What to Expect in Your First Therapy Session: A Complete Guide for Illinois Residents
Creating a comfortable, welcoming environment is essential for your first therapy session. Most therapists focus on helping you feel at ease during your initial visit.
Introduction
Sarah sat in her car outside my office building, hands gripping the steering wheel as she stared at the entrance. She'd been thinking about therapy for months, but now that her first therapy session was just minutes away, her mind raced with questions: "What if I say something wrong? What if the therapist judges me? What if I start crying and can't stop?"
Sarah's experience is incredibly common. In my eight years as a licensed therapist in the Chicago suburbs, I've worked with hundreds of people walking through my door for the first time. Nearly everyone feels nervous, uncertain, or even scared before their first therapy session.
If you're reading this, you might be feeling similar emotions. Maybe you've been struggling with anxiety, depression, or stress. Perhaps you're going through a difficult life transition or dealing with relationship challenges. The good news? Taking that first step to schedule therapy shows incredible strength and self-awareness.
In this guide, I'll walk you through exactly what to expect in your first therapy session, from the moment you arrive until you leave. You'll learn how to prepare, what questions to ask, and how therapy actually works. I'll also cover practical concerns like insurance coverage in Illinois and how to make the most of your therapeutic journey.
Understanding What Therapy Actually Is
Therapy comes in many formats - individual, couples, group, and online sessions. Your therapist will help you determine which approach works best for your needs.
Before diving into what happens in your first session, let's clear up some common misconceptions about therapy. Many people think therapy is like what they see in movies – lying on a couch while someone in a suit takes notes and asks, "How does that make you feel?"
The reality is much more collaborative and down-to-earth. Think of therapy as having a conversation with someone who's trained to help you understand your thoughts, feelings, and behaviors. I often tell my clients that I'm like a guide who helps you navigate through challenges, discover your strengths, and develop tools to feel better.
Therapy isn't about being "broken" or "crazy." In my practice, I work with successful professionals, college students, parents, and people from all walks of life who simply want to improve their mental health and well-being. Just like you might see a doctor for physical health or a trainer for fitness goals, therapy is about taking care of your emotional and mental health.
Different Types of Therapy
There are many different approaches to therapy, and during your first session, your therapist will likely explain their particular style. In my practice, I use several evidence-based methods:
Cognitive Behavioral Therapy (CBT) helps you understand how your thoughts, feelings, and behaviors are connected. If you're dealing with anxiety or depression, CBT can be particularly helpful.
Neuropsychotherapy is my specialty – it combines traditional therapy with knowledge about how the brain works. This approach is especially effective for trauma, anxiety, and stress-related issues.
Mindfulness-Based Therapy teaches you techniques to stay present and manage overwhelming emotions.
Integrative Mental Health looks at the whole person, including how nutrition and lifestyle affect your mental health. As a Certified Integrative Mental Health Professional, I often discuss how things like sleep, exercise, and diet impact mood and anxiety.
Don't worry if these terms sound complicated – your therapist will explain their approach in simple terms that make sense for your specific situation.
Before Your First Therapy Session: How to Prepare
Proper preparation can help you make the most of your first therapy session. Arriving early and bringing necessary documents sets you up for success.
Practical Preparations
Arrive Early: Plan to arrive about 10-15 minutes before your appointment. This gives you time to fill out any remaining paperwork and settle in without feeling rushed.
Bring Important Documents: If you haven't already submitted them, bring your insurance card, a photo ID, and any intake forms your therapist sent you. Some offices handle all this electronically, but it's good to be prepared.
Consider Transportation and Parking: Check where you'll park and how long the session will last. Most first sessions are 50-60 minutes, but some therapists schedule longer initial appointments.
Dress Comfortably: Wear whatever makes you feel comfortable and confident. There's no dress code for therapy – some people come from work in business attire, others wear jeans and sneakers.
