By Calvin Field, founder of MindTrace. Last updated 13 November 2026.
Quick answer: To prepare for your first therapy session, check the practical details (the time, the place or video link, the cost and any forms), then jot down why you're seeking help now, two or three recent examples, and what you'd like to change. Add a couple of questions for your therapist. The session itself is mostly about getting to know each other: your therapist will usually ask what's brought you, some background and what you hope for, and explain how they work and how confidentiality applies. It's normal to feel nervous, and it's fine to bring notes.
Key takeaways
A first session is usually an introduction and assessment: what's going on, your background and what you hope for.
Prepare in two parts: check the practical details (time, place or link, cost, forms), then jot down why now, a few recent examples and what you'd like to change.
You can ask questions, including how your therapist works and what confidentiality means.
The first few sessions are also about fit. It's okay to look for a different therapist if it doesn't feel right.
Real examples are easier to talk about than general feelings, and they fade fast, so note them down when they happen.
Many therapies, especially CBT, ask you to practise and keep a record between sessions.
What happens at your first therapy session?
Most first sessions follow a similar shape, whether you're seeing an NHS service, a counsellor or a psychologist. The British Association for Counselling and Psychotherapy (BACP) says a first session should cover three things: introductions, where your therapist explains how they work; an assessment, where you can talk about the history of your difficulties; and agreeing how you'll work together (BACP: What is counselling?).
You'll usually be asked:
What's brought you to therapy now.
When things started, and what makes them better or worse.
Some background, such as family, work, relationships and any past support.
What you'd like to be different by the end.
The American Psychological Association notes that the first session can feel like a lot of questions, and that once your psychologist has a full picture, you'll work on a plan together (APA: Understanding psychotherapy). The Canadian Psychological Association adds that this can take one or more sessions (CPA: What to expect from a psychologist).
If you're having CBT through the NHS, you'll usually start with an assessment to decide on the best treatment. The therapist asks about your symptoms and what you hope to get from treatment (NHS: Cognitive behavioural therapy). In England, you can usually refer yourself to NHS Talking Therapies for anxiety and depression without seeing a GP first.
How do I prepare for my first therapy session?
Preparing for a first session comes in two parts: the practical details, and a few notes about what's going on for you. Neither needs to take long.
Practical details to check
Confirm the time and place, or the video link. Check how long the session lasts and whether it's in person, on video or by phone.
Fill in anything sent beforehand. Some therapists and services send forms or questionnaires before the first appointment. Doing them early leaves more of the session for talking.
Check the cost and how you'll pay. The APA notes that a first appointment may cover practical matters such as fees, how to make or cancel appointments, and confidentiality, if these weren't covered by phone. In the US and Canada, check whether your insurance or workplace benefits cover sessions, and whether you need a referral.
Note any medication you take. The CPA says questions about your history can include whether you use medication, alcohol or drugs, so it helps to have a list to hand.
Notes to make beforehand
Mind suggests using any time before your first appointment to think about what you want to get out of therapy, because your therapist is likely to ask, and writing it down as ideas come up (Mind: How to cope on a waiting list for therapy). A few lines is enough:
Why you're looking for help now, rather than six months ago.
Two or three recent moments that show what's been hard.
What you'd like to be different.
A couple of questions for your therapist (there are ideas below).
The table further down shows what each of these can look like in practice.
On the day
Leave a buffer before and after. Try not to rush in from something else or straight back out. Mind says some people use the journey to the session to prepare, for example by walking there if they can.
For an online or phone session, set up early. Mind suggests testing the technology beforehand, finding somewhere you won't be disturbed, using headphones if you're worried about being overheard, and turning off notifications.
Bring your notes. Paper or your phone, whichever is easier to glance at.
Plan something gentle for afterwards. A first session can bring up a lot. A walk, some music or a quiet half hour helps many people wind down.
Is it normal to feel nervous before your first session?
