What to Expect in Your First Therapy Session

If you have been thinking about starting therapy but keep putting it off, you are not alone. In my 14 years of practice, I have seen hundreds of people walk through my door at Wimpole Street for the first time — and nearly every one of them tells me the same thing: “I almost didn’t come.” The fear of the unknown is the single biggest barrier to getting help, bigger than cost, bigger than time, bigger than anything else.

This article is here to change that. I want to walk you through exactly what happens before, during, and after your first therapy session, so that when you are ready, you know precisely what to expect.

Why is starting therapy so intimidating?

It is completely normal to feel nervous. You are about to sit with a stranger and talk about things you may never have said out loud before. Research from the British Association for Counselling and Psychotherapy (BACP) shows that the average person waits over two years from first considering therapy to actually booking a session. Two years of carrying something alone that could have been addressed much sooner.

The fear usually comes down to a few things: not knowing what will happen, worrying about being judged, or feeling that your problems are not “serious enough” to warrant professional help. I want to address each of these directly, because none of them should stand between you and feeling better.

Do I need to prepare anything before my first session?

No preparation is required. You do not need to write anything down, organise your thoughts, or have a clear idea of what you want to talk about. In my practice, I always tell new clients: just show up as you are. That is genuinely enough.

Some people find it helpful to jot down a few things that have been on their mind, and if that feels right for you, go ahead. But there is no homework, no questionnaire to fill out beforehand (though some therapists do use brief intake forms), and no expectation that you arrive with a neatly packaged summary of your life. Therapy is not a presentation. It is a conversation.

The one practical thing I would suggest is to make sure you know the logistics — where the office is, how long the session lasts, and what the fee is. At my practice, sessions are 50 minutes, and I am based at 85 Wimpole Street in central London (W1G 9RJ), which is a short walk from Bond Street or Oxford Circus stations. For online sessions, I will send you a secure video link in advance, so all you need is a quiet space and a stable internet connection.

What actually happens in the first session?

The first session is primarily about getting to know each other. I will ask you what brought you to therapy and what you are hoping to get from it. We will talk about what is going on in your life right now, and I will explain how I work so you can decide if it feels like a good fit.

As a gestalt therapist, my approach focuses on your present experience — what you are feeling right now, in this room, in this moment — rather than simply analysing the past. Of course, we may talk about your history, your relationships, your childhood — the place where your attachment patterns first took shape. But the emphasis is on how those experiences are showing up for you today. You might notice a tightness in your chest when you talk about a certain topic, or realise that you keep deflecting with humour when something feels uncomfortable. These are the moments where real insight happens, and they often start in the very first session.

I will not bombard you with questions. This is not an interview. I will guide the conversation gently, but there will be plenty of space for you to lead. If you want to talk about something specific, we will start there. If you have no idea where to begin, that is perfectly fine too — I will help us find a starting point together.

Is it OK to cry, or to not know what to say?

Absolutely, yes — to both. Crying in therapy is incredibly common and nothing to feel embarrassed about. Many people cry in their first session, and just as many do not. There is no right way to respond. My consulting room has tissues, comfortable seating, and no judgement.

Silence is equally welcome. Some of the most meaningful moments in therapy happen in silence — when you are processing something, sitting with a feeling, or simply gathering your thoughts. In gestalt therapy, we pay close attention to these pauses. They are not awkward gaps to fill; they are part of the work. You will never be rushed or pressured to speak before you are ready.

And if you find yourself thinking “I don’t even know why I’m here” — that is one of the most honest and useful things you can say. We can work with that.

How many sessions will I need?

This is one of the most common questions I hear, and the honest answer is: it depends. Every person is different, and therapy is not a one-size-fits-all process.

Research gives us some useful benchmarks. A widely cited meta-analysis published in the Journal of Counseling Psychology found that approximately 50% of people show clinically significant improvement after 8 sessions, and around 75% improve after 14 sessions. The NHS typically offers between 6 and 16 sessions of structured therapy (usually CBT) through its Talking Therapies programme — I’ve written a full comparison of private therapy and NHS routes in London if you’re weighing up the two.

In private practice, we have more flexibility. Some clients come for a few months to work through a specific issue — a relationship breakdown, a career crisis, a period of intense anxiety. Others stay for a year or more, using therapy as an ongoing space for self-understanding and growth. There is no minimum commitment and no maximum limit. We work at your pace, and we check in regularly about how things are going.

I am also transparent about progress. If I feel that a different approach or a different therapist would serve you better, I will tell you. Good therapy is collaborative, and that includes being honest about what is working and what is not.

What happens after the first session?

After the session, you might feel a range of things — relief, tiredness, a sense of lightness, or sometimes a bit stirred up. All of this is normal. You have just done something courageous, and it takes energy.

We will usually end the session by briefly reflecting on how it felt for you and discussing whether you would like to continue. There is no pressure to commit on the spot. Some people know immediately that they want to keep going; others need a day or two to think about it. Both are completely fine.

If you do decide to continue, we will agree on a regular time that works for both of us — most clients come weekly, though fortnightly is also an option. Consistency matters in therapy, because it builds the trust and safety that allow deeper work to happen.

What if I am not ready for a full session yet?

This is exactly why I offer a free 15-minute introductory consultation via Zoom. It is a chance to ask me any questions, get a feel for how I work, and see whether we might be a good match — with absolutely no obligation. Many of my clients started this way, and they often tell me it was the thing that made booking a full session feel manageable.

Think of it as a conversation, not a commitment. You can ask about my approach, my experience, my qualifications, or anything else that matters to you. And if you decide therapy is not for you right now, that is completely OK too. The door is always open.

Taking the first step

Starting therapy is one of those things that feels enormous before you do it and surprisingly natural once you are in the room. The hardest part is not the session itself — it is the moment before you book it.

If something in this article resonated with you, I would encourage you to trust that feeling. You do not need to have a crisis to seek therapy. You do not need to have your thoughts perfectly organised. You just need to be willing to start — even if what brought you here is a long-standing pattern like perfectionism or burnout that has finally caught up with you.