What Should I Expect in My First Therapy Session?
You've decided to book your first therapy session because your work stress has started spilling into every part of your life in ways it never used to, or you’ve just had it with feeling like an imposter. Now that the appointment is coming closer and closer, you begin to feel a bit intimidated. What are you even supposed to talk about? How personal is this going to get? Is there a wrong way to start?
If any of that sounds familiar, read on. The first session is more structured than most people expect. It's a chance for me to begin understanding the situation/s that brought you in and what you'd like to change, not a deep dive into your most painful memories. In my practice, we rarely go into that kind of territory in the first hour unless you want to. We're just getting to know each other, and there's no expectation you'll share more than what brought you in and what you’d like to get out of our time together.
And, as an aside, the type of therapy I use rarely goes into your most painful memories at all (again, unless you want to) as we concentrate on recent struggles and how to handle your difficult situations in the present.
Before Your First Appointment
Before we ever sit down for a full session, I offer a free 15-minute consultation. It's a low-stakes way for us to talk briefly about what's bringing you in, what you're hoping to get help with, and whether my approach seems like a good fit for what you need. Having that conversation first tends to make our actual first appointment feel more comfortable since we're not meeting each other for the first time and we’ve already established a bit of rapport.
In the time between our consultation and our first appointment, I will send you a few forms to sign including a questionnaire covering what you're currently experiencing along with some relevant background. I read through it ahead of time and build my questions for our first session around what you share, so you don't need to arrive already knowing where to start or how to explain everything.
What Happens When You Arrive
In person appointments. If you arrive early for your appointment, you’re welcome to have a seat in the waiting room. I share an office suite with another therapist so you could occasionally see another person there, but our appointment times are staggered so you’ll usually be there on your own.
When it's time, I'll open the door and invite you in, and you can sit wherever feels comfortable. We’ll usually start with something simple, for example, I’ll ask how your day's going, whether you had any trouble finding the office, or a simple follow up question from our consultation. You don't have to walk in and launch straight into the hardest part of your life.
You don't need to arrive already knowing where to start or how to explain everything.
Virtual Appointments: When it’s time for your appointment you’ll click on the link you received in your appointment reminder and you’ll immediately enter the virtual waiting room in my HIPAA-compliant video platform. At our start time, I’ll let you in to my virtual office and we’ll be able to see and talk with each other.
We'll do everything else that follows; we'll just do it online. This is also how I'm able to work with clients in Ohio and Minnesota through Counseling Compact privileges, in addition to Indiana.
We'll Go Through the Paperwork Together
The first part of the session is definitely the least exciting but is still important. We'll review the policies you signed and talk through privacy and confidentiality. We’ll then go over the informed consent documents you signed which explain how therapy generally works, introduces the approach I use most (Acceptance and Commitment Therapy), and gives general information about how virtual appointments work (even if you’re an in-person client, you may at some point choose a virtual appointment due to weather, sickness, etc). I walk you through all of the forms so you understand what you’ve signed and have the ability to ask questions.
Paperwork isn't the part anyone gets excited about, but clear expectations and boundaries from the start make everything that follows work better.
Most of the Session Is Just Getting to Know You
After that, we spend most of the appointment talking through what you wrote in your intake questionnaire. I'll ask follow-up questions to better understand what's been happening and how it's affecting you. We'll also talk about your goals and what you want out of therapy.
The questionnaire gives us a starting point, but it never tells the whole story. Two people can both write "work stress" for the same question and mean completely different things: there could be different team dynamics surrounding the stress, people have different histories, and different emotional weight can be attached to work stress for each person. I'll ask how long this stress has been going on, what makes it better or worse, and what you've already tried. We'll also talk about how it’s affected the rest of your life – your sleep, your concentration, even the Sunday Scaries.
You Don't Have to Know What to Say
Many people worry they'll say the wrong thing in that first session. Here's the truth: there isn't a wrong thing to say. Therapy is a non-judgmental place to share your thoughts and feelings. Chances are, if you’re dealing with work stress, imposter experiences, or burnout, I’ve had those very same feelings. You don't need a polished version of your story or the perfect words to share how you're feeling. A big part of my job is asking the right questions, helping things come into focus, and even noticing connections that can be hard to see when you're the one living inside the situation.
Here’s the truth: there isn’t a wrong thing to say.
It's also completely normal to get emotional. If that happens, you're not doing it wrong. As therapists we are taught that getting emotional is just like laughing, being angry, or being irritated. They’re all simply emotions. You are in control of how much you share, and you can always tell me when you're not ready to go further.
What I'm Actually Listening For
While I'm taking in the details of what's been going on for you, I'm also listening underneath those details for your values, thoughts, and goals that will shape everything else we'll do together.
What Matters Most to You. I'm listening for your values, meaning the things that matter most to you and the kind of person you want to be at work and beyond. Someone dealing with work stress might care deeply about doing good work, being treated fairly, or feeling like their effort actually means something. Someone weighing a career change might crave more stability, more autonomy, or simply more room to be creative. Understanding what you value helps explain why this situation hurts as much as it does, and it shapes where we head from here.
