Tools & Guides
The First Therapy Session
Therapy can be intimidating, especially for first-time clients who are new to the psychotherapy setting and may feel nervous about the experience.
Last updated: October 2024
However, providers can ease the process by starting the therapeutic relationship with a level of organization that removes a lot of the guesswork for clients, freeing them to focus on progressing toward their goals.
Building an optimal first therapy session for clients includes addressing needs that arise before, during, and after the meeting has concluded. This includes:
- Completing administrative tasks before the first session
- Building an understanding of the client’s goals and needs for therapy
- Ensuring that your specialties and expertise align with their needs and expectations
Before the first therapy session
Clients will need to fill out certain documents so you have all the information necessary to add to your practice. Relevant information includes:
1. Insurance and payment
If you accept insurance, details should be handled before the first appointment so any concerns regarding insurance can be addressed. You can also encourage clients to enroll in Autopay to lessen the likelihood of any missed payments down the line.
If you don’t take insurance and rely on cash pay, let clients know what will be owed for the first and subsequent sessions, and consider saving a card on file for all clients.
2. Intake forms
Intake forms allow providers to share all important information as it relates to their practice and should clearly state practice, policies, and procedures. Clients should sign these forms prior to beginning treatment. Intake forms should include but aren’t limited to:
- Clinical Intake Questionnaire
- Email/Text Consent
- Informed Consent for Assessment and Treatment
- Notice of Privacy Policies
- Telehealth Consent
- No-show/cancellation policy
- Procedures for charging credit cards, including fees
3. Clinical assessments
Assessments create a baseline understanding of the client’s health and track their progress between sessions. Two relevant clinical assessments include:
- Depression Assessment (PHQ-9)
- Anxiety Assessment (GAD-7)
Whether in your intake forms or in your email/text communications with your client, you’ll need to include specific information that lays out clear guidelines and expectations regarding communication.
This means detailing your preferred methods of communication (email, text, etc.) and setting expectations on which hours you’ll be available for contact. Clinicians should notify clients that they’ll utilize only HIPAA-compliant platforms to communicate with clients, and should not use personal cell phones for communication, as these are not HIPAA-compliant.
Clinicians should also set expectations around appropriate communication methods between sessions, the hours they’ll be available to respond, and guidance for seeking help in case of an emergency. Establishing healthy boundaries is essential for providing high-quality clinical care, and staving off burnout’s negative effects - which is a growing issue among providers.
By setting professional expectations beforehand, providers are better positioned to avoid problems related to emotional exhaustion and overload from work. Burnout can feel overwhelming, but the following tips can help you alleviate the symptoms and lessen their impact.
Clinicians are not setting boundaries in terms of their work, and don’t have healthy boundaries in terms of responding to multiple emails and texts from clients.
Assist clients by sharing tips on how to prepare
When asked, “How to prepare for your first therapy session?” Alma member Ayana Ali, LCSW, offered these three suggestions that should be added to every clinician’s playbook. You can email these tips to clients before their first session to aid them and your therapeutic process. Watch Alma’s video to learn more about helpful tips to share before the first session.
- Emphasize the importance of honesty
I think that [clients] should go into the session with a degree of honesty that perhaps they’ve never utilized before. Whatever is on their mind, whatever issues that they want to work on in therapy, they should be prepared to discuss them without shame, without worry that someone’s going to be judging them.
Therapists should create an environment where full transparency feels safe for clients, while also respecting that clients may need to build trust over time before disclosing highly sensitive information.
- Tell clients to be themselves
[Clients] don’t need to come with a million things that are on their mind. They just need to be themselves and speak from the heart.
Clients shouldn’t feel like they must come equipped with a laundry list of topics/ issues to make the most out of their sessions. Approaching a session from a place of authenticity is often all that’s needed to make progress within sessions.
- Explain that therapy is a marathon, not a sprint
Remind [clients] that they don’t have to get everything out in the first session. If there’s things they forgot to say at the end of a session, there’s always next week.
As in other areas in life, making progress in therapy takes consistent effort and dedication. Clients should understand this before they begin investing their time. Make it known that they shouldn’t feel as though every one of their problems must be addressed in the first meeting.
A fundamental balancing act that you’re always dealing with is how do you balance getting sufficient information while establishing sufficient rapport. Because if they don’t come back for a second session, the treatment is surely a failure.
Access the full guide
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With this resource, you'll learn how to:
Learn the administrative tasks to complete before the first session
Understand the expectations to set regarding communication boundaries
Get tips on how to approach follow-up after the first session
