Taking the step to start therapy is brave—and it's also normal to feel nervous about your first session. What will you talk about? Will it be awkward? What if you cry? What if you don't know what to say?
This guide will walk you through exactly what to expect in your first telehealth therapy session so you can show up feeling prepared and confident.
Before Your First Session
1. Choosing the Right Space
Find a private, comfortable spot where you won't be interrupted:
Good options:
- Your bedroom with the door closed
- A quiet home office
- Your car parked somewhere private
- A private room at work (if available)
What to avoid:
- Public spaces (coffee shops, libraries)
- Spaces where family members can overhear
- Areas with lots of background noise
Pro tip: Test your space beforehand. Sit where you'll be during the session and make sure you're comfortable and won't be disturbed.
2. Technology Setup
What you'll need:
- A device with a camera and microphone (computer, tablet, or phone)
- Stable internet connection
- Headphones (optional but recommended for privacy)
- Charger nearby (nothing worse than your device dying mid-session!)
Technical tips:
- Test your video platform ahead of time
- Make sure your camera and microphone work
- Have your therapist's contact info in case of tech issues
- Close other programs that might slow your device
Lighting: Position yourself facing a window or light source so your therapist can see you clearly.
3. What to Have Nearby
Recommended:
- Water or tea
- Tissues (yes, crying is normal and okay!)
- A notebook and pen (if you like to take notes)
- Your insurance card and ID (if you haven't submitted them yet)
Optional:
- A comfort item (blanket, stuffed animal, pet)
- Fidget toy or stress ball
4. Preparing Mentally
It's okay to:
- Be nervous
- Not know exactly what to say
- Cry
- Pause and think
- Ask questions
- Admit you're unsure
Remember: Your therapist has seen it all. They're not judging you—they're there to help.
What Happens in the First Session
The First 5-10 Minutes: Getting Settled
Your therapist will likely:
- Welcome you and introduce themselves
- Make small talk to help you relax
- Explain confidentiality and its limits
- Go over session structure and what to expect
You might discuss:
- How telehealth sessions work
- When/how to contact them between sessions
- Payment and insurance
- Cancellation policies
This is normal paperwork and logistics—it won't take the whole session.
The Next 30-40 Minutes: Your Story
Your therapist will want to understand:
1. What Brought You to Therapy
Common questions:
- "What made you decide to start therapy now?"
- "What are you hoping to work on?"
- "What's been going on for you lately?"
You don't have to have it all figured out. It's okay to say:
- "I'm struggling with anxiety but I'm not sure exactly what I need"
- "A lot of things are overwhelming me right now"
- "I don't really know where to start"
2. Background and History
Your therapist might ask about:
- Your current life situation (work, relationships, living situation)
- Mental health history (past therapy, diagnoses, medications)
- Family background and childhood (briefly, not a deep dive on day one)
- Medical history or medications
- Current support system
You're in control: You can say "I'm not ready to talk about that yet" or "Can we come back to this?"
3. Current Symptoms or Concerns
Depending on what you're there for, they might ask:
- About your mood, anxiety, sleep, appetite
- Specific symptoms (intrusive thoughts, panic attacks, etc.)
- How long you've been struggling
- What you've tried before
4. Goals for Therapy
You might discuss:
- What you want to feel different
- What "better" looks like for you
- Any specific outcomes you're hoping for
It's okay if you don't know yet. Many people start therapy without clear goals—that's part of what therapy helps you figure out.
The Last 5-10 Minutes: Wrapping Up
Your therapist will likely:
- Summarize what you discussed
- Give initial thoughts or reflections
- Discuss next steps or treatment approach
- Answer any questions you have
- Schedule your next session
You might receive:
- Homework or something to think about
- Resources or reading materials
- Coping strategies to try
Common First Session Questions (Answered)
"What if I don't know what to say?"
Your therapist will guide the conversation. You don't need to have a speech prepared. If you go blank, your therapist will ask questions to help.
"What if I cry?"
Crying in therapy is completely normal and expected. Your therapist won't be uncomfortable—they're used to it and have tissues ready (even virtually!).
"Do I have to talk about my childhood?"
Not necessarily, especially not in the first session. You'll only go as deep as you're comfortable. Therapy isn't always about the past—it can focus on the present too.
