What to Expect in Your First Therapy Session: A California Therapist’s Guide
Starting therapy can feel daunting. Whether it’s your first time in therapy or you’re starting with a new therapist, it’s normal to feel anxious when setting up a consultation call or attending your first intake session. You might have lots of questions: What happens? What does it look like? What can I expect? Where do I begin? I’m a LCSW in CA, CO, and TX, and in this post I’ll break down what to expect during your first session with me: informed consent, intake assessment, goals, and how to prepare.
1. Greeting and Introduction
The first few minutes is an introduction and brief check-in on how you feel. Typically, people describe feeling nervous or excited, which is normal. I’ll begin by providing an overview of how the first session will flow before we jump into talking about you and what brought you in. I will educate you on how I will approach the session, and provide education on the importance of the therapeutic relationship. I encourage clients to ask questions throughout and seek clarity on anything confusing or unclear.
2. Review of Informed Consent and Policies
My informed consent is thorough and informative. Now, I know a lot of folks may not read through it all, but I do encourage you to because it contains helpful information about the entire process, including answering questions like: What happens if see each other in public? Having said that, I will review some of it in session, particularly highlighting 3 things: 1) confidentiality and its limitations, 2) 24-hour late cancellation and missed appointment policy, and 3) navigating mental health emergencies.
HIPAA protects your privacy, so what we discuss in our sessions stays confidential; however, there are several exceptions to this, including but not limited to intent and plan to harm to self or others, child or older adult abuse, and court orders.
3. Intake Assessment
Once we’re done with the informed consent, I’ll move onto reviewing the Client History Form, which is a form that’s completed by you prior to your appointment. I review all the completed intake forms prior to scheduled appointments and create a list of follow-up questions. The Client History Form serves as a biopsychosocial assessment. A biopsychosocial assessment is a holistic evaluation that helps mental health professionals understand a person’s health and well-being by looking at multiple factors. It’s a snapshot of you and your ecosystem, and everything that shapes you. This means looking at biological factors (health, genetics), psychological factors (thoughts, emotions, behaviors), and social factors (relationships, culture, environment).
We’ll review your current concerns and symptoms, plus important context like: mental health and trauma history, family dynamics and significant relationships, work, education, career, culture, spirituality, identity, and hobbies and what brings you joy. This assessment helps me to begin understanding you and the root causes of issues to create a comprehensive treatment plan. This initial session can be overwhelming for some, because it covers a lot of ground. Some therapists complete intake and goal-setting in one 50-60 minute session. Others spread it across 2-3 sessions, especially if there’s a lot to cover. Both approaches are normal, and the pace should feel right for you. If it takes longer, that’s okay. I allow my client to lead on the pacing of the intake.
4. Identifying Therapy Goals
Once we’re done reviewing the Client History Form, I’ll help you develop your therapy goals. I start by providing education on the treatment planning process and what to look out for on the therapeutic journey. I approach goal-setting collaboratively. I typically ask clients to bring in 1-3 ideas on goals they’d like to accomplish in therapy. I’ll help you expand on your ideas and define specific, measurable objectives. For example, if your goal is “managing anxiety better,” we’ll define what that means for you specifically, like “practice grounding techniques when I feel overwhelmed” or “set boundaries at work without guilt.” It’s helpful to create progress indicators, too. The idea behind progress indicators is to identify how you’ll know that you’re making progress. For instance, if the goal is to manage anxiety, a progress indicator might be: “I’m able to speak up in meetings without panic” or “I’m sleeping better at night.” So, during treatment planning, we’re looking at two important questions: 1) What do you want to accomplish? and 2) What will be different once you start making progress? What will change?
5. Orientation to Treatment
After finalizing the treatment plan, I provide a brief orientation to treatment by discussing my therapy frameworks and philosophy. And I’ll orient you to future therapy sessions structure. I'll share a flexible structure to help you visualize how to prepare for sessions. Even with this structure, it takes time to get into the groove of things and that’s normal. I end the intake process by encouraging my clients to start integrating any self-reflective practices into their daily routine, such as journaling, self-reflective walks, painting—anything that may help you be more present. It’s beneficial for two reasons: it helps you grow your self-awareness muscle and it helps you identify things you may need to process in our sessions.
6. Questions and Feedback
At the end of most sessions, I encourage clients to ask questions, seek clarity, express concerns, or provide positive and constructive feedback. For example, feedback-oriented questions like: How was today? What’s the take home message? Was something unclear? Anything that didn’t work? It’s important for me to know how you’re feeling about therapy, whether the process is going for you, and if our therapeutic connection feels right, because it helps me understand whether we’re on the right track or whether we need to switch gears, or explore your options.
Closing Thoughts: Important Reminders About Starting Therapy
Starting therapy is a major step and it takes a lot of courage. Here are a few things to keep in mind:
Be patient with the process. Therapy isn’t a quick fix. It’s a gradual unfolding that helps you gain awareness and develop tools for navigating emotions, relationships, and life challenges.
The work happens between sessions, too. Therapy is most effective when you’re actively engaged through journaling, noticing patterns, trying new approaches, and reflecting on what’s coming up for you.
Transparency takes time. You don’t have to share everything immediately. Take your time with it. Building trust with your therapist, or anyone for that matter, is a process. In fact, research shows that the therapeutic relationship, whether you feel safe, is one of the strongest predictors of positive therapy outcomes.
Heavy feelings are normal. Therapy can bring up anger, sadness, or resentment, even towards your therapist or the process. This may be a sign that the work is happening. You might feel worse before you feel better, especially when processing experiences you’ve never shared before.
Growth requires discomfort. Therapy will ask you to try things that feel uncomfortable. That discomfort is often where the most meaningful change happens. Future you will thank you for avoiding shortcuts.
Every therapist has their own style. Don’t hesitate to ask about approach or what to expect. I believe that the more informed and engaged you feel, the more effective therapy can be.
Ready to Schedule Your First Session?
If you're in California, Colorado, or Texas and ready to start this work, I'd be honored to collaborate with you on your journey. I provide virtual therapy for queer people and women navigating anxiety, depression, trauma, spirituality, identity exploration, and life transitions. I also offer immigration psychological evaluations.
Your first session with me will include a curious space to share what brings you in, collaborative goal-setting that honors your pace, clear expectations, and time for questions.
Email noemi@stillnesstherapy.net or call (562) 204-6025 to schedule a complimentary 20-minute consultation. We'll discuss whether we're a good fit before you commit to your first full session.
