For many people, the hardest part of therapy is simply getting started. The fear of the unknown — what actually happens in therapy, what you’re expected to talk about, and how it might feel to open up about things you’ve kept private for years — can be a huge barrier. That anxiety at this stage can feel overwhelming enough to stop you from reaching out at all.

One of the common questions I am asked in initial calls is about what to expect from therapy. This guide is here to gently walk you through what therapy usually looks like, what you can expect from the process (and what you won’t get from your therapist)*.

Before You Begin: The Introductory Call

You’ve searched the directories, done an online search or even better got a recommendation, once you have someone that seems to be a possible therapist for you it’s time to reach out. Most therapists offer a short introductory phone call. It’s not a therapy session — it’s a chance for both of you to get a sense of whether you’re the right fit for each other.

During this call, you can:

• share a little about what’s bringing you to therapy
• ask questions about how the therapist works
• get a feel for whether you feel comfortable with them

You’re not expected to “offload” everything in 20 minutes. But offering a brief explanation of what brings you to therapy is helpful – what if what you’re looking for isn’t within the therapist’s area of expertise, it’s better to know early on rather than a few sessions in. Ask the questions you need to in order to know if you feel this therapist is someone you can see yourself being open with.

You might book your first session during the call, or you might want some time to reflect. Both are completely OK — choosing a therapist that is the right fit for you is an important part of the process, and you should never feel rushed.

The First Session: Setting the Foundations

Once your appointment is booked, you’ll usually receive a contract or working agreement. This outlines:

• confidentiality and the rare situations where it may need to be broken (e.g. where concerns for safety arise)
• how your data and notes are stored
• session frequency
• payment and cancellation policies

It’s not meant to overwhelm you — it’s there to create clarity, safety and boundaries so you know exactly what to expect.

Weekly sessions are often recommended because they help build momentum and build the relationship with your therapist.  However, if practically this would be difficult, have the discussion of what feels manageable for you.

In your first session, you may explore your goals. These might be practical (“I want to manage my anxiety”) or more abstract (“I want to understand myself more clearly”). There’s no right or wrong way to approach this. And if you’ve not got a specific goal, that’s Ok too, sometimes therapy is about having a space to talk and process life events and challenges.

The Nerves: What If I Don’t Know Where to Start?

Arriving for that first session can feel scary. You might find yourself thinking:

• “Where do I even begin?”
• “Will I sound dramatic?”
• “Will she think I’m a lost cause?”
• “What if she agrees with my family and thinks it’s all my fault?”
• “Will this even help?”

These thoughts are incredibly common.

Your therapist won’t be sitting there judging you. They’re listening with curiosity, empathy and care. They’re trying to understand your experience from your perspective — not anyone else’s.

And as for where to start? Wherever feels right.

Many people come in with what feels like a box of jigsaw pieces — memories, moments, worries, patterns — all mixed together. It’s normal to jump around and bring lots of the pieces in the first sessions. Your therapist is following you, noticing what matters, and beginning to gently piece things together.

As Therapy Progresses

Over time, sessions naturally become more focused. Patterns start to emerge. Your therapist will use reflections, questions and gentle challenges to help you explore the areas that will support your growth.

Some sessions will be rooted in the present. Others may involve looking back at earlier experiences.

Therapy isn’t always a linear process; if you feel stalled, overwhelmed or unsure, bring it into the room. It helps your therapist understand how to support you and whether something needs to be paced differently or approached more safely. You and your therapist might both be aware of something key that you want to bring, however somethings need to be handled with care. If you don’t feel ready – acknowledge that, your therapist will work with you. It’s important to consider this as a collaborative process.

It’s also important to remember that these are your sessions, you may have booked the sessions to help you with a particular topic/theme, but that doesn’t mean that you can’t bring other things into the room too that come up along the way, often these moments reveal more insight into the very patterns you’re working on.

What Your Therapist Will (and Won’t) Do

Your therapist will:

• listen without judgement
• help you explore your thoughts and feelings
• offer reflections or alternative perspectives
• support you in understanding patterns
• help you work towards your goals

Your therapist won’t:

• tell you what to do
• give personal opinions
• judge your choices
• collude with guilt or shame

Depending on their approach, they may offer exercises — for example, CBT worksheets, grounding techniques to manage anxiety out of sessions, or reflective practices — but only where appropriate and helpful, not all therapy involves “homework tasks”.

Moving Towards an Ending

As you get closer to your goals, you and your therapist may discuss reducing session frequency or planning an ending. This is a collaborative conversation — you should feel fully involved in the decision. For some, especially when therapy has been a long journey, ending it can feel daunting. Again, this is part of the process to be discussed, and there will often be multiple options to consider to how the sessions wind down.

Ultimately therapy is a unique process for all. No two people are identical and no two experiences are experienced the same. Starting therapy is often a something that feels uncomfortable at first, but finding the right person will help that to become easier.

If you have been considering therapy but held off through apprehension, please do think about taking that step forward and reaching out to someone, remember that the first hurdle is often the hardest.

 

 

*All therapists who are registered with a regulatory body follow a code of ethics, and while many aspects of therapy are common across the profession, each therapist has their own style and approach. This article reflects my experience of working with clients and aims to give you a grounded, reassuring sense of what therapy often looks like.