Mental and Emotional Preparation
Think About Your Goals: Before your first therapy session, spend some time thinking about what you hope to accomplish. This might include:
Feeling less anxious or depressed
Improving relationships
Managing stress better
Working through a difficult life transition
Understanding yourself better
Write Down Key Points: Many people find their minds go blank when they're nervous. Consider jotting down the main things you want to discuss, including any symptoms you've been experiencing and when they started.
Prepare for Emotions: It's completely normal to feel emotional during therapy. Some people cry, others feel angry or frustrated, and some feel relieved just to talk openly. All of these reactions are okay and expected.
Set Realistic Expectations: Therapy is a process, not a quick fix. While some people feel better after just one session, lasting change typically takes time. Think of it like going to the gym – you wouldn't expect to be in perfect shape after one workout.
What Actually Happens in Your First Therapy Session
The First Few Minutes: Getting Comfortable
When you arrive for your first therapy session, you'll typically check in with the front desk (if there is one) or your therapist will greet you personally. In my practice, I like to meet clients in the waiting area and walk with them to my office.
The first few minutes are about getting comfortable. Your therapist might offer you water or tea, show you where the bathroom is, and help you settle into your seat. This isn't just politeness – these small gestures help create a safe, welcoming environment where you can open up.
Don't be surprised if you feel nervous or awkward at first. I often tell my clients, "It's okay to feel weird about this. You're sitting in a room with a stranger, talking about personal things. That would feel strange to anyone!" Acknowledging these feelings often helps people relax.
Reviewing Paperwork and Policies
If you completed intake forms before your appointment, your therapist will likely review some of this information with you. If not, you might spend the first 10-15 minutes going over basic details like your contact information, emergency contacts, and health history.
This is also when your therapist will explain important policies:
Confidentiality: What you say in therapy stays in therapy, with very few exceptions (like if you're in immediate danger of hurting yourself or someone else). Your therapist will explain exactly what this means.
Cancellation Policy: Most therapists require 24-48 hours notice to cancel appointments. Understanding this upfront prevents any confusion later.
Communication Between Sessions: Some therapists are available for brief check-ins via email or phone, while others prefer to keep all communication within scheduled sessions.
Payment and Insurance: This is a good time to clarify any questions about costs, insurance coverage, or payment methods.
The Heart of the Session: Sharing Your Story
The main part of your first therapy session involves telling your story. Your therapist will ask open-ended questions to understand what brought you to therapy and what you hope to achieve.
Common questions include:
"What made you decide to start therapy now?"
"Can you tell me about what's been going on in your life recently?"
"What are your main concerns or symptoms?"
"How are these issues affecting your daily life?"
"What have you tried so far to address these challenges?"
Remember, there are no wrong answers. Your therapist isn't judging you or looking for specific responses. They're trying to understand your unique situation so they can help you most effectively.
In my experience, people often worry about where to start or what's "important enough" to mention. I usually tell clients, "Start wherever feels right to you. We have time to cover everything, and what matters most to you is what matters to me."
Assessment and Understanding
Throughout your first session, your therapist is conducting what's called a "clinical assessment." This isn't a test you can pass or fail – it's a way for them to understand your mental health, strengths, challenges, and goals.
They might ask about:
Your family background and relationships
Previous experiences with therapy or medication
Your work or school situation
How you typically cope with stress
Your sleep, appetite, and energy levels
Any history of mental health concerns in your family
Some of these questions might feel very personal, and it's okay to say if something feels too difficult to discuss in the first session. A good therapist will respect your boundaries and move at a pace that feels comfortable for you.
Beginning to Develop a Treatment Plan
Toward the end of your first therapy session, many therapists will start discussing potential treatment approaches and goals. This might include:
How often you'll meet (usually weekly or every other week to start)
What therapy methods might be most helpful for your situation
Initial goals you'd like to work toward
Any homework or exercises they might suggest
This is preliminary planning – your treatment plan will evolve as your therapist gets to know you better and as you make progress.
Understanding Therapy Insurance Coverage in Illinois
Illinois law requires most insurance plans to cover mental health services equally to physical health services, making therapy more accessible for residents.
