What to Expect in Your First Therapy Session
- Elemental Wellness
- 11 hours ago
- 4 min read
A Therapist Explains the Intake Session
If you’re feeling nervous or unsure about what to expect in your first therapy session, you’re not alone—and you don’t have to have it all figured out.
Let’s clear something up right away: Your first therapy session is not where you spill your entire life story, sob uncontrollably, and magically feel healed by the end.
It’s called an intake session, and its main purpose is orientation, safety, and information gathering. Think of it as laying the foundation—not the deep work itself.
The First Session = Intake Session
This is your first official meeting with your therapist. You’ll likely have some paperwork to sign (informed consent, privacy policies, insurance forms, etc.), and your therapist will explain the basic rules of therapy.
The most important one? Confidentiality and its limits.
A Quick (Important) Talk About HIPAA & Safety
Therapy is confidential—with a few legally required exceptions. Therapists are mandated reporters, which means we must take action if:
There is known or suspected child or elder abuse
You are at immediate risk of harming yourself
You are at immediate risk of harming someone else
Here’s the part that often gets misunderstood:
There is a huge difference between
“I’m exhausted, my life feels unbearable, and I’m done”and“I am going to leave here and hurt myself or someone else.”
Thoughts and feelings live on a spectrum. Having them does not automatically mean emergency intervention.
Side Note (And I’m Saying This Boldly)
If a therapist panics the moment you hint at suicidal thoughts—that may not be the right therapist for you.
Not all therapists are trained equally in crisis work. Some have limited experience or comfort in this area, and that matters. I say this as someone who has spent most of her career working with clients in crisis.
You deserve a therapist who can stay grounded while holding hard conversations.
This Session Is About Gathering Information
The intake session helps your therapist understand the big picture so they can:
Complete a psychosocial assessment
Create a treatment plan
Make sure therapy is appropriate and supportive for you
This does not mean you need to share every traumatic experience you’ve ever had.
In fact, I strongly encourage you not to do that.
Take your time to get to know your therapist before openings Pandora's Box.
You Do Not Have to Share Everything
You are not required to unload your entire trauma history in session one.
Please don’t retraumatize yourself before you’ve learned skills to cope with the aftermath. You’re allowed to keep things brief, surface-level, or say:
“There’s stuff there, and I’m not ready to talk about it yet.”
That is more than enough.
At the same time, it is helpful for your therapist to know that trauma exists in your history.
Naming it—without details—is often the safest middle ground.
As someone with a trauma history myself, I know how hard it can be to say those words out loud. Go at your pace.
You Might Not Leave Feeling “Better”
This surprises people, so let’s normalize it.
You may not walk out of your first session with coping skills, insight, or a sense of relief. Sometimes the intake process takes a few sessions before the real work begins.
That doesn’t mean therapy isn’t working. It means it’s being done responsibly.
Treatment Plans (Yes, They Exist)
During the intake process, your therapist will create a treatment plan. Some therapists review this with you and have you sign it. Others complete it behind the scenes.
Why? Because insurance requires it.
We have to document goals so sessions get paid—and so if your chart is audited, insurance companies don’t demand their money back. (Yes, that’s a thing. It’s literally called a clawback.)
Fun, right?
Session Length & the Insurance Reality
Most therapy sessions are 45–60 minutes. Intake sessions are usually closer to an hour because there’s more to cover.
Here’s a not-so-fun industry secret:Insurance companies pay in strict time increments. A “60-minute session” is actually 53 minutes. Once that clock hits 54 minutes, insurance stops paying.
So if your therapist spends extra time with you, they’re doing so unpaid.
This isn’t to rush you—it’s just part of the reality of working within insurance systems.
A Brief (Honest) Insurance Blurb
Some practices have entire billing departments that can tell you your copay or deductible ahead of time.
Many don’t.
Insurance companies also frequently give incorrect information. Shocking, I know.
Some plans consider therapists specialists, others don’t. Coverage varies wildly by plan.
There is no universal cheat sheet.
As frustrating as it is, the best thing you can do is know your benefits and advocate for yourself. Therapists are often just as stuck navigating the system as clients are.
Final Thoughts on What to Expect in Your First Therapy Session
Your first therapy session is about orientation, safety, and fit—not perfection or transformation.
You don’t need to perform.You don’t need to overshare.You don’t need to be “good” at therapy.
Just showing up is enough.
If you leave feeling a little awkward, tired, or unsure—that’s normal. Therapy is a relationship, and relationships take time.
The important thing is are making yourself a priority!
Written by: Jamie Hogan, MA, LPC, NCC
Jamie Hogan is a guide, space-holder, and founder of Elemental Wellness. With nearly 20 years in the healing world—and lived experience on the client side of therapy—she trusts in the wisdom that emerges when safety, curiosity, and compassion are present. Her writing offers a gentle pause and a reminder that healing does not have to be done alone.
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