What it's like to begin therapy

Dec 15, 2025 · 7 min read

You've done a lot already.

You've thought about whether therapy might help. You've scrolled through profiles, sorted through acronyms, maybe had a consultation call. You've picked a therapist and scheduled a first appointment.

Now you might be wondering: What actually happens next? What will it be like to begin?

This article walks through what many people experience as they start therapy: the practical steps, the emotional ups and downs, and some things you don't have to have figured out before you walk in the door.

Before the first session: the quiet work you're already doing

Once you schedule, there's usually a gap—days or weeks—before your first session. During that time, a few things often happen:

• Paperwork and logistics.

  You might receive intake forms, consent documents, or brief questionnaires. These can feel dry, but they're part of making sure your therapist understands the basics about your history, safety, and what you're hoping for.

• A mix of anticipation and doubt.

  It's common to feel nervous, hopeful, relieved, or to think, "Maybe it's not that bad... do I really need this?" All of that belongs. Ambivalence—mixed feelings about starting—is a normal part of the process, not a sign you're doing anything wrong.

• Trying to decide what to say.

  You might start mentally rehearsing: "Should I start from the beginning, from childhood? The recent crisis? The thing I've never told anyone?" Or, maybe you're drawing a blank. You don't have to get this perfect. Your first session isn't a test.

If you feel like you're "overthinking it," that likely means you care about using this opportunity well. Most people feel that way.

What you don't have to figure out ahead of time

Beginning therapy doesn't require a polished life story. You do not need to:

• Have a clear diagnosis for yourself
• Explain every important event in your life in perfect order
• Know exactly what kind of therapy you want
• Come up with the "right" way to describe your pain

What you need is a sense that something isn't working as well as you'd like and a willingness to look at it together.

If all you can say is, "I've been struggling and I'm not sure how to talk about it," that's a completely valid place to start.

The first session: what usually happens

Every therapist has their own style, but many first sessions include some version of the following:

• Settling in.

  You'll arrive (in person or online), confirm basic details, and go over any remaining paperwork or consent questions. Your therapist might explain confidentiality and how sessions are structured.

• Getting a sense of what brings you in.

  Your therapist will likely ask open questions like, “What made you decide to reach out now?” or “What feels most important to talk about today?” You don’t have to tell everything at once; the goal is to get a starting point.

• Hearing a bit of your story.

  You might touch on current stressors, past experiences, relationships, work or school, health, or anything else that feels relevant. It’s normal to jump around or forget things—therapy is a conversation, not a formal presentation.

• Beginning to clarify focus.

  Toward the end, your therapist may reflect back what they're hearing and ask what you'd most like to be different over time. This is often a first step toward shared goals, not a final plan.

You can also ask your own questions:

• "What will our next few sessions look like?"
• "How do you usually work with concerns like mine?"
• "What should I expect between sessions?"

How beginning therapy often feels

The content of first sessions varies, but some emotional themes are very common:

• Awkward or exposed.

  Talking openly with someone new about personal things can feel strange at first. This doesn’t mean it’s a bad fit; it may just be new.

• Relieved.

  Saying some of this out loud, with a person who is genuinely listening, can bring a sense of relief: “Okay, I’m not carrying this entirely alone anymore.”

• Unsure ("Did I do that right?").

  Many people leave the first session wondering if they talked too much, didn’t say enough, cried “too soon,” or stayed too guarded. These are all common reactions. You can even bring these questions into the next session.

• Tired or stirred up.

  Sometimes, after a first session, people feel emotionally tired, thoughtful, or a little “off.” That doesn’t necessarily mean anything has gone wrong—it can simply mean you touched on something important.

If you notice any of these reactions, you’re not alone. Beginning therapy is an adjustment, and it makes sense that you'd feel emotions stirred up as you start doing something with your concerns.

The first few sessions: getting to know each other

Therapy doesn’t fully reveal itself in a single hour. The first few sessions often focus on:

• Filling in more of your story.

  You may revisit topics from the first session or add new pieces as they surface and feel shareable.

• Clarifying what you’re hoping for.

  Together, you and your therapist might refine the focus: easing certain symptoms, understanding patterns, improving relationships, making decisions, or building specific skills.

• Starting to notice patterns.

  Over time, you may start to hear themes: how you respond to stress, how you relate to others, how you talk to yourself internally. Your therapist may gently point some of these out as they emerge.

These early sessions are also a time for you to pay attention to the fit:

• Do I feel reasonably safe and respected?
• Do I feel listened to, even if we’re still figuring things out?
• Do I have the sense that this person is trying to understand me, not just apply a script?

You don't have to decide everything right away, but these questions can be useful guides.

Talking about the fit (yes, you can do this)

It can feel uncomfortable to talk directly about whether therapy feels like a good fit, but it’s a normal part of the process—and often helpful.

You might say things like:

• “I’m still trying to get used to talking in here.”
• “Sometimes I worry I’m not explaining things well.”
• “I’m not sure yet how this is supposed to feel, but I’d like to talk about it.”
• “I’m wondering how you see what we’re working on together.”

A thoughtful therapist will welcome this kind of conversation. It’s part of building a therapy relationship that feels workable and honest.

If, after a few sessions, it doesn’t feel workable—even after some conversation—that’s information, not failure. It may be worth discussing a referral or thinking together about what might suit you better.

What you can expect over time

As you move beyond the very beginning, therapy often starts to feel a bit more familiar:

• You’ll likely develop a rhythm of what you tend to bring into the room.
• You may notice that you’re able to talk about things that once felt off-limits.
• You might start experimenting with new ways of responding to situations outside of therapy, and then reflecting on those experiments in session.

Progress tends to be uneven. Some sessions feel more productive, others more confusing or quiet. Part of the work of beginning therapy is learning to tolerate that ebb and flow while staying oriented toward what matters to you.

In summary: beginning therapy is a process, not a single moment

Starting therapy isn’t just the hour on the calendar. It’s all the steps before and after:

• Wondering if you should reach out
• Choosing someone to contact
• Showing up to that first session
• Living with the feelings that come after
• Returning again to see what unfolds

People don’t begin therapy with the right words, the perfect starting point, or a fully formed story. That’s part of the work you and your therapist do together. You’re bringing yourself, as you are, into a room with someone whose job is to pay close attention and work with you on what you’re facing.

That’s what it’s like to begin therapy: not a polished performance, but the start of a working relationship that you and your therapist build together, one conversation at a time.

Keep reading

How to find a therapist?

So many therapists. How do you choose?

Read

Which kind of therapy is right for me?

Acronyms abound—here's how to focus on what actually matters.

Read

All articles