When you go to a physician, you probably know what to expect: your vital signs will be taken by a nurse, you will wait on the exam table, perhaps changing into a gown, and then the doctor will come in, ask you questions about your health, and physically examine you. Most people have had this experience many times since childhood and know exactly what to expect.
When they make an appointment with a psychologist or other therapist, however, many people have no idea what to expect. They are usually coming in at a time that is already quite difficult and can be quite apprehensive about the initial appointment. For therapists, on the other hand, the process is so familiar that they forget that not everyone knows it as well as they do and don’t offer much of an explanation.
So, what should you expect?
The initial meeting, or intake session, will be an opportunity for the therapist to learn the reason the client has chosen to come in, which is also call the presenting problem. It is also an opportunity for the therapist and client (or patient) to get to know each other. For human beings, change takes place primarily in relationship with another human being so feeling comfortable in the relationship with the therapist is key.
The initial session is sort of a mutual interview, where both client and therapist get to know each other a little and find out if they feel comfortable with each other, and are a “good fit” to work together. The session may feel uncomfortable because it is difficult to talk about whatever brings you in but the therapist will attempt to empathize with your situation and help you to feel at ease.
After one or two initial sessions you will likely have a good idea whether this therapist is someone with whom you feel comfortable enough to work on the difficulties in your life that prompted you to seek psychotherapy. If you identify discomfort with the therapist that is not related to the distress of discussing your situation, it is perfectly fine to look for someone else.
Before the first appointment, you may be asked to complete some initial paperwork in which you will provide your contact information, describe the reason you’ve come in, and any symptoms related to this issue. You may also be asked for information about your relationships, occupation, medical care, drug and alcohol use, and previous experience with mental health care such as previous psychotherapy, hospitalizations, and medications prescribed. You may also be asked to complete standardized questionnaires to provide further indications of how you’re feeling.
During the first meeting the therapist will ask you to describe the issues verbally and in more detail. She or he will also ask questions to clarify the problem and to understand the wider context of your life. The provider will also inquire about current and past drug/alcohol use, thoughts about death or suicide, including previous attempts, and any traumatic experiences. You may also be asked questions about unusual experiences or beliefs related to delusion and hallucination.
These questions are asked of everyone who presents for psychotherapy and should not be interpreted as an indication that the therapist thinks you are more disturbed than you are. Most people who do have problems related to these issues will not talk about them unless directly asked so these inquiries must be made in every initial interview.
While asking these questions, the therapist will also be making an effort not only to listen and understand your situation but to make an emotional connection with you, communicate understanding and empathy, and to facilitate the discussion of your concerns. At the same time, he or she will also be looking for patterns in your presentation and symptoms to consider possible diagnoses.

Sometimes all these inquiries can be completed in one session; often it takes 2-4 sessions to fully assess a person’s situation and concerns. As this process continues, the client and therapist will begin to set goals for their work together. The therapist may also make referrals to other providers, such as the primary care physician or a psychiatrist. With these preliminaries completed, you and the therapist will begin to work together to resolve your problems and improve your situation.
Nancy R. Soro, Ph.D.
Licensed Clinical Psychologist