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Your First Online Therapy Session: What to Expect

Published August 2025 · Last updated · Written by Paul Paradis, Editor · Educational information – not medical or mental-health advice

What changed: Reworded link and heading text without ranking claims: “Best Online Therapy Platforms” to “Online Therapy Platforms Compared”. Earlier on October 30: Retitled 2 headings in plainer words: “Understanding Different Therapy Approaches” to “Therapy styles you may run into”, “Understanding Confidentiality” to “What stays confidential, and the exceptions”.

Reviewed for educational clarity and safety language by Lisa Lewis, RN, BSN

If you've never done therapy before, or never done it online, it's completely normal to feel uncertain about what to expect. Knowing what happens during your first session can help ease anxiety and set you up for a productive experience. This guide walks you through the typical first-session process, common questions, and how to make the most of this important step.

Rows of empty wooden chairs and desks beside a large window.

Before Your First Session

Most online therapy platforms will have you complete several steps before your first appointment. For a complete checklist, see our step-by-step preparation guide.

Intake Questionnaires

You'll typically fill out forms covering:

Your provider should also give you its HIPAA Notice of Privacy Practices, usually at your first appointment, and may ask you to sign that you received it. You do not have to sign, and signing does not give permission for any special sharing of your records (HHS).

Insurance and Payment Setup

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Whether using platforms like BetterHelp or Talkspace, or insurance-based services like Headway, you'll need to provide payment information or verify insurance coverage before your session. If you haven't yet decided on a platform, see our guide on choosing the right platform first.

Technology Check

Test your setup beforehand:

What Happens During the First Session

The Introduction (First 5-10 Minutes)

Your therapist will likely start by:

Getting to Know You (Main Portion)

The therapist will gather information about you, including:

Assessment and Planning

Near the end, your therapist may:

Common First Session Questions

Questions Your Therapist May Ask

Questions You Might Ask

It's helpful to come prepared with your own questions:

Tips for a Successful First Session

Prepare Your Space

Mental Preparation

During the Session

After Your First Session

It's normal to have mixed feelings after your first therapy session. You might feel:

Give yourself time to process the experience. Consider journaling about what came up and any questions for next time.

What If the First Session Doesn't Feel Right?

Not every therapist-client match is perfect. Consider these factors:

Finding the right fit is important: don't give up on therapy if the first match isn't ideal.

Special Considerations for Online Sessions

Online therapy has unique aspects to keep in mind:

Session Length and Frequency

First sessions are typically:

Therapy styles you may run into

Your therapist may mention different therapeutic approaches during your first session. Here is a brief overview of common methods:

Cognitive Behavioral Therapy (CBT)

CBT focuses on the connection between thoughts, feelings, and behaviors. In this approach:

Dialectical Behavior Therapy (DBT)

DBT was originally developed for borderline personality disorder but helps with many issues:

Psychodynamic Therapy

This approach explores how past experiences influence current behavior:

Person-Centered Therapy

Also called humanistic or Rogerian therapy:

EMDR (Eye Movement Desensitization and Reprocessing)

Primarily used for trauma:

Solution-Focused Brief Therapy

A practical, short-term approach:

Common Concerns Before Your First Session

What If I Cry?

Therapists are trained to handle emotional responses:

What If I Do Not Know What to Say?

Many people worry about this:

What If I Feel Embarrassed?

Sharing personal information with a stranger can feel vulnerable:

What If Online Therapy Feels Weird?

Some people find the video format initially awkward:

Building a Therapeutic Alliance

Research consistently shows that the therapeutic relationship is one of the strongest predictors of positive outcomes. Here is how to build that connection. For more in-depth strategies, see our guide on building a relationship with your therapist.

Be Honest

Communicate About the Process

Show Up Consistently

Give It Time

What stays confidential, and the exceptions

Your therapist should explain confidentiality in detail, but here is what you should know:

What Is Kept Private

Limits to Confidentiality

There are legal exceptions where therapists must break confidentiality:

Online-Specific Privacy

After Session Self-Care

Taking care of yourself after therapy is important, especially early on:

Immediate Aftercare

Between Sessions

When to Seek Additional Help

Your first therapy session might reveal needs beyond weekly therapy:

Your therapist can help connect you with appropriate resources if needed.

Frequently asked questions

What happens during a first online therapy session?

Your first session typically includes introductions where the therapist explains their background and confidentiality, gathering information about what brought you to therapy, your history, goals, daily life, and strengths, and then assessment and planning where the therapist shares initial observations, discusses treatment approaches, and schedules your next appointment.

How should I prepare for my first online therapy session?

Before your session, complete intake questionnaires, set up insurance and payment, test your technology (camera, microphone, internet), prepare a private quiet space with good lighting, and write down key points you want to discuss. Have water, tissues, and a notepad nearby.

What if I cry or get emotional during therapy?

Crying during therapy is completely normal and expected. Therapists are trained to handle emotional responses. Have tissues nearby, know that crying can be a healthy release and part of processing, and your therapist will not judge you. It's okay to take a moment to compose yourself.

What if the first therapy session doesn't feel right?

It can take 2-3 sessions to get comfortable with a new therapist. Communicate any concerns to your therapist and trust your instincts. If you feel truly uncomfortable, it's okay to try someone else. Most online platforms make it easy to switch therapists. Finding the right fit is important: don't give up on therapy if the first match isn't ideal.

What questions should I ask my therapist in the first session?

Helpful questions include: What is your therapeutic approach? Do you have experience with my specific concerns? How often should we meet? How will I know if therapy is working? What should I do between sessions? How do you handle emergencies or crises?

How long is a typical first therapy session?

First sessions are typically 45-60 minutes, sometimes longer for intake. Weekly sessions are most common initially. Some platforms also offer messaging between sessions for ongoing communication with your therapist.

Keep reading after your first online therapy session

Using this your first online therapy session guide safely

Treat this your first online therapy session guide as general background information only. It is not medical advice or a substitute for professional consultation. Every therapeutic experience is unique, and your first session may differ from what's described here.

If you are experiencing a mental health crisis, contact the 988 Suicide and Crisis Lifeline (call or text 988 in the US) or go to your nearest emergency room.

Sources

Who wrote this your first online therapy session guide

This your first online therapy session guide was written and edited by Paul Paradis, founder and editor of Telehealth Navigator, who spent more than two years working inside a forensic mental health hospital setting, and mental health also runs through his own life and family. He reads the source documents most people don’t have time to get through, especially APA and NIMH guidance, SAMHSA program documents, and CMS telehealth policy, and he turns that reading into plain English, linking each original so you can check his work. Paul is not a licensed clinician, so please treat this your first online therapy session guide as information rather than medical advice, and see our editorial standards for the full process of how every guide is researched, reviewed, and updated.