One of the most common concerns people have about starting therapy is cost and insurance coverage. Here's what you need to know about therapy insurance in Illinois:
Illinois Insurance Requirements
Illinois law requires most insurance plans to cover mental health services equally to physical health services. This is called "mental health parity," and it means your therapy sessions should be covered similarly to visits to your regular doctor.
However, coverage varies significantly between plans. Some important things to understand:
In-Network vs. Out-of-Network: If your therapist is "in-network" with your insurance, you'll typically pay just a copay (often $20-50 per session). If they're "out-of-network," you might pay the full fee upfront and get partially reimbursed later.
Deductibles: Some plans require you to meet your annual deductible before therapy coverage kicks in. Others cover therapy with just a copay from the first session.
Prior Authorization: Certain insurance plans require approval before you can start therapy. Your therapist's office can usually help with this process.
Questions to Ask Your Insurance Company
Before your first therapy session, call the number on your insurance card and ask:
"Is mental health/behavioral health covered under my plan?"
"What's my copay for outpatient mental health services?"
"Do I need a referral from my primary care doctor?"
"Is [therapist's name] in-network with my plan?"
"How many therapy sessions are covered per year?"
What If You Don't Have Insurance?
Many therapists offer sliding scale fees for people without insurance or those facing financial hardship. Community mental health centers also provide lower-cost options. Don't let cost prevent you from getting help – there are usually options available.
Common First Session Concerns and How to Handle Them
"What If I Can't Stop Crying?"
Crying in therapy is incredibly common and completely okay. I keep tissues readily available in my office, and I've learned that tears often signal someone is processing important emotions. If you start crying, take your time. Your therapist won't rush you or make you feel embarrassed.
"What If I Don't Know What to Say?"
Sometimes people worry they'll sit in silence or won't know how to start. Remember, your therapist is trained to guide conversations and ask helpful questions. They won't expect you to fill every moment with talking. Silence is okay too – sometimes it gives you time to think.
"What If My Therapist Judges Me?"
Professional therapists are trained to be non-judgmental and compassionate. We've heard almost everything, and our job is to help, not judge. That said, it's important that you feel comfortable with your therapist. If something feels off, it's okay to discuss it or even consider finding a different therapist.
"What If I Don't Like My Therapist?"
The relationship between you and your therapist is crucial for success. Research shows that feeling comfortable with and trusting your therapist is one of the most important factors in therapy outcomes. If you don't feel a connection after a session or two, it's perfectly acceptable to try someone else.
"What If Someone Finds Out I'm in Therapy?"
Therapy is confidential, and your therapist cannot tell anyone you're receiving services without your written permission (except in very specific safety situations). Many people worry about stigma, but therapy is becoming increasingly common and accepted. You're taking a positive step for your mental health.
Different Therapy Formats: Finding What Works for You
Different therapy formats serve different needs. Group therapy can be particularly helpful for people who feel isolated or want to learn from others facing similar challenges.
Individual Therapy
This is what most people think of when they hear "therapy" – one-on-one sessions with a therapist. Individual therapy allows you to focus entirely on your own concerns and goals without having to consider other people's needs or perspectives.
Couples Therapy
If relationship issues are part of what brought you to therapy, couples counseling might be helpful. In my practice, I work with couples dealing with communication problems, trust issues, life transitions, and other relationship challenges.
Online Therapy vs. In-Person
Especially since 2020, online therapy has become increasingly popular and effective. Some people prefer the convenience and comfort of meeting from home, while others find in-person sessions more engaging. Both formats can be effective – it depends on your personal preferences and situation.
Group Therapy
Some therapists offer group sessions focused on specific issues like anxiety, depression, or life transitions. Group therapy can be particularly helpful for people who feel isolated or want to learn from others facing similar challenges.
