First Therapy Session, What to Talk About

First Therapy Session, What to Talk About

So you are about to have your first therapy session and you realize you do not know what to talk about. Do you let the therapist just ask you questions? Do you start by asking questions? What questions should be asked and by who? Before you know it, you are in the chair across from your therapist for the first time and your brain is blank. This is a totally normal reaction and I have seen it often. I have done this myself when I was first learning how to be a therapist. Meeting new people is anxiety-provoking and meeting your therapist for the first time is often even more intense. It’s only natural, therapy is scary and requires vulnerability with a stranger. Insiders tip, event therapists get nervous at meeting a new client. At least you’re both nervous even if only one of you shows it. 

First Therapy Session, Therapeutic Style

Each therapist has a different style. This is a worthwhile conversation to have during your first therapy session because it naturally breaks the ice and allows you to listen and not speak. Ask your therapist about their style. This differs from an approach that I will go over later in this blog. Think of style like penmanship. You and I can write the same words on a piece of paper but our penmanship will look different. A therapeutic style is unique to each therapist. For example, I tell my clients I am straightforward and blunt. I speak with honesty and compassion for your pain and my goal is to maximize your time with me so that requires me to get straight to the point. Your therapist might say something similar or tell you they are quick to use humor during sessions. It is important to consider what style best suits your needs for therapy.


Therapists are trained in different theoretical perspectives or theoretical approaches. Terms like Gestalt, Cognitive Behavioral Therapy (CBT), Humanistic, Depth, and Internal Family Systems (IFS) are all examples of different approaches. It is important to understand what approach your therapist uses during a first therapy session as each approach has a different focus within clients. For example, Gestalt focuses on building your self-awareness or mindfulness. While CBT focuses on changing your cognitions. Both aim for the same overarching goal, a higher quality of life. Asking this question gives you another opportunity to listen instead of talk if you are trying to get your nerves under control but also lets you get to know your therapist better and see if they are a good fit for you. It is important that your therapist is a good fit for your needs. Otherwise, you can end up wasting both your time and money in this process.


Since no two therapists are created equal, neither are the limitations they have. There are a plethora of limitations to consider. One limitation is which insurance your therapist accepts if any. One of my limitations is that I do not accept insurance so all of my clients are private pay. Another limitation is what pain points a therapist does not work with. For example, several clients I have worked with have ADHD. ADHD is not something I focus on so explain if that is their primary concern I am not a good fit. Others want to bring in their romantic partners and that is another limitation as I only do individual work, no family, couples, or groups. Asking about limitations for a first therapy session lets you know where the boundaries are. Also, make sure you ask about limits to confidentiality as therapists are mandated reporters. 

First Therapy Session, Goals

Now, this topic will require you to talk while your therapist listens. It is important to talk about your goals during your first therapy session because this conversation will allow your therapist to better understand you and how they can help. Also, some of your goals might land in the area of limitations for your therapist and this is also important to know. Try to talk about your goals without overthinking them. Having goals is also a way to measure your progress in therapy. Without setting clear and reasonable goals how will you measure how far you have come? These goals will be a moving target too. It is normal to set goals within the first month and track your progress. Eventually, you will meet some of these goals and then change your list to include ones you have yet to meet. The conversation surrounding your goals will be ever-changing throughout the process. So it makes sense to start this conversation early as it will happen repeatedly. 

Pain Points

This is the topic that is usually the hardest to verbalize. Every time I meet a new client for a first therapy session, this is where I notice the most struggle to talk about. This topic is the reason you are talking to a therapist but is also the topic you are most likely to avoid. Hopefully, the above-mentioned topics have given you enough time and information regarding your therapist to give you enough comfort to start talking about why you decided to seek therapy. This to me as a therapist is by far the most important topic of conversation and is understandably the hardest to discuss. This requires you to be vulnerable about what you feel is wrong or missing in your life. These might be things that are hard to admit or you might not know how to verbalize what you feel. Regardless of what your pain points are, your therapist will need to know them in order to start thinking about how to both understand and help you. 

Speak Your Mind


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