Feeling Anxious About Starting Therapy? Here’s What to Expect in Your First Counseling Session

Many people feel nervous about seeking counseling, and that’s completely understandable. The stigma surrounding mental health can make it hard to reach out, leaving many worried they’ll be judged for their struggles. On top of that, uncertainty about what actually happens in a therapy session can make the idea even more intimidating.

You might picture the stereotypical scene: lying on a sofa while the therapist silently takes notes, offering the occasional nod or word of encouragement. But that couldn’t be further from the truth. If you’re feeling anxious about starting therapy or unsure about what will be expected of you, this guide is here to help.

Overcoming the Stigma: Why You Shouldn’t Feel Ashamed to Seek Counseling

Despite persistent mental health stigma, there is no reason to feel ashamed for seeking help. Counseling for anxiety, depression, trauma, or any other issue is a positive step toward healing, not a sign of weakness.

Your therapist is there to support you—not to judge you. In fact, therapists are trained to offer what’s called unconditional positive regard. This means we accept and value you as a person, no matter what you’re going through. It’s a concept that’s deeply embedded in counselor training programs, and research consistently shows that the best therapy outcomes occur when clients feel accepted and supported.

We know how important it is for you to feel safe and valued in your sessions. Helping people through their mental health challenges is why we became therapists in the first place.

What Happens in Your First Therapy Session?

One of the biggest sources of anxiety about therapy is not knowing what to expect. Let’s break down what typically happens during your first counseling session to help ease those worries.

The Intake Process: Paperwork and Privacy

Your first session will usually start with some important intake paperwork. This includes reviewing and signing an informed consent document, which covers details like billing, scheduling, and your privacy rights. Your therapist will also go over HIPAA paperwork to explain how your personal information is protected under federal and state laws.

You might be asked about your preferences for appointment times or whether you’d like to use telehealth counseling. This is your time to ask questions about how the process works, so don’t hesitate to speak up if something isn’t clear.

Talking to Your Therapist: What Should You Say?

After the paperwork is complete, your therapist will likely ask why you’re seeking counseling. This is your opportunity to share as much—or as little—as you feel comfortable with. Some people dive right into their story, while others take more time to open up. Both approaches are completely normal.

If you’re more reserved or unsure of what to say, your therapist will guide the conversation with questions about your background and mental health history. This process might take a few sessions, depending on your situation, but it’s all part of building a strong therapist-client relationship.

Creating a Therapy Treatment Plan

By the end of your initial sessions, you and your therapist will likely develop a treatment plan. This plan outlines your specific goals for therapy, ensuring that both you and your therapist stay focused on addressing your needs. After all, therapy isn’t just about chatting—it’s about working together to find solutions and improve your mental health.

What to Expect in Ongoing Counseling Sessions

After your first counseling session, each appointment will follow a similar structure. Your therapist will check in on your progress, discuss any recent events, and review any therapy homework or strategies you’ve been practicing between sessions.

It’s important to remember that real progress happens outside of therapy. Sessions are designed to equip you with tools and skills to apply in your daily life, helping you make informed decisions and improve your overall functioning.

Taking the First Step Toward Better Mental Health

Feeling anxious about starting therapy is normal, but understanding what to expect can make the process less intimidating. Your therapist is there to guide you, support you, and create a safe space where you can work through your challenges without fear of judgment.

If you’re ready to take that first step, know that seeking counseling is a courageous and empowering decision. You don’t have to navigate life’s challenges alone—help is available, and healing is possible.