Making the Most of Your Therapeutic Journey
Be Honest and Open
The more honest you can be with your therapist, the more they can help you. This includes sharing things that feel embarrassing, scary, or difficult to talk about. Remember, therapists are bound by confidentiality and are trained to handle sensitive information with care.
Ask Questions
If something doesn't make sense or you want to understand more about your therapist's approach, ask! Good therapists welcome questions and want you to feel informed about your treatment.
Practice Patience with the Process
Therapy takes time, and progress isn't always linear. Some weeks you might feel like you're making great strides, while others might feel more difficult. This is normal and part of the healing process.
Complete Homework or Exercises
Many therapists assign small exercises or ask you to practice certain skills between sessions. These assignments are designed to help you apply what you're learning in therapy to your daily life.
Communicate About What's Working
If something your therapist suggests feels helpful, let them know! Similarly, if an approach isn't working for you, speak up. Therapy should be collaborative, and your feedback helps guide the process.
Red Flags: When to Consider Finding a Different Therapist
While most therapists are professional and helpful, it's important to know what to watch out for:
Your therapist frequently cancels or reschedules appointments
They seem distracted, check their phone, or appear uninterested during sessions
They push their personal beliefs, politics, or religion on you
They violate boundaries by sharing too much about their own life
They make you feel judged, criticized, or uncomfortable
They pressure you to continue therapy when you want to take a break
They don't seem to remember important details from previous sessions
Trust your instincts. If something feels wrong, it probably is, and you deserve to work with someone who makes you feel safe and supported.
Special Considerations for Different Life Stages
Young Adults (18-29)
If you're in your twenties, you might be dealing with unique challenges like transitioning from college to work life, developing your identity, or navigating first serious relationships. Many young adults worry that their problems aren't "serious enough" for therapy, but this isn't true. This is actually an ideal time to develop healthy coping skills and self-awareness.
Working Professionals
Many of my clients are working professionals dealing with job stress, work-life balance, or career transitions. If this describes you, don't hesitate to discuss how your work life affects your mental health. Understanding workplace stress and burnout is a significant part of my practice.
People with Complex Backgrounds
If you've experienced trauma, have a family history of mental health concerns, or are dealing with multiple stressors, your first session might feel particularly overwhelming. That's okay – therapists are trained to work with complex situations, and we'll move at whatever pace feels right for you.
Bilingual Considerations
For those who speak English as a second language, therapy can sometimes feel easier in your native language. If you're more comfortable speaking Polish, for example, working with a bilingual therapist can help you express nuanced emotions and cultural experiences that might be difficult to communicate in English.
Understanding Different Therapeutic Approaches
My Integrative Approach
In my practice, I combine several different methods based on what works best for each individual client. This might include:
Neuropsychotherapy: This approach uses our understanding of how the brain works to inform treatment. For example, if you're dealing with anxiety, I can explain what's happening in your brain during panic attacks and teach you specific techniques to regulate your nervous system.
Cognitive Behavioral Therapy (CBT): This helps you understand the connections between your thoughts, feelings, and behaviors. It's particularly effective for anxiety, depression, and stress management.
Mindfulness-Based Techniques: These help you stay present and manage overwhelming emotions. Simple breathing exercises and grounding techniques can be incredibly powerful.
Integrative Mental Health: As a Certified Integrative Mental Health Professional, I consider how lifestyle factors like nutrition, sleep, and exercise affect your mental health. Sometimes small changes in these areas can make a big difference in how you feel.
What This Means for You
You don't need to understand all these approaches before your first session. During our initial meeting, I'll explain which methods might be most helpful for your specific situation and why. The important thing is finding an approach that feels right for you.
Questions You Might Want to Ask Your Therapist
Don't hesitate to ask questions during your first therapy session. A professional therapist will welcome your questions and help you feel informed about your treatment approach.
Don't hesitate to ask questions during your first therapy session. Here are some good ones to consider:
About Their Approach:
"What therapy methods do you typically use?"
"How do you usually approach concerns like mine?"
"What can I expect from our work together?"
About Logistics:
"How often do you recommend we meet?"