Yes. The APA says it's normal to feel a little anxious in the first few sessions, and Mental Health America notes that going to therapy for the first time makes a lot of people nervous (Mental Health America: How does therapy work?). Mind says it's common to feel unsure whether therapy will help (Mind: How to get the most out of therapy).
You don't need to arrive with everything worked out. Saying "I'm nervous and I'm not sure where to start" is a perfectly good way to begin.
What questions can I ask my therapist?
A first session works both ways. BACP says you can ask about your therapist's qualifications and experience, your therapy, or anything you're unsure about. Mental Health America suggests treating the first appointment like a consultation, and says it's a great time to ask questions. Useful ones include:
How do you usually work, and what kind of therapy do you offer?
Have you worked with people with difficulties like mine?
How does confidentiality work, and what are its limits?
What will a typical session look like?
Will there be anything to do between sessions?
How will we know if it's helping?
The CPA says a psychologist should explain the limits of confidentiality early on. If anything isn't clear, Mind suggests asking your therapist to explain it.
What if my therapist doesn't feel like the right fit?
The first few sessions are partly about whether you can work together. BACP says your relationship with your therapist is very important, and that you don't have to continue if you can't relate to them or don't feel safe. Mind notes that it can take time to build trust, and that some people work with a few therapists before finding the right one.
Give it a couple of sessions if you can, because first meetings can feel awkward on both sides. If it still doesn't feel right, it's okay to say so or to look for someone else.
Why do notes and thought tracking help when you start therapy?
Therapy works best with specific, real examples, but those are exactly what's hardest to remember once you're sitting in the room. A moment that felt huge on Tuesday can be hard to describe by the following week, and a nervous first session makes it even harder to think clearly.
Writing things down helps in three ways:
You can explain what's going on. "I felt sick before the team meeting and thought 'they'll see I don't know what I'm doing'" gives your therapist far more to work with than "work has been stressful".
You start to see patterns. A few weeks of notes can show when difficult thoughts tend to come up, which helps you and your therapist decide where to focus.
It's often part of the therapy anyway. The NHS says that in CBT you'll usually practise between sessions, and you may be asked to record your progress in a worksheet or diary. The APA suggests keeping a notebook for your therapist's suggestions and your own questions, and Mental Health America gives "write down how you feel each day" as an example of therapy homework.
You don't need a perfect system. A few words close to the moment is enough. Our guide to what thought tracking is explains the basics, and how to track negative thoughts in the moment shows a quick method.
What should I write down before my first session?
In the week or two before your first appointment, try noting:
What to note | Example |
Why now | "I've been avoiding friends for two months and I don't want it to get worse." |
Two or three recent moments | "Sunday night, dreading Monday, couldn't sleep until 2am." |
The thought in your own words | "I'm going to mess this up and everyone will notice." |
How you felt, and how strongly | "Anxious, 8 out of 10." |
What you'd like to change | "Feel able to go to things without panicking beforehand." |
Questions for your therapist | "Is it normal to feel worse before better?" |
It's fine to bring these notes and read from them. Many people do, especially when nerves make their mind go blank. We cover this in is it okay to bring notes to therapy?, and our guide to what to write in a therapy journal has more prompts.
Example: one week of notes before a first session
Here's how this can look in practice. This is an illustration, not a real person.
Leah's first appointment is on Thursday. She's worried she'll freeze and say "I'm fine". Over the week she notes four moments in her phone: a panicky feeling on the bus, a thought before a work call ("they'll think I'm useless"), lying awake on Sunday, and a good afternoon with her sister. On Wednesday evening she reads them back and picks two to mention. In the session she reads the work-call note aloud, and her therapist asks about it. Twenty minutes later they're talking about a pattern Leah hadn't noticed: the worst thoughts come before situations where she might be judged.
What happens after the first session?
After the assessment, you and your therapist usually agree goals and a plan. The CPA says psychologists help you set goals early on and review progress at intervals, sometimes with short questionnaires. Mind suggests setting small, achievable goals and giving your therapist feedback on how sessions are going.
Keep noting moments between sessions, then use our guide to preparing for your next therapy session to turn them into a short list for each appointment. If you're new to CBT, what CBT is explains the approach in plain language.
