Your First Online Therapy Session: What to Expect

Starting therapy can feel daunting, especially when it's online. Knowing what to expect from 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.

Before Your First Session

Most online therapy platforms will have you complete several steps before your first appointment:

Intake Questionnaires

You'll typically fill out forms covering:

• Basic demographic information
• Reason for seeking therapy
• Mental health history
• Current medications
• Past therapy experiences
• Emergency contact information
• Safety screening questions

Insurance and Payment Setup

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.

Technology Check

Test your setup beforehand:

• Ensure your camera and microphone work
• Check your internet connection stability
• Download any required apps or software
• Know how to log in and access the session

What Happens During the First Session

The Introduction (First 5-10 Minutes)

Your therapist will likely start by:

• Introducing themselves and their background
• Explaining confidentiality and its limits
• Reviewing informed consent
• Discussing the platform's features and how sessions work
• Asking if you have any questions before starting

Getting to Know You (Main Portion)

The therapist will gather information about you, including:

• What brought you to therapy: Your current concerns and challenges
• Your history: Relevant background, past treatment, family history
• Your goals: What you hope to achieve through therapy
• Your daily life: Work, relationships, support systems
• Your strengths: Coping skills and resources you already have

Assessment and Planning

Near the end, your therapist may:

• Share initial observations
• Discuss potential treatment approaches
• Set preliminary goals together
• Explain what to expect in future sessions
• Schedule your next appointment

Common First Session Questions

Questions Your Therapist May Ask

• "What made you decide to start therapy now?"
• "What would you like to accomplish through our work together?"
• "Have you been in therapy before? What was that experience like?"
• "Tell me about your support system."
• "How has this issue affected your daily life?"
• "What coping strategies have you tried?"

Questions You Might Ask

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

• "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?"

Tips for a Successful First Session

Prepare Your Space

• Find a quiet, private location
• Minimize potential interruptions
• Have water and tissues nearby
• Ensure good lighting for video calls
• Consider using headphones for privacy

Mental Preparation

• Write down key points you want to discuss
• It's okay to feel nervous—this is normal
• Remember you don't have to share everything in the first session
• Be open to the process, even if it feels awkward initially

During the Session

• Be as honest as possible
• Ask for clarification if something isn't clear
• It's okay to say "I don't know" or "I'm not ready to discuss that"
• Take notes if it helps you remember
• Share feedback about what's working or not

After Your First Session

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

• Relief: Finally taking action on your mental health
• Emotionally drained: Discussing difficult topics takes energy
• Hopeful: Seeing a path forward
• Uncertain: Wondering if this therapist or approach is right for you
• Impatient: Wanting faster progress

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:

• Give it a few sessions: It can take 2-3 sessions to get comfortable
• Communicate concerns: Let your therapist know if something isn't working
• Trust your instincts: If you feel truly uncomfortable, it's okay to try someone else
• Most platforms allow switching: Services like BetterHelp and Talkspace 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.

Special Considerations for Online Sessions

Online therapy has unique aspects to keep in mind:

• Technical issues: Have a backup plan (phone number) if video fails
• Privacy: Ensure no one can overhear your session
• Body language: Position your camera so your therapist can see your face and upper body
• Eye contact: Looking at the camera (not the screen) creates better connection
• Distractions: Close other apps and silence notifications

Session Length and Frequency

First sessions are typically:

• Duration: 45-60 minutes (sometimes longer for intake)
• Frequency: Weekly sessions are most common initially
• Ongoing communication: Some platforms like Talkspace offer messaging between sessions

Understanding Different Therapy Approaches

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:

• You will learn to identify negative thought patterns
• Sessions involve practical exercises and homework
• The focus is on present problems rather than past history
• Treatment is typically structured and goal-oriented
• Usually involves 12-20 sessions for specific issues

Dialectical Behavior Therapy (DBT)

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

• Combines acceptance and change strategies
• Teaches specific skills in mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness
• Often includes both individual therapy and skills groups
• Particularly helpful for intense emotions and relationship difficulties

Psychodynamic Therapy

This approach explores how past experiences influence current behavior:

• Sessions are less structured than CBT
• Focuses on unconscious processes and patterns
• The therapeutic relationship itself is a tool for healing
• May involve discussing childhood and family history
• Often longer-term than CBT

Person-Centered Therapy

Also called humanistic or Rogerian therapy:

• Emphasizes unconditional positive regard and empathy
• The therapist provides a supportive environment for self-exploration
• Less directive than CBT—you guide the conversation
• Focuses on personal growth and self-acceptance

EMDR (Eye Movement Desensitization and Reprocessing)

Primarily used for trauma:

• Uses bilateral stimulation (eye movements, taps, or sounds)
• Helps process traumatic memories
• Can be done effectively via telehealth
• Often produces results more quickly than talk therapy alone for trauma

Solution-Focused Brief Therapy

A practical, short-term approach:

• Focuses on solutions rather than problems
• Looks at what is already working in your life
• Typically involves fewer sessions
• Goal-oriented and future-focused

Common Concerns Before Your First Session

What If I Cry?

