What to Expect From Your First Counselling Session

Deciding to talk to a counsellor or therapist is a big step. Whether you are coping with the after-effects of an accident, a bereavement, stress, low mood or something you cannot quite name, it is natural to feel nervous about the first appointment. Knowing what usually happens can take some of the uncertainty away.

Finding someone

In the UK, you can often refer yourself to NHS talking therapies services for problems such as anxiety and depression, or your GP can refer you. Some workplaces offer free, confidential counselling through an employee assistance programme. Private therapists are another option. If you go privately, check that they are registered with a recognised professional body, which means they meet training standards and follow a code of ethics.

Before the session

Many services begin with a short phone call or questionnaire to understand what you are looking for. It can help to think beforehand about what has led you to seek support and what you hope might change. You do not need to have it all worked out; working things out is part of what counselling is for.

What happens in the first session

First sessions are usually a little different from later ones. The therapist will often:

• explain how they work, how long sessions last and how often you will meet
• talk about confidentiality, including the rare situations in which they might need to share information, such as if someone is at serious risk of harm
• ask what has brought you to counselling and how it is affecting your life
• ask some background questions about your health, relationships and any previous support

You do not have to share everything at once. It is fine to say, "I'm not ready to talk about that yet."

How you might feel

Some people feel relieved after a first session; others feel tired, emotional or unsettled. All of these reactions are normal. Talking about difficult things can stir up feelings, and it may take a few sessions before you start to notice a difference.

Questions you can ask

Counselling is a working relationship, and it is reasonable to ask questions, such as:

• What kind of approach do you use, and why?
• How many sessions might I need?
• What happens if I need to cancel?
• How will we know if this is helping?

Is it a good fit?

The relationship between you and your therapist matters. You should feel listened to and respected, even when the conversation is challenging. If, after a few sessions, it does not feel right, it is okay to say so or to look for someone else. That is not a failure; it is part of finding the right support.

If you need help urgently

Counselling is not an emergency service. If you are in crisis or worried about your safety, contact NHS 111, speak to your GP urgently, call Samaritans, or call 999 if you are in immediate danger.

A step worth taking

Starting therapy takes courage. A first session is simply a conversation to see whether this kind of support can help you. Many people find that having a regular, confidential space to talk makes a real difference in how they cope and recover.