How MindTrace helps
MindTrace is a CBT-inspired thought tracker for iOS and Android. In the weeks before your first session, and between sessions after that, you can capture thoughts and feelings in the moment by text or voice, so you don't have to remember them later. Charts and graphs show patterns over time, and you can read an AI summary of your recent thoughts before each session, so you walk in with real examples. MindTrace supports therapy and doesn't replace it.
Try MindTrace free for 7 days
Frequently asked questions
How do I prepare for my first therapy session?
Check the practical details first: the time, the place or video link, the cost and any forms to fill in. Then note why you're seeking help now, two or three recent examples, what you'd like to change and any questions you have. A few lines is enough.
What should I bring to my first therapy session?
Bring your notes, a list of any medication you take, and any forms the service sent you. If you're paying through insurance or a benefits plan, have those details to hand. For an online session, have headphones and a charged device ready.
What should I say in my first therapy session?
Start with what's brought you to therapy now, a couple of recent examples, and what you'd like to change. If you're not sure where to begin, it's fine to say so. Your therapist will guide you with questions.
How long is a first therapy session?
It varies by therapist and service, so ask when you book. Many first sessions are similar in length to later ones, and some services offer a separate assessment appointment first.
Can I bring notes to my first therapy session?
Yes. Notes help many people remember what they wanted to say, especially when they're nervous. You can read from them, hand them over, or just glance at them.
Do I have to talk about everything in the first session?
No. You can go at your own pace. The APA notes it's okay to tell your psychologist you're not ready to talk about something yet.
How do I know if my therapist is right for me?
Notice whether you feel listened to, safe and able to be honest. Trust can take a few sessions to build. If it still doesn't feel right, you can raise it or look for a different therapist.
MindTrace is not a crisis service and doesn't replace professional care. If you're in crisis or worried about your safety, call or text 988 in Canada or the US, call 999 or Samaritans on 116 123 in the UK, or contact your local emergency services.
By Calvin Field, founder of MindTrace. Last updated 13 November 2026.
Quick answer: To prepare for your first therapy session, check the practical details (the time, the place or video link, the cost and any forms), then jot down why you're seeking help now, two or three recent examples, and what you'd like to change. Add a couple of questions for your therapist. The session itself is mostly about getting to know each other: your therapist will usually ask what's brought you, some background and what you hope for, and explain how they work and how confidentiality applies. It's normal to feel nervous, and it's fine to bring notes.
Key takeaways
A first session is usually an introduction and assessment: what's going on, your background and what you hope for.
Prepare in two parts: check the practical details (time, place or link, cost, forms), then jot down why now, a few recent examples and what you'd like to change.
You can ask questions, including how your therapist works and what confidentiality means.
The first few sessions are also about fit. It's okay to look for a different therapist if it doesn't feel right.
Real examples are easier to talk about than general feelings, and they fade fast, so note them down when they happen.
Many therapies, especially CBT, ask you to practise and keep a record between sessions.
What happens at your first therapy session?
Most first sessions follow a similar shape, whether you're seeing an NHS service, a counsellor or a psychologist. The British Association for Counselling and Psychotherapy (BACP) says a first session should cover three things: introductions, where your therapist explains how they work; an assessment, where you can talk about the history of your difficulties; and agreeing how you'll work together (BACP: What is counselling?).
You'll usually be asked:
What's brought you to therapy now.
When things started, and what makes them better or worse.
Some background, such as family, work, relationships and any past support.
What you'd like to be different by the end.
The American Psychological Association notes that the first session can feel like a lot of questions, and that once your psychologist has a full picture, you'll work on a plan together (APA: Understanding psychotherapy). The Canadian Psychological Association adds that this can take one or more sessions (CPA: What to expect from a psychologist).
If you're having CBT through the NHS, you'll usually start with an assessment to decide on the best treatment. The therapist asks about your symptoms and what you hope to get from treatment (NHS: Cognitive behavioural therapy). In England, you can usually refer yourself to NHS Talking Therapies for anxiety and depression without seeing a GP first.