The Thoughts Keeping You Stuck. I'm also listening for thoughts that tend to trap us, as humans: the fear that you’re not good enough, that you'll make the wrong decision, or that you’ll say the wrong thing. In ACT, we're not trying to prove that your thoughts are true or false. Thoughts with truth in them can still pull you away from what matters most, so we look at whether the difficult thought is helpful or not helpful to the project at hand or even simply to your mental health. Then, our goal is to help you build a different relationship with those unhelpful thoughts so they stop running your life.
Our goal is to help you build a different relationship with those unhelpful thoughts so they stop running your life.
What You Want from Our Time Together. Your goals shape our whole plan, so I ask a lot about what you hope will be different when our time is finished, how you'll know that what we’ve done is working for you, and how what you do (your behaviors in support of your values) will be different. I'll also ask about any therapy you've done before meeting with me as knowing what helped and what didn’t helps me understand how we’ll best work together.
The Types of Questions I Ask in the First Session
Stressful situations at work often involve a cast of characters with overlapping roles, unclear expectations, and a long history behind the current conflict. I'll ask questions to help me keep everyone straight: who's creating the most friction, how they typically handle conflict, and what usually happens when you and/or your team try to respond.
I'm also paying attention to what's underneath the stress itself. You might feel discouraged, anxious, irritated, or exhausted. Two people in nearly identical workplace situations can need very different kinds of support. One might need help with anxiety and self-doubt, another might need space to process anger, and someone else might be wrestling with whether staying is even worth it anymore.
I've spent years working in business, higher education, and academia myself, and that background often helps here. I understand a lot of the pressures clients describe because I've been inside those environments, and when it's useful, I'll share. The focus stays on you, but I want you to know I understand the kind of situation you're describing and that your reaction to it makes sense.
Wrapping Up the Session
The last part of the appointment gets practical. I want you to leave with something to try over the next week, instead of the experience of having described a hard situation and then going home.
We usually spend the final part of the session on a grounding exercise, something ACT calls "dropping anchor," where we re-orient ourselves to the present moment. It’s helpful to do at the end of the session when we’ve been discussing a stressful work situation, and even in the moment when stress starts to build at work. I'll send you a recording afterward and ask you to use it daily until our next session. Practicing it outside of session makes it much easier to do without the recording when your distressing thoughts keep coming in real time.
You don't need to stop your distressing thoughts. You just need to notice where the spiral starts.
I'll also ask you to notice and make note of the first thought that kicks off a longer chain of distressing or negative thoughts. You know the pattern: you said something “wrong” in a meeting, which leads to you thinking about (and regretting) something you said three days ago, to then thinking about how toxic your work environment is, which leads to deciding you can’t take it anymore and need to quit. You don't need to stop your distressing thoughts; you just need to notice where the spiral starts. We'll work with whatever you notice at your next appointment, since this type of therapy works best when it stays connected to what's actually happening in your week, not just what happened months ago.
How You Might Feel Afterward
By the end of that first appointment, I hope you feel heard and like your experience was taken seriously, with a clearer sense of how I work and what will come next.
Some people leave feeling relieved just to have said it out loud. Others feel tired, reflective, or a mix of several things at once, and that's all normal. Nobody walks out of one session with the problem solved. That first hour is about building a foundation and figuring out what matters most, so we can start building a real plan from there.
If the Fit Isn't Right
The relationship between a therapist and client matters more than people often expect. Our consultation gives us an early indication on whether how I work fits your situation, though sometimes it takes a full session to know whether someone's approach or style actually works for you.
If either of us senses it isn't the right match, we can just say so. That's not a failure; it's part of making sure you end up with the right person. My priority is getting you connected to the support you actually need, and if that's someone else, I'll help you find them.
What Happens in Future Sessions
Each week, we'll check in on what you tried since we last met, what helped, what didn't, and whatever else came up along the way. We’ll also keep working on loosening the grip your difficult and stressful thoughts have on the choices you make, and on identifying your values and your goals your choices are tied to.
Mostly, we're building something together, session by session. Whatever you're hoping for from therapy is what shapes where we go.
Moving Forward
If you’re curious about whether this kind of work might be helpful for you, you’re welcome to start with the 15-minute consultation (mentioned above) which offers space to talk through what has been coming up and get a sense of whether working together feels like a good fit.
No pressure, just a conversation.
Related Articles
If you’d like to read more about what therapy for work challenges can look like in practice, you can read more here: What Working Through Imposter Syndrome in Therapy Looks Like
Curious whether therapy can help if you're dealing with imposter syndrome specifically? Read Rethinking Imposter Syndrome: Can Therapy Actually Help?
If you're trying to understand where these patterns come from in the first place, What Causes Imposter Syndrome in High-Achieving Professionals? is a good next read.
Related Support
Whatever's bringing you to that first session, work stress, imposter syndrome, or a career decision you're sitting with, here's more on how I can help with each:
—> Work stress and burnout therapy for professionals
—>Therapy for imposter syndrome
—> Career counseling for professionals navigating transitions