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Preparing for your First Therapy Appointment: What you Need to Know

preparing for therapy

The first time I walked into a counselling appointment, I was a ball of nerves. I didn't know what to expect. I didn't have any real goals - other than to stop feeling the way I was feeling. And I felt pretty powerless about the whole process. Teenage me was experiencing anxiety attacks, intrusive 'what if' thoughts, and a loop of negative self-judgements on replay in my mind. Walking into a counselling appointment with unclear expectations felt pretty scary!

You are Not Alone: It's Okay to Feel Nervous..or excited, or apprehensive...

It may have taken you months, or even years, to work your way toward sending an email about booking. You may have tried a session here or there with different counsellors. You might be thinking, 'I don't know if it was helpful'. But, if you are reading this, I'm guessing you are starting to feel ready to book an appointment and you might be feeling excited, nervous, apprehensive or a combination of all three.

How to Get the Most out of Your First Therapy Appointment

There are no rules about preparing for therapy, but there are a few things you can do to get the most out of this time.

therapy journal

1. Take some time to think about the problem(s) you have been facing before your first appointment.

Think about the symptoms you notice, the feelings you are having, and changes in your behaviours and actions. As you reflect on these answers, ask yourself what your goal in therapy might be. You may not have a clear answer yet, and that is okay. But your therapist will probably ask you about your hopes and goals for therapy, so taking some time to think about it ahead will allow you to feel more ready to talk about this. If you are someone who likes to write things down, bring your journal or notes into the session. This can be a great tool and you may find you want to write a few reminder notes down at the end of your appointment.

2. Manage your Expectations

It is normal to feel excitement about making change, healing, and growing. And, it is possible you will walk away from your first appointment feeling a sense of relief or accomplishment about finally sharing the challenges you have been facing. But, this isn't necessarily what a first (or second or third) appointment will look like.

Your first therapy appointment will probably look different from the second, third, fourth, etc. Your therapist does not know a lot about you yet and will take some time to learn about the problem that brought you in. Every therapist is different, but most will want to learn a bit about your work, family, relationships, childhood, lifestyle, thoughts, and feelings. This information will help your therapist begin to understand you and the best approaches to help.

therapy housekeeping details

Your first appointment will also probably include 'housekeeping' details. You may discuss billing and insurance, paperwork, consent and confidentiality, and expectations.

Knowing that this first appointment will include 'housekeeping' and 'history taking' may help you manage expectations about how much change and success you feel when finishing the first appointment. While there are times when one session can be successful, therapy is often about building a relationship and long-term changes don't always happen with one session.

3. Know that Therapy Takes Work

Therapy can be powerful, but it is not a magic cure-all. Depending on your goals, therapy may take months or years and it may be a series of stops and starts, sometimes with new therapists. Each time you begin therapy and engage with a therapist, you might be at a different stage of readiness and you are bringing new insight and skills that you have learned.

Your therapist will want to learn about the time and space you have in your life right now, so they can explore appropriate and achievable strategies, skills, and tools for you to take away and try. Your therapist may ask you about journaling or trying new activities, creating opportunities for self-care, and stress reduction, or challenge you to look at boundaries you have set. These things can be hard to do and your therapist will work to understand your life and circumstances to find the most manageable ways to feel success.

self-reflection in therapy

Therapy also involves self-reflection, introspection, developing your insight, and being open with another person about your thoughts and feelings. This can feel intimidating, awkward, and uncomfortable. There may be sessions where you walk away feeling exhausted.

4. Give Yourself Enough Time

Feeling nervous about your appointment can trigger the fight-or-flight response. You may notice your hands feel clammy, or your heart beating faster. If you are coming to your appointment from work, school, or home, it may take some time for you to wind down and be ready for introspection. Scheduling 5-10 minutes of quiet time before your appointment can help you to get the most out of this time. Try to turn off your phone and notice how you are feeling about your day and about your appointment. Take the time to tune into what your body is telling you and remind yourself that this is a normal response. Then take some slow, deep breaths.

woman reflecting on therapy goals

Likewise, it can be difficult to walk right back into a busy schedule after a therapy visit. Try to give yourself a few minutes of quiet to process your session be

fore changing gears again. There might be times that you walk away feeling energized and refreshed. Likewise, there might be times when you need a few moments to yourself, so it is helpful to plan for this time in advance.

5. Don't Worry about What to Say

Your therapist will lead the first session. They will ask questions to better understand your thoughts and feelings and the behaviours that you might like to be doing more/or less of. Of course, it can be helpful to take time to think about important points you would like to discuss or any questions you have about the counselling process. But, you don't need to worry about w

hat to say!


Starting therapy is brave and vulnerable. It is exciting and scary. If nothing else, just remind yourself to show up and be yourself.

brave woman in therapy


About the Author

Brittany Rickett - Clinical Director at 3 Rivers Counselling

Brittany Rickett, Bachelor of Education, MA in Counselling Psychology, CCC, LCT-C

Brittany has her Master of Arts in Counselling Psychology from Yorkville University. She worked as a teacher for 13 years before becoming a school counsellor and opening a private practice for virtual and in-person therapy in St. Stephen, New Brunswick. Brittany is passionate about ACT in therapy, and also draws on EFT, IFS, Polyvagal and somatic approaches in her work. Brittany is a certified yoga instructor and Social Emotional Wellness coach offering online workshops and professional development on resilience, mental health, and mind-body connection. She values inclusivity, diversity, anti-oppression, anti-racism, and neurodiversity and is affirmative of all sexual and gender diversities.

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