"What's your policy if I need to cancel or reschedule?"
"Are you available between sessions if I have questions?"
About Your Treatment:
"What goals should we set together?"
"How will we know if therapy is working?"
"What homework or exercises might you give me?"
About Their Experience:
"How long have you been practicing?"
"Do you have experience with issues like mine?"
"What additional training or certifications do you have?"
Remember, these questions help you determine if this therapist is a good fit for you. A professional therapist will welcome your questions and answer them honestly.
Building a Strong Therapeutic Relationship
The relationship between you and your therapist is one of the most important factors in successful therapy. Research consistently shows that people who feel connected to and trusting of their therapist have better outcomes.
What Makes a Good Therapeutic Relationship
Trust: You should feel safe sharing personal information and emotions with your therapist.
Respect: Your therapist should treat you with dignity and respect your values, even if they differ from their own.
Collaboration: Therapy works best when you and your therapist work together as a team toward your goals.
Consistency: Your therapist should be reliable, professional, and consistent in their approach.
Cultural Sensitivity: If you come from a specific cultural background, your therapist should be respectful and curious about how your culture influences your experiences.
How to Build This Relationship
Building trust takes time, but there are things you can do to help the process:
Be as honest as possible, even when it feels uncomfortable
Let your therapist know if something isn't working for you
Ask questions when you don't understand something
Give feedback about what feels helpful
Be patient with yourself and the process
What Happens After Your First Session
Immediate Next Steps
Before you leave your first therapy session, you'll typically schedule your next appointment. Many therapists recommend meeting weekly initially, especially if you're dealing with acute symptoms like severe anxiety or depression.
Your therapist might also give you some initial suggestions or exercises to try between sessions. These aren't usually complicated – maybe a simple breathing technique or a suggestion to notice certain thought patterns.
Processing Your Experience
It's normal to feel a range of emotions after your first therapy session. Some people feel relieved to have finally started the process. Others might feel emotionally drained from sharing personal information. Some feel hopeful, while others might feel uncertain about whether therapy is right for them.
All of these reactions are completely normal. Give yourself time to process the experience before making any major decisions about continuing therapy.
What to Do Between Sessions
Reflect on what you discussed and how it felt
Try any exercises or suggestions your therapist gave you
Notice any patterns in your thoughts, feelings, or behaviors
Jot down any questions you want to ask next time
Be gentle with yourself as you begin this process
When You Might Need Additional Support
Building a comprehensive mental health care team may include psychiatrists, medical doctors, and specialized therapists. Your primary therapist can help coordinate additional support when needed.
While therapy is incredibly helpful for most people, sometimes additional support is necessary. Your therapist might recommend:
Medication Evaluation: If you're dealing with severe depression, anxiety, or other mental health conditions, medication prescribed by a psychiatrist or primary care doctor might be helpful alongside therapy.
Medical Evaluation: Sometimes mental health symptoms can be related to medical conditions, sleep disorders, or nutritional deficiencies. Your therapist might suggest seeing your doctor for a physical exam.
Intensive Treatment: If you're having thoughts of hurting yourself or others, your therapist might recommend more intensive treatment options like intensive outpatient programs or inpatient care.
Specialized Services: Depending on your specific needs, you might benefit from additional services like psychiatric testing, couples counseling, or support groups.
Remember, recommending additional support doesn't mean therapy isn't working or that you're "too sick" for regular therapy. It means your therapist wants to make sure you get the best possible care.
Special Considerations for Illinois Residents
Seasonal Mental Health Challenges
Living in Illinois means dealing with long, dark winters that can significantly impact mental health. Seasonal Affective Disorder (SAD) and winter depression are common concerns I address in my practice. If you notice your mood consistently dips during fall and winter months, this is definitely worth discussing in therapy.
Urban vs. Suburban Mental Health Resources
The Chicago suburbs offer many mental health resources, but navigating them can feel overwhelming. Your therapist can help connect you with local support groups, psychiatric services, crisis resources, and other community mental health options specific to your area.