Crying during therapy is completely normal and expected. Therapists are trained to handle emotional responses:

• Have tissues nearby—this is standard advice for a reason
• Crying can be a healthy release and part of processing
• Your therapist will not judge you for becoming emotional
• It is okay to take a moment to compose yourself
• Some people feel better after crying in session

What If I Do Not Know What to Say?

Many people worry about this:

• Your therapist will guide the conversation, especially at first
• Silence is okay—it can be a time for reflection
• Starting with "I'm not sure where to begin" is perfectly valid
• Bringing notes or topics can help if you are worried
• Even talking about not knowing what to say can be therapeutic

What If I Feel Embarrassed?

Sharing personal information with a stranger can feel vulnerable:

• Remember that therapists hear difficult topics every day
• They are bound by confidentiality
• You can share at your own pace
• Many people feel the same way you do
• The embarrassment usually fades as you build trust

What If Online Therapy Feels Weird?

Some people find the video format initially awkward:

• This is a common feeling that typically improves with time
• Focus on the therapist rather than your own video image
• You can hide your self-view on most platforms
• Some find it easier to open up without being in the same room
• The therapeutic relationship can be just as strong online

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:

Be Honest

• Share your true thoughts and feelings, even if they seem minor
• Let your therapist know if something they say does not resonate
• Be truthful about whether you are doing homework or practicing skills
• Honesty allows for more accurate help

Communicate About the Process

• Tell your therapist what is helpful and what is not
• Share if you feel misunderstood
• Ask questions about the approach being used
• Voice concerns about pacing or topics

Show Up Consistently

• Regular attendance builds momentum and trust
• Communicate if you need to reschedule
• Arrive on time and prepared
• Complete any between-session tasks

Give It Time

• Trust develops over multiple sessions
• Early discomfort is normal
• Progress often happens gradually
• Three to four sessions is usually enough to know if it is working

Understanding Confidentiality

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

What Is Kept Private

• Everything you share in session is generally confidential
• Your therapist cannot share information without your consent
• Session notes are protected under HIPAA
• Even the fact that you are in therapy is private

Limits to Confidentiality

There are legal exceptions where therapists must break confidentiality:

• Imminent danger to self: If you are at serious risk of suicide
• Danger to others: If you threaten serious harm to someone
• Child or elder abuse: Therapists are mandated reporters
• Court orders: In rare cases, courts can compel disclosure
• Insurance requirements: Diagnosis and some information may be shared for billing

Online-Specific Privacy

• Sessions should be encrypted and HIPAA-compliant
• Your therapist should be in a private location too
• Recording sessions is typically not allowed without consent
• Messaging through therapy platforms is more secure than regular texting

After Session Self-Care

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

Immediate Aftercare

• Give yourself buffer time: Do not schedule anything demanding right after
• Hydrate: Emotional processing can be physically tiring
• Gentle activity: A short walk or stretching can help
• Process in writing: Journaling can help integrate insights
• Be patient with yourself: Feeling tired or emotional is normal

Between Sessions

• Complete any homework or exercises your therapist suggests
• Notice patterns, moods, or triggers to discuss next time
• Practice skills you learned
• Write down questions or topics as they come up
• Reach out to your therapist via platform messaging if available and needed

When to Seek Additional Help

Your first therapy session might reveal needs beyond weekly therapy:

• Medication evaluation: Your therapist might recommend seeing a psychiatrist
• Higher level of care: Intensive outpatient or partial hospitalization programs
• Specialized treatment: Programs for specific issues like eating disorders or substance abuse
• Support groups: Peer support in addition to individual therapy
• Crisis resources: If you are in danger, get help immediately

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

Related Guides

• How to Prepare for a Telehealth Appointment
• Building a Relationship with Your Online Provider
• How to Choose an Online Therapy Platform
• Telehealth Technology Setup Guide
• Getting the Most from Text/Messaging Therapy

Important Reminder