How do I prepare for my first therapy session?
Preparing for a first session comes in two parts: the practical details, and a few notes about what's going on for you. Neither needs to take long.
Practical details to check
Confirm the time and place, or the video link. Check how long the session lasts and whether it's in person, on video or by phone.
Fill in anything sent beforehand. Some therapists and services send forms or questionnaires before the first appointment. Doing them early leaves more of the session for talking.
Check the cost and how you'll pay. The APA notes that a first appointment may cover practical matters such as fees, how to make or cancel appointments, and confidentiality, if these weren't covered by phone. In the US and Canada, check whether your insurance or workplace benefits cover sessions, and whether you need a referral.
Note any medication you take. The CPA says questions about your history can include whether you use medication, alcohol or drugs, so it helps to have a list to hand.
Notes to make beforehand
Mind suggests using any time before your first appointment to think about what you want to get out of therapy, because your therapist is likely to ask, and writing it down as ideas come up (Mind: How to cope on a waiting list for therapy). A few lines is enough:
Why you're looking for help now, rather than six months ago.
Two or three recent moments that show what's been hard.
What you'd like to be different.
A couple of questions for your therapist (there are ideas below).
The table further down shows what each of these can look like in practice.
On the day
Leave a buffer before and after. Try not to rush in from something else or straight back out. Mind says some people use the journey to the session to prepare, for example by walking there if they can.
For an online or phone session, set up early. Mind suggests testing the technology beforehand, finding somewhere you won't be disturbed, using headphones if you're worried about being overheard, and turning off notifications.
Bring your notes. Paper or your phone, whichever is easier to glance at.
Plan something gentle for afterwards. A first session can bring up a lot. A walk, some music or a quiet half hour helps many people wind down.
Is it normal to feel nervous before your first session?
Yes. The APA says it's normal to feel a little anxious in the first few sessions, and Mental Health America notes that going to therapy for the first time makes a lot of people nervous (Mental Health America: How does therapy work?). Mind says it's common to feel unsure whether therapy will help (Mind: How to get the most out of therapy).
You don't need to arrive with everything worked out. Saying "I'm nervous and I'm not sure where to start" is a perfectly good way to begin.
What questions can I ask my therapist?
A first session works both ways. BACP says you can ask about your therapist's qualifications and experience, your therapy, or anything you're unsure about. Mental Health America suggests treating the first appointment like a consultation, and says it's a great time to ask questions. Useful ones include:
How do you usually work, and what kind of therapy do you offer?
Have you worked with people with difficulties like mine?
How does confidentiality work, and what are its limits?
What will a typical session look like?
Will there be anything to do between sessions?
How will we know if it's helping?
The CPA says a psychologist should explain the limits of confidentiality early on. If anything isn't clear, Mind suggests asking your therapist to explain it.
What if my therapist doesn't feel like the right fit?
The first few sessions are partly about whether you can work together. BACP says your relationship with your therapist is very important, and that you don't have to continue if you can't relate to them or don't feel safe. Mind notes that it can take time to build trust, and that some people work with a few therapists before finding the right one.
Give it a couple of sessions if you can, because first meetings can feel awkward on both sides. If it still doesn't feel right, it's okay to say so or to look for someone else.
Why do notes and thought tracking help when you start therapy?
Therapy works best with specific, real examples, but those are exactly what's hardest to remember once you're sitting in the room. A moment that felt huge on Tuesday can be hard to describe by the following week, and a nervous first session makes it even harder to think clearly.
Writing things down helps in three ways:
You can explain what's going on. "I felt sick before the team meeting and thought 'they'll see I don't know what I'm doing'" gives your therapist far more to work with than "work has been stressful".
You start to see patterns. A few weeks of notes can show when difficult thoughts tend to come up, which helps you and your therapist decide where to focus.