Cultural Considerations
Illinois is home to diverse communities with different cultural attitudes toward mental health and therapy. If you come from a cultural background where therapy is stigmatized or misunderstood, your therapist should be sensitive to these concerns and help you navigate them.
Building Long-Term Mental Health Skills
Understanding That Therapy Is Skill-Building
Think of therapy like learning any other important life skill. Just as you might take driving lessons or learn a musical instrument, therapy teaches you skills for managing emotions, relationships, and life challenges.
The goal isn't to become dependent on therapy forever. Instead, it's to develop tools and insights you can use throughout your life. Many people find that even after completing therapy, they return occasionally for "tune-ups" during stressful periods or major life transitions.
Developing Your Personal Toolkit
Through therapy, you'll develop a personalized set of coping strategies that work for your specific needs and lifestyle. This might include:
Breathing techniques for managing anxiety
Communication skills for better relationships
Stress management strategies for work pressures
Mindfulness practices for staying present
Problem-solving approaches for life challenges
Recognizing Progress
Progress in therapy doesn't always feel dramatic or obvious. Sometimes it's subtle changes like:
Feeling slightly less anxious in situations that used to overwhelm you
Having difficult conversations with more confidence
Sleeping better or having more energy
Feeling more self-compassionate when you make mistakes
Bouncing back more quickly from setbacks
Your therapist will help you recognize and celebrate these improvements, even when they feel small.
Conclusion: Taking the First Step Toward Better Mental Health
Starting therapy takes courage, and simply reading this article shows you're taking your mental health seriously. Your first therapy session might feel nerve-wracking, but remember that thousands of people take this step every day and find it incredibly helpful.
Every therapist understands that first sessions can feel overwhelming. We're trained to help you feel comfortable, ask the right questions, and begin developing a plan that works for your unique situation and goals.
The most important thing to remember is that therapy is for you. It's your time to focus on your wellbeing, process your experiences, and develop skills for a healthier, more fulfilling life. Whether you're dealing with anxiety, depression, relationship issues, work stress, or simply want to understand yourself better, therapy can provide valuable support and guidance.
You don't have to have everything figured out before your first session. You don't need to be in crisis to benefit from therapy. You just need to be willing to show up and be honest about your experiences.
If you're ready to take that first step, trust that you're making a positive choice for your mental health. The journey of therapy is unique for everyone, but it's a journey toward greater self-understanding, better coping skills, and improved overall wellbeing.
About the Author: Monika Breidenbach is a Licensed Clinical Professional Counselor (LCPC) with specialized certifications in Neuropsychotherapy (NPT-C) and Integrative Mental Health (CIMHP). She has been practicing in the Chicago suburbs for over eight years, helping individuals navigate anxiety, depression, trauma, workplace stress, and life transitions. Monika offers both in-person therapy in Westmont, IL, and online therapy services, providing bilingual support in English and Polish. Her integrative approach combines evidence-based therapy techniques with an understanding of how nutrition, lifestyle, and brain science affect mental health.
References:
American Psychological Association. (2023). Understanding psychotherapy and how it works. APA.org.
Illinois Department of Insurance. (2023). Mental health parity in health insurance. Insurance.illinois.gov.
National Alliance on Mental Illness. (2023). Finding a mental health professional. NAMI.org.
Norcross, J. C., & Lambert, M. J. (2018). Psychotherapy relationships that work III. Psychotherapy, 55(4), 303-315.
Substance Abuse and Mental Health Services Administration. (2023). Finding treatment: What to expect. SAMHSA.gov.
Disclaimer: This article is for informational purposes only and does not constitute medical or psychological advice. The information provided should not replace professional mental health treatment. If you are experiencing severe mental health symptoms, thoughts of self-harm, or are in crisis, please contact your local emergency services, call 988 (Suicide & Crisis Lifeline), or go to your nearest emergency room. Every individual's therapy experience is unique, and outcomes may vary.