"What if I don't like my therapist?"
It's okay if the fit isn't right. You can:
- Give it 2-3 sessions to see if comfort grows
- Be honest: "I'm not sure we're the right fit"
- Request a different therapist
Finding the right therapist is important. Don't settle for someone who doesn't feel right.
"What if my internet cuts out?"
Tech issues happen! Your therapist will:
- Wait a few minutes for you to reconnect
- Call or text if you don't come back
- Reschedule if the connection doesn't work
Have a backup plan: Know your therapist's phone number in case you need to call.
"How much should I share in the first session?"
Share whatever feels comfortable. You don't have to tell your whole life story on day one. Therapy is a marathon, not a sprint.
What Your Therapist Is Thinking
It might help to know what's going on in your therapist's mind during the first session:
They're thinking about:
- How to make you feel comfortable
- What might be contributing to your struggles
- What treatment approach might help
- How to build trust and rapport
They're NOT thinking:
- "This person is crazy"
- "This is the worst problem I've ever heard"
- "I can't help them"
Therapists chose this profession because they want to help. They're on your side.
After Your First Session
What to Expect
You might feel:
- Relieved that you took the first step
- Emotionally tired (therapy is hard work!)
- Hopeful about the process
- Uncertain if it was helpful yet
All of these are normal.
Give It Time
The first session is mostly information-gathering. Real progress usually starts in sessions 2-4 once your therapist understands your situation better.
Don't judge the whole process on one session.
Between Sessions
Take care of yourself:
- Notice how you feel
- Jot down anything that comes up that you want to discuss next time
- Try any strategies or homework your therapist suggested
Reach out if needed: If you're in crisis or have urgent questions, contact your therapist.
Telehealth-Specific Tips
Advantages of Telehealth for the First Session
- More comfortable: You're in your own space
- Less intimidating: The screen can feel less vulnerable than face-to-face
- Convenient: No travel time or waiting rooms
- Private: No running into people in a clinic
Making Telehealth Feel Personal
Look at the camera (not the screen) when you want to make "eye contact"
Speak naturally—you don't need to perform or be "on"
Get cozy: Grab a blanket, sit in your favorite spot, have tea
Remember: Your therapist can still read your emotions, body language, and expressions on video
Red Flags vs. Green Flags
Green Flags (Good Signs)
✅ Therapist listens without interrupting ✅ You feel heard and validated ✅ They explain their approach clearly ✅ They respect your boundaries ✅ You feel comfortable (even if nervous) ✅ They ask clarifying questions
Red Flags (Concerns)
🚩 Therapist talks more than you do 🚩 They seem judgmental or dismissive 🚩 They push you to share more than you're ready to 🚩 They guarantee quick fixes 🚩 They push their personal beliefs onto you 🚩 You feel uncomfortable or unsafe
Trust your gut. If something feels off, it's okay to find someone else.
Making the Most of Your First Session
Come Prepared (But Not Over-Prepared)
Helpful:
- Think about what you want help with
- List any questions you have
- Note any recent stressors or triggers
Not helpful:
- Writing a 10-page essay about your life
- Memorizing what you want to say
- Trying to impress your therapist
Be yourself. That's who they need to see to help you.
Be Honest
Your therapist can only help you if they understand what's really going on. It's okay to say:
- "I'm not telling my family I'm in therapy"
- "I'm worried about being judged"
- "I don't know if I really need to be here"
Ask Questions
Good questions to ask:
- "What's your approach to treating [your issue]?"
- "How long does therapy usually take for something like this?"
- "What should I expect from the process?"
- "How will we know if it's working?"
- "What should I do if I'm struggling between sessions?"
The Bottom Line
Your first therapy session is mostly about:
- Getting to know each other
- Understanding what you're dealing with
- Figuring out how to move forward
It's not about:
- Fixing everything immediately
- Having a breakdown
- Impressing your therapist
Therapy is a collaborative process. Your therapist is your partner in this journey, not an authority figure judging you.
You've already done the hardest part: deciding to start. The rest will unfold one session at a time.
Ready to schedule your first therapy session? If you're in Missouri, New Jersey, or another PSYPACT state, book a free 15-minute consultation to discuss how telehealth therapy can help.
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