What Actually Happens in a First Therapy Session

One of the most common things I hear from new clients is some version of 'I didn't know what to say in the first session.' Not knowing what to say is entirely normal. The first session is not a test. There is no right way to show up.

Before we begin

Before a first session, I usually have a brief phone call with a new client. This is a chance to check that we might be a good fit, to answer any practical questions, and to get a rough sense of what has brought you to therapy. It is not part of the therapy itself, and there is no obligation on either side.

The session itself

A standard session lasts fifty minutes. We sit in comfortable chairs in my room at Millbrook House, which I have worked to make as calm and unhurried a space as possible. There is no desk between us, no clinical feel. It is simply a quiet room.

I will begin by checking how you are and whether there is anything you would like me to know before we start. Then I will usually ask you to tell me a little about what has brought you here. Not your whole life story, not everything at once: just what feels relevant and ready to be said.

“You do not need to arrive with a clear account of your problems. You just need to show up. We will find the words together.”

What I am listening for

I am not listening in order to diagnose or categorise. I am listening to understand how you experience your life and yourself, what patterns seem to be present, and what you are hoping might be different. Sometimes people arrive with a clear sense of what they want help with. Other times, they arrive knowing only that something feels wrong. Both are fine starting points.

At the end

Towards the end of the session, I will check in with you about how you found it and whether you would like to continue. There is no pressure. Some people find they want to think about it; others know straightaway. I will share my initial sense of how I think I might be able to help, and we will decide together whether it makes sense to carry on.

The first session often feels more like a conversation than what people imagine therapy to be. That is intentional. Therapy only works if it is built on trust, and trust takes time. We begin by beginning.