The first therapy session
Why it is a powerful and important step for therapist and client
June 25, 2025
By Aviva Boxer, Registered Psychotherapist
I am a therapist and a therapy client and I can say from both perspectives, that one of the most special yet daunting parts of therapy for me is the first session. The first session is important because this is the first chance a client and a therapist get to spend time together getting to know each other to see if they truly connect.
As a client, coming to the first session means I have selected my prospective therapist based on her areas of focus matching up with what I want to work on and I am hoping by her description that she is a good fit. By this point I have already had a chat with her over the phone to determine if it feels right to move to the next step — the first session.
Logging on to meet a client on video for the first time is exciting but can also feel daunting.
“I know from my own experience as a client and my work as a therapist, that it is imperative, especially in that first session, that I keep an open mind, not judge, and lead with curiosity, not assumptions.”
The first session as a client
Before the first session, I am nervous but also excited! I am really hoping this is going to work out and that we will have a great connection and that I can just get started on all the work I want to do. At some points in my life when I have had pressing issues, the first session experience was heightened and lots of emotion came up right away. I felt great when I felt comfortable with the therapist. But I have also had first sessions that did not go well.
I remember meeting a therapist for a first session years ago. I was really looking forward to talking with her and getting started because I was upset about some things happening in my life and I was eager to process my feelings and get some support. Soon after I met this therapist and opened up about the hard situation I was dealing with at the time, I felt judged by some of the things she said to me about my situation and felt she made some assumptions from that first session. Needless to say, I never went back to see her for a second session. I felt bad after the first session and did not feel that she understood me nor cared about me, two essential ingredients to a positive first session and therapeutic relationship. I knew from that first session that this was not the therapist for me.
I have been a client both virtually and in person and my preference is to see my therapist virtually because I can be at home and relaxed when I click online to talk with her.
When I click on the video and my therapist is there, it is exciting to see her for the first time, but I am assessing a lot at once — how do I feel talking with her, is she listening to me, do I feel she is getting me and what I am saying, and the deeper meaning behind my words and the experiences I am sharing? Do I feel safe emotionally to be vulnerable and open?
The first session as a therapist
As a therapist, the first session is exciting and also daunting but in a different way. Before seeing a client for the first time on video, we talk on the phone for a short consultation call. That call really gives me a good idea of what the client wants to work on and how they are feeling about the issues in their lives. Sometimes clients become emotional in that call because they are bringing up very sensitive issues that they have been holding on to for a long time. The consultation call is important for me to learn more about the client’s concerns and important for the client to assess how comfortable they feel talking with me. Because no matter what modality we ultimately use in therapy together, them feeling comfortable and safe with me and us building a relationship together is the foundation of all the work we will do together.
So, back to that first session feeling — yes I get a bit nervous too — will it go well, will my client connect with me, will I be present for them in the way they need me to? Will they feel safe and feel they can be open with me soon after we start talking? Will they get what they need? I know from my own experience as a client and my work as a therapist, that it is imperative, especially in that first session, that I keep an open mind, not judge, and lead with curiosity, not assumptions.
In that first session I also want to gather some information about my client and their life to date. What was childhood like, how did they feel about school and friends, what was their family structure? The good thing about asking these questions in a first session is that it puts the client into context for me and it gives them something to start with, some easier biographical details about their life they can talk about when they may be feeling nervous to get into the bigger issues they came to work on.
Once the first session is complete, both the client and the therapist usually have a better sense of what will come next in future sessions and that can be relieving, motivating and empowering for clients especially. After that we can just be open to where the experience takes us.
If you have been thinking about starting therapy and you are feeling a little nervous about it, please know that you are not alone! You can try a free consultation and then a first session and go from there. Sometimes starting therapy is just about starting, and taking it one step at a time. When you are ready, we are here.