It's often part of the therapy anyway. The NHS says that in CBT you'll usually practise between sessions, and you may be asked to record your progress in a worksheet or diary. The APA suggests keeping a notebook for your therapist's suggestions and your own questions, and Mental Health America gives "write down how you feel each day" as an example of therapy homework.
You don't need a perfect system. A few words close to the moment is enough. Our guide to what thought tracking is explains the basics, and how to track negative thoughts in the moment shows a quick method.
What should I write down before my first session?
In the week or two before your first appointment, try noting:
What to note | Example |
Why now | "I've been avoiding friends for two months and I don't want it to get worse." |
Two or three recent moments | "Sunday night, dreading Monday, couldn't sleep until 2am." |
The thought in your own words | "I'm going to mess this up and everyone will notice." |
How you felt, and how strongly | "Anxious, 8 out of 10." |
What you'd like to change | "Feel able to go to things without panicking beforehand." |
Questions for your therapist | "Is it normal to feel worse before better?" |
It's fine to bring these notes and read from them. Many people do, especially when nerves make their mind go blank. We cover this in is it okay to bring notes to therapy?, and our guide to what to write in a therapy journal has more prompts.
Example: one week of notes before a first session
Here's how this can look in practice. This is an illustration, not a real person.
Leah's first appointment is on Thursday. She's worried she'll freeze and say "I'm fine". Over the week she notes four moments in her phone: a panicky feeling on the bus, a thought before a work call ("they'll think I'm useless"), lying awake on Sunday, and a good afternoon with her sister. On Wednesday evening she reads them back and picks two to mention. In the session she reads the work-call note aloud, and her therapist asks about it. Twenty minutes later they're talking about a pattern Leah hadn't noticed: the worst thoughts come before situations where she might be judged.
What happens after the first session?
After the assessment, you and your therapist usually agree goals and a plan. The CPA says psychologists help you set goals early on and review progress at intervals, sometimes with short questionnaires. Mind suggests setting small, achievable goals and giving your therapist feedback on how sessions are going.
Keep noting moments between sessions, then use our guide to preparing for your next therapy session to turn them into a short list for each appointment. If you're new to CBT, what CBT is explains the approach in plain language.
How MindTrace helps
MindTrace is a CBT-inspired thought tracker for iOS and Android. In the weeks before your first session, and between sessions after that, you can capture thoughts and feelings in the moment by text or voice, so you don't have to remember them later. Charts and graphs show patterns over time, and you can read an AI summary of your recent thoughts before each session, so you walk in with real examples. MindTrace supports therapy and doesn't replace it.
Try MindTrace free for 7 days
Frequently asked questions
How do I prepare for my first therapy session?
Check the practical details first: the time, the place or video link, the cost and any forms to fill in. Then note why you're seeking help now, two or three recent examples, what you'd like to change and any questions you have. A few lines is enough.
What should I bring to my first therapy session?
Bring your notes, a list of any medication you take, and any forms the service sent you. If you're paying through insurance or a benefits plan, have those details to hand. For an online session, have headphones and a charged device ready.
What should I say in my first therapy session?
Start with what's brought you to therapy now, a couple of recent examples, and what you'd like to change. If you're not sure where to begin, it's fine to say so. Your therapist will guide you with questions.
How long is a first therapy session?
It varies by therapist and service, so ask when you book. Many first sessions are similar in length to later ones, and some services offer a separate assessment appointment first.
Can I bring notes to my first therapy session?
Yes. Notes help many people remember what they wanted to say, especially when they're nervous. You can read from them, hand them over, or just glance at them.
Do I have to talk about everything in the first session?
No. You can go at your own pace. The APA notes it's okay to tell your psychologist you're not ready to talk about something yet.
How do I know if my therapist is right for me?
Notice whether you feel listened to, safe and able to be honest. Trust can take a few sessions to build. If it still doesn't feel right, you can raise it or look for a different therapist.
MindTrace is not a crisis service and doesn't replace professional care. If you're in crisis or worried about your safety, call or text 988 in Canada or the US, call 999 or Samaritans on 116 123 in the UK, or contact your local emergency services.
