid yourself of these distractions so you can get the most from your experience. Talk to your family members about giving you the space you need. Put the dog or cat up if they’ll be a distraction to you (I personally love meeting people’s pets though, and I’m more than fine with them there if you are!). You are worthy of prioritizing your time, and you deserve the time and space it takes to heal.

Test Technology for Virtual Sessions:

If your therapy sessions will be conducted virtually, take some time to test the technology beforehand. Ensure that your computer's audio and video are functioning properly, and that your internet connection is stable. Familiarizing yourself with the platform can help minimize technical issues and ensure a smooth virtual session.


Be Prepared for Questions:

During your first session, expect to be asked many questions as your therapist gathers essential information to better understand your concerns and goals. The more detail you gave on your intake paperwork, the fewer questions you might be expecting in the initial intake session, but you’ll still likely be asked more questions in a row during your first session than you ever will in any future sessions. Being prepared to openly discuss your experiences and challenges can help facilitate a productive therapeutic dialogue.


Take Notes:

Throughout the session, consider taking notes on key insights, reflections, or assignments provided by your therapist. These notes can serve as valuable reminders between sessions and aid in the retention and implementation of therapeutic strategies. I can’t stress this enough. We cannot overcome our human limitations through willpower alone. You cannot will yourself to remember every vital insight, idea, strategy, or breakthrough you achieve in sessions. I want you to remember everything from your therapy that you consider to be vital or important. Writing it down solidifies it, helps you take it with you. The information and insight you gain from your sessions is part of what you’re paying for. Writing it down helps you get your money’s worth.


Mind the Time:

Now that you’ve started therapy, make sure you’re paying attention to the time. As each session comes to a close, be mindful of where you’re at in the discussion and aim to wrap things up smoothly. Many therapists prefer to conclude sessions with a summary of key points discussed and planning for next steps, in addition to hopefully getting feedback from you about how the session went for you. This allows for a sense of closure and ensures that important topics are addressed within the allotted session time. Instagram-famous therapists joke about clients waiting until the end of the session to drop bombs. And I get it, sometimes as a client I’ve wrestled with whether or not I should bring something up, and as the session closes I’ve felt the pressure mounting to get it off my chest and it just…spills out. So I’ve been there. As I learned to mind the time in my own sessions, I was better able to prioritize how we spent the sessions and got more out of it. It also helps that I wrote down things we didn’t get to talk about yet and was able to bring those things up next time, or bring them up at the end of session— not to talk about or try and deal with, but simply to get them on the agenda for the next session.


By following these steps and adequately preparing for your first therapy session, you can approach the experience with confidence and openness, laying the foundation for meaningful progress and growth on your mental health journey. Remember, embarking on therapy is a courageous act of self-care, and taking this step is the first toward achieving greater well-being and fulfillment in your life. It is worth the time it will take to prepare. And so are you.



If you’re a Missouri resident and are looking for a therapist who will meet with you virtually, adapt their style to fit your needs, and who will regularly seek to collaborate with you and get feedback from you along the journey, reach out for a free Discovery Call. I’d love to hear from you, and I’m ready when you are.

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