Sometimes the hardest part of counseling is the part before it begins. You have decided to reach out, maybe after months of doing research and thinking about it, and wondering what it will be like, while the intensity of the issue that caused you to consider it seems to get better and worse depending on the day. It is completely normal to feel nervous, unsure what to say, or worried you will be judged. Knowing what actually happens in a first session can take a lot of that fear out of the experience, so here is an honest walkthrough of the session, but also what to expect even before.
Before the Session
Because Heal.online sessions take place online, a little preparation goes a long way. Once people make the commitment by submitting a request for services through the Heal.online website, they are matched to a potential therapist based upon the information provided in their request for services. The therapist then reaches out to make contact by email with a link and specific instructions on how to set up a client portal account within InSync – the confidential, HIPAA-compliant electronic health record. In the client portal there will be several necessary documents that are common and essential to providing professional counseling services. This typically includes a brief history; an informed consent document that explains confidentiality, its legal limits and exceptions; and a client agreement, financial agreement, key policies including telehealth specific policies. It is worth reading carefully and noting any questions. Therapists would much rather answer questions up front than have someone sign something they do not understand. Once the documents are complete, the therapist will reach out to schedule the first appointment.
Prior to a session individuals receive an email link and often a text reminder of the appointment with a link to login to InSync. A few minutes before the appointment, it helps to find a private space free from interruption and where conversation will not be overheard. Some clients use a parked car, a closed bedroom, or an office with a door. Headphones help with privacy. A charged device, a stable internet connection, a glass of water, and a box of tissues nearby are all worth having. Tears in a first session are common and nothing to be embarrassed about.
The First Few Minutes
The therapist will begin with introductions and a review of the essentials: how confidentiality works, the specific situations where the law requires a therapist to break it (such as a serious risk of harm to the client or someone else, or suspected abuse of a child or vulnerable adult), how sessions are scheduled, and what to do if help is needed between appointments. This can feel a bit formal, but it exists to protect the client. Knowing the boundaries of the room helps a person decide what they are ready to share.
Telling the Story, at Each Client’s Own Pace
Most of the first session is about getting to know the client. The therapist will likely ask what prompted counseling now, how long the struggle has lasted, and how it is affecting sleep, work, relationships, and faith. There may be questions about family background, health, past counseling, alcohol or substance use, and support systems. Some questions may feel personal. Clients are always free to say, “I’m not ready to talk about that yet.” However, the more information the therapist has, the better the understanding and the more likely they will be able to help.
No one needs to arrive with a polished explanation. Many people start with, “I don’t really know where to begin.” That is a perfectly good place to start. Proverbs describes the counselor’s task beautifully: “The purposes of a person’s heart are deep waters, but one who has insight draws them out” (Proverbs 20:5, NIV). It is the therapist’s job to help draw things out, not the client’s job to have everything sorted before arriving.
Talking About Faith in Session
At some point, the therapist will ask about the role faith plays in the client’s life and how much it should be part of counseling. There is no wrong answer. Some clients want prayer and Scripture woven throughout their sessions. Others prefer to keep the focus mostly clinical, with faith in the background. Some are carrying questions or hurts connected to church and want to move slowly.
That question is not a formality. The American Association of Christian Counselors’ code of ethics calls on Christian counselors to obtain informed consent before using explicitly spiritual practices such as prayer or Scripture in counseling, and to respect a client’s right to decline them (American Association of Christian Counselors, 2014). In other words, faith integration is something the client chooses, not something done to them regardless, and clients can change their minds at any time.
The Relationship Matters More Than Many Expect
By the end of the first session, most clients have a sense of whether they and their therapist are a good fit. That sense deserves attention. A large meta-analysis led by Christoph Flückiger, drawing on hundreds of studies, found that the strength of the working alliance, meaning the collaborative bond and shared goals between client and therapist, is one of the most consistent predictors of how well therapy turns out (Flückiger et al., 2018). Feeling heard, respected, and safe is not a luxury. It is part of what makes counseling work.
It also helps to know that early uncertainty is common. A meta-analysis by Joshua Swift and Roger Greenberg found that roughly one in five adult clients ends therapy prematurely (Swift & Greenberg, 2012). Sometimes that is because the fit is wrong. Often, though, it happens because the first sessions felt awkward or slow and no one talked about it. When something is not working, saying so matters. A good therapist will welcome the feedback and adjust, or help the client find someone who fits better.
How the Session Ends
Toward the end of the first appointment, the therapist will usually summarize what they have heard, share some initial thoughts about what might help, and talk about goals. They will discuss how often to meet, often weekly at first, and what the next few sessions might focus on. No one leaves a first session with every problem solved, and no one should expect to. But many people leave with something they did not have when they arrived: a sense that their struggle has been named, and that they are no longer carrying it completely alone.
The psalmist’s prayer is a fitting one to bring into this first step: “Show me your ways, Lord, teach me your paths. Guide me in your truth and teach me, for you are God my Savior, and my hope is in you all day long” (Psalm 25:4-5, NIV).
Common Questions About the First Session
How long is the first session? Generally, each session is approximately from 50 minutes to 1 hour. Sometimes additional time is needed for the first session to grasp a full understanding of the client’s concern and desired outcome. When this is true, the therapist will request more time before continuing and gain consent for approximately 30 more minutes.
What if a client cries or cannot find the words? Both are common and completely acceptable. Therapists are trained to sit with clients in silence or in tears without rushing them.
Does the first session require talking about childhood? The therapist may ask some background questions, but the client decides how deep to go and when. Sometimes background information can provide a context Counseling moves at the client’s pace.
What if the client does not click with the therapist? It is fine to say so. It’s important to give the therapist feedback and if the person is open to it, it is best to give them the opportunity to make adjustments if needed. If that doesn’t work or if it is clearly not working, fit matters. Asking to work with someone else is a reasonable request, not an insult.
A Closing Word
Showing up for a first session takes courage, even when it does not feel courageous at the time. No one needs perfect words, a tidy story, or certainty that counseling will help. They only need to show up as they are. A good therapist will meet them there, and together they can begin to figure out the next step.
Tim Putman, LMHC-QS, MAMFC, MARE
Scripture quotations taken from The Holy Bible, New International Version®, NIV®. Copyright © 1973, 1978, 1984, 2011 by Biblica, Inc.™ Used by permission. All rights reserved worldwide.
Sources cited:
American Association of Christian Counselors. (2014). AACC Code of Ethics.
Flückiger, C., Del Re, A. C., Wampold, B. E., & Horvath, A. O. (2018). The alliance in adult psychotherapy: A meta-analytic synthesis. Psychotherapy.
Swift, J. K., & Greenberg, R. P. (2012). Premature discontinuation in adult psychotherapy: A meta-analysis. Journal of Consulting and Clinical Psychology.
Educational Only. Not Professional Advice. This article is provided by Heal.online for general educational and informational purposes and reflects our Christian perspective. It is not medical, psychological, psychiatric, or counseling advice, does not create a therapist-client relationship, and is not a substitute for individualized care by a licensed professional. Reading this article does not enroll you in our therapy services, which are provided under a separate client agreement. If you or someone you know may need care, please consult a licensed professional. In an emergency, call 911. For a mental health crisis, call or text 988. For domestic violence, call 1-800-799-7233. To report suspected abuse in Florida, call 1-800-96-ABUSE. Full disclaimer and legal notices. Information about our therapy services.
