What to Expect in Your First Therapy Session
Also see My Approach to Therapy in Philadelphia.
You’ve decided to try therapy. That’s the hard part.
Now comes the anxiety: What happens when I walk in? What will they ask? Will I have to share everything immediately? How much will it hurt?
The truth is, most people don’t know what to expect in a first therapy session because they’ve never done it before. And that uncertainty creates a lot of unnecessary anxiety.
Here’s what actually happens—from the moment you contact me through your first real therapy work.
If you’re ready to start but want to know exactly what the process looks like, I offer a free 30-minute consultation to walk you through it and answer questions. Contact me here.
The 30-Minute Consultation (Before the Intake)
Before we formally start therapy, we have a consultation call.
This is not therapy. This is not your intake. This is a chance for both of us to figure out if we’re a fit.
What happens:
You tell me a bit about what’s going on—whatever you’re comfortable sharing. I listen. No judgment, no note-taking on your life story.
Then I explain who I work with and how I work. If you’re dealing with anxiety, I explain what I do with anxiety. If it’s a relationship issue, I explain my approach to relationships. I’m clear about what I can help with and what I can’t.
The goal: You get a sense of whether this feels right. I get a sense of whether I’m equipped to help you. We both decide: do we want to move forward?
This is the only part of the process where either of us can say “I don’t think this is the right fit” without any commitment.
Length: 30 minutes, usually by video.
Cost: Free.
What you should do: Be honest about what you’re dealing with. Ask questions. Pay attention to whether you feel comfortable. You’re interviewing me as much as I’m assessing you.
The 60-Minute Intake (The Real First Session)
If we both decide to move forward, we schedule your intake.
This is the session where therapy officially begins. We do consent to treatment paperwork, which is basically saying “Yes, we’re starting a professional relationship.” That’s the moment the therapist-client relationship is formed—not before the intake, but during it.
Here’s how the 60 minutes breaks down:
Minutes 1–5: Logistics and paperwork
You’ll sign consent forms. I’ll collect basic information—emergency contact, insurance if needed, superbill info. This is quick.
Minutes 5–45: Your history (the foundation)
I ask a lot of questions. Not because I’m nosy, but because understanding where you come from matters.
We’ll cover:
Family background: What was your family like growing up? What were the unwritten rules? What did you learn about emotions, conflict, success?
Your story: Education, work history, major life events and transitions.
Relationship patterns: Friendships, romantic relationships, how you relate to people.
The presenting problem: When did this start? What does it look like? How is it affecting your life right now?
Relevant medical/psychiatric history: Any previous therapy? Any medications? Sleep, substance use, physical health?
Lifestyle: Work stress, daily habits, what you do to cope.
This isn’t interrogation. It’s conversation. You’re not performing or trying to impress me. You’re giving me the actual picture of your life so I understand the context.
Minutes 45–60: Understanding the issue and making a plan
Once I have the picture, we talk about what you want to work on and how. I explain what I think might be happening and what I think could help. We collaborate on a plan—not me telling you what to do, but us figuring out together what therapy might look like.
“Many clients are anxious to start therapy—anyone would be. Part of my job is explain what to expect and guide you through the process.”
-Matt Sosnowsky, founder of Philadelphia Talk Therapy
The Therapist-Client Relationship Starts Here
After you sign that consent form and we’ve finished the intake, we’re officially in a therapeutic relationship.
This is important because it means:
Confidentiality is now in effect
We have an actual commitment to work together
The boundaries and structure of therapy apply
You’re not “in therapy” until this moment. The consult doesn’t count. The intake itself is where it starts.
Therapy Starts Immediately
Here’s the part that surprises people: We don’t wait around.
Once the intake is done, we’re already working. We’re not going to spend weeks just “assessing”—occasionally I might have one or two follow-up questions if we didn’t get to something in the intake, but we don’t postpone getting into the actual issues.
If you came in because you’re stuck in a relationship pattern or anxiety is running your life, we’re addressing it. Not gently tap-dancing around it. Actually working.
Practical Questions
Virtual or in-person?
Your choice. The intake can happen either way. Some people feel more comfortable on video. Some want to be in the room. Both work equally well.
What should I bring?
Just yourself. Maybe bring your insurance card if you have one, but that’s it. I’ll send you paperwork to fill out beforehand if needed.
What if I’m nervous?
Normal. Everyone is. I know you don’t know me yet. That’s why we have a consult first. And I’m not going to push you to share anything you’re not ready for in the intake—the goal is understanding, not shocking you into vulnerability.
What if I cry?
Also normal. I have tissues. No big deal. Crying in therapy is not a failure. It’s usually a sign you’re being honest.
What if I forget something important?
We’ll catch it. If you walk out and think “Oh, I should have mentioned...”, you can email me or bring it up in the next session. The intake gives me the foundation; we fill in details as we go.
Final Thoughts
The first session is less about fixing anything and more about building understanding. By the end of the intake, I should have a real picture of who you are and what you’re dealing with. You should feel heard—not judged, not minimized, just heard.
And we should both be ready to work.
If you’re in Philadelphia or anywhere in PA, NJ, DC, MD, VA, or WA, and you’re ready to understand what’s happening and actually do something about it, the first step is that free 30-minute consult. Contact me here. You’ll hear back within 24 hours.
About the Author:
Matt Sosnowsky, LCSW, MAPP, is a therapist in Philadelphia specializing in relationship patterns, communication, attachment, and therapy for men. He works with high-functioning professionals navigating the complexities of intimate relationships. He uses evidence-based approaches including emotion-focused therapy, attachment work, and communication skills training. He has been featured in The New York Times, Oprah Daily, Self Magazine, VeryWell Mind, and HuffPost. His practice serves young and middle-aged adults in Center City Philadelphia and virtually across PA, NJ, DC, MD, VA, and WA.
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