Starting therapy can feel like a big step.
For many people, one of the hardest parts is not knowing what to expect. What will the therapist ask? Do I need to know exactly what’s wrong? What if I don’t know where to start?
These are some of the most common questions people have before their first appointment — and they’re completely understandable.
As a Clinical Psychologist based in Melbourne, I often meet people who feel nervous about walking into therapy for the first time. Often, they worry they won’t know what to say, or that they need to arrive with a clear explanation of what’s been going on.
You don’t.
The first therapy session is not about saying the perfect thing or having your thoughts neatly organised. It’s about beginning to understand what feels difficult right now, and creating a starting point for the work ahead.
Here’s what I typically focus on in a first session, and why.
1. Understanding what brought you to therapy
The first thing I usually want to understand is what has brought you in.
I might ask questions like:
- What’s brought you in today?
- What would you like help with?
- Where would you like to start?
This is often the most important part of the first session.
Before therapy can move forward, we need a shared understanding of what feels most difficult right now.
For some people, that is very clear. They might come in knowing exactly what they are struggling with — anxiety, burnout, relationship difficulties, grief, or feeling stuck.
For others, it is much harder to put into words. Sometimes people simply know that they haven’t been feeling like themselves, and that they would like something to change.
That is very common.
Sometimes, the first piece of therapeutic work is simply helping someone make sense of their experience and find language for what they have been feeling. And sometimes, that can take up the whole first session.
2. Exploring the bigger picture
If there is time, and if it feels appropriate, I will usually begin to ask about your background and what has been happening in your life more broadly.
For example:
- Have you felt this way before?
- What’s been happening in your life recently?
- Are there past experiences or important relationships that might help me understand what you’re going through?
I ask these questions because emotional struggles rarely happen in isolation.
Current difficulties often make more sense when we understand the wider context — your personal history, recent stressors, relationships, and the ways you have learned to cope over time.
In psychology, we often call this a formulation.
A formulation is like building a working understanding of how your present struggles may connect with your life experiences, relationship patterns, and underlying psychological processes.
In other words, we start putting the pieces together.
3. Paying attention to how we relate
In a first session, I’m also paying attention to something beyond the content of what you say.
I notice how it feels for us to be in the room together.
That might include noticing:
- how you’re talking about something
- your body language
- moments of hesitation or uncertainty
- topics that feel easier or harder to talk about
I also pay attention to my own responses during the session.
This can sometimes offer helpful information about a person’s interpersonal patterns — typically, how a client is with me in the therapy room is similar to how they relate to others outside of the therapy room.
What if I don’t know what to say in therapy?
One of the most common worries people have before starting therapy is: What if I don’t know what to say?
That is completely okay.
You do not need to arrive with a perfect explanation of your problems.
You do not need to have a clear goal.
You do not even need to know exactly where to begin.
Part of my role is helping you make sense of what feels confusing, overwhelming, or difficult to put into words.
Final thoughts
If you have been thinking about starting therapy, I hope this gives you a clearer sense of what a first session can look like.
The first appointment is usually not about solving everything straight away. It is about understanding what is going on, identifying what feels important, and beginning to build a shared understanding of where therapy might go.
Every therapist will have their own style, but most first sessions are about creating a foundation.
And often, that first conversation can be the beginning of something meaningful.
If you would like to make an enquiry or book an initial appointment, I’d be glad to hear from you.
Written by Luvena Susanto, Clinical Psychologist