Most people who book a first session with a therapist arrive nervous. Some are visibly so; most are quietly so. The nervousness is rarely about the session itself. It's about everything that surrounds it. Will I cry? Will I freeze and have nothing to say? What do I even bring up first? Will this person judge me? Am I making a fuss about nothing?
These worries are extremely common, and worth answering before you arrive — partly because the answers might lower the bar enough for you to actually make the call, and partly because knowing what to expect is one of the best ways to settle a nervous body.
This article is about what actually happens in a first session, what's normal to feel beforehand, and how to tell whether you've found the right therapist. It's written from my own practice, but most of it generalises to any reputable therapist working in the UK.
What the session is, and isn't
The first session is, in essence, an extended conversation. There is no test. There is no diagnostic process you can fail. The therapist is not assessing whether you are sufficiently broken to qualify for help. There is no specific story you need to have prepared.
What the therapist actually wants to do in the first session is meet you. Get a sense of what's brought you here. Understand a little about your life, your situation, what's been weighing on you. Notice how you talk about it. Begin to form a picture of what you might be looking for, and what working together might involve.
What you actually need to do in the first session is rather less than people imagine. You don't need to summarise your entire life. You don't need to know the official name of what you're going through. You don't need to come with a list. If you arrive and say "I don't really know where to start", that is a perfectly good place to start. A good therapist will help you find the thread.
The practical bits
Length and format. Sessions are typically fifty minutes. The first one is sometimes called an introductory or assessment session — a slightly more conversational, exploratory version of an ongoing session. With me it begins with a free fifteen-minute call, before any commitment to a full session is made. That call is just to get a sense of each other, to find out whether working together feels right.
In person versus online. I see clients in person in Weybridge (Surrey, KT13) and Kensington (London, SW1), and online via Zoom for clients further away or with weeks that don't allow easy travel. There is no quality difference between online and in-person therapy for most kinds of work — the research on this is now reasonably clear. People often have a strong intuition about what they prefer, and that intuition is usually right. If you're not sure, you can try one and see.
Frequency. Most ongoing therapy happens weekly, at the same day and time, for as long as makes sense. Some people do twice-weekly work; some find fortnightly enough. The right frequency isn't a matter of severity — it's a matter of what allows the work to keep moving without becoming overwhelming.
Cost and insurance. I am a recognised provider with BUPA, AXA, and AVIVA. If you have a workplace policy that covers psychotherapy, your sessions may be funded — usually after a referral via your insurer. For self-funded work, fees are agreed upfront; ask about them on the introductory call. Most insurance plans cover a fixed number of sessions, after which you can either continue privately or pause.
Confidentiality. Whatever you say in the room stays in the room. The only exceptions, set out by the BACP ethical framework, are situations involving serious risk to your life or someone else's, or where I would be required by law to disclose. I'd talk you through this in the first session if it ever became relevant.
The worries, addressed
What if I cry?
People often do, sometimes a lot, sometimes a little. Crying isn't a sign that something has gone wrong — it's frequently a sign that something has been heard for the first time in a long while. There are tissues. The session keeps going. Most people feel lighter afterwards, even when they've spent half of it in tears.
What if I freeze and don't know what to say?
This happens to a lot of people, particularly in early sessions. It is not a problem. Therapists are trained to work with silence. We can sit with it, or we can ask a gentle question, or we can sometimes just notice the freeze itself and wonder aloud what it might be about. Whatever happens, it isn't your job to keep the conversation rolling.
What if I bring up something embarrassing or shameful?
If you've been a therapist for any length of time, almost nothing surprises you. The thing you're most worried about saying is often the thing most worth saying — and saying it to a person who isn't going to flinch is almost always a relief, even when it doesn't feel that way before the words come out.
What if I don't have anything serious enough to need this?
You don't need to qualify. You don't need to be at a particular level of distress. Therapy is genuinely useful at many points along the spectrum — from a quiet sense that something isn't right, all the way through to acute crisis. The threshold is whether you're curious enough about your own life to look at it more closely.
What if I don't connect with this particular therapist?
This one is real, and worth saying out loud. The relationship between client and therapist is the single biggest factor in whether therapy works. If something feels off after one or two sessions — if you don't feel quite met, if something about the rapport isn't there — that's important information. A good therapist will welcome you raising it. Sometimes the rapport just needs a few weeks to settle. Sometimes it tells you that this isn't the right person for you, in which case the most useful thing is to find someone else. Therapists are not interchangeable. Trust your instincts.
A small note on starting
If you've been thinking about therapy for a while, and the thought has been getting harder rather than easier to ignore, that itself is worth attending to. The fact that something in you keeps returning to the idea is information.
The first step is not a decision to do six months of therapy. It's a fifteen-minute conversation, free of charge, with no obligation. If, after that call, something in you settles a little — and something else in you wants to come back — that's a good sign. If not, you've lost nothing but a quarter of an hour, and possibly learned something useful about yourself in the process.