Starting therapy can feel like a big step, whether it’s your first time or you’ve worked with a psychologist before. You might be feeling a mix of emotions—hope, curiosity, or even uncertainty—about what to expect in your first session. Finding the right therapist and understanding how the process unfolds can make all the difference in feeling comfortable and confident as you begin. This guide will walk you through what happens in those initial sessions, the different ways psychologists work, and how to navigate your therapeutic journey to get the most out of it.
The First Therapy Sessions
It’s important that we start by getting to know each other. In the first few sessions, a psychologist will strive to understand your background, mental health history, the challenges you bring to therapy, and what you hope to gain from treatment. I typically spend the first two-thirds of the session learning about you. In the remaining time, I will ask about how you would like your sessions to feel moving forward and provide my professional opinion on the best treatment approach.
It’s not essential to understand everything about you at the beginning—after all, there will be time to learn more in the future. What matters most is building a relationship that fosters trust and safety, allowing you to explore your challenges and work toward change.
As I learn more about you, we will develop a shared understanding—or, in psychological terms, a ‘formulation’—of the challenges you face. As this formulation evolves, I may suggest adjustments to the treatment plan or emphasise particular presenting problems and treatment needs.
Therapeutic Modalities & Approaches
All therapists work slightly differently, but what we all have in common is that we use evidence-based therapeutic approaches (such as Cognitive Behavioural Therapy (CBT), Acceptance and Commitment Therapy (ACT), Schema Therapy, or Psychodynamic Therapy) as the foundation of treatment. The therapeutic approach your therapist takes will depend on what research indicates as the most effective treatment for your presenting concerns. Often, several approaches have a strong evidence base for treating a given issue, and your therapist’s experience and preferences may also guide their approach.
Most psychologists describe their approach as ‘integrative,’ meaning they draw from multiple evidence-based modalities to create a treatment plan tailored to your needs and preferences.
As therapists, we also differ in our delivery style. For example, I describe my approach as dynamic, meaning I flexibly adapt each session based on what you bring up that day while staying true to the chosen therapeutic approach. I help you understand your presenting issues in the context of your broader history or ‘formulation,’ and together, we will address your concerns while also developing strategies to navigate similar challenges in the future. I may also introduce relevant skills or tools when appropriate.
Other therapists may take a different approach. Some prefer a more structured format, with a strong focus on skills-building exercises. They might ask for real-life examples of challenges you want to work on and then teach you specific tools or strategies to address them. This structured approach can foster a sense of achievement and progress for both the client and therapist.
These are just two examples of how psychologists work. You are encouraged to discuss your preferences with your therapist and collaborate on shaping your sessions to best suit your needs. For instance, if you find a conversational style unhelpful and prefer to focus on learning specific skills, let your therapist know—they can adapt accordingly.
What If I Feel Like Therapy Isn’t Working?
Research shows that the ‘therapeutic alliance’—the relationship between you and your therapist—is the single most important predictor of therapy outcomes. This makes finding the right therapist crucial.
Not all personalities click, and even without conflict, you may find that you and your therapist are not the right fit. As psychologists, we understand this well and take no offense if you decide to work with someone else. After all, we may be the perfect fit for the next person who sits across from us.
If you feel your therapy isn’t working, we encourage you to discuss this with your therapist. There may have been a misunderstanding about your needs, and a small adjustment could make all the difference. If not, your therapist can offer a referral to another colleague. If you prefer, you can also send an email explaining your decision to discontinue therapy, whether you plan to see someone else or take a break from treatment.
Finishing Mental Health Treatment
Your progress and ongoing therapeutic needs will be a common topic of discussion throughout treatment. When you have made sufficient progress, you and your therapist can begin planning to conclude therapy. The final sessions typically focus on summarizing your work, reflecting on your growth, and discussing relapse prevention strategies to help maintain your progress.
Ending therapy does not have to be abrupt. Many clients choose to space out their sessions—moving to monthly, three-monthly, or six-monthly check-ins before finishing completely. Some prefer to schedule sessions in advance and cancel them (with appropriate notice) if they feel they no longer need them.
Finding the right psychologist is key to achieving your desired treatment outcomes. It’s important to choose both a therapist and a therapeutic approach that align with your needs. While this process can take time, reading a psychologist’s profile and reaching out to the intake team with any questions can help determine if they might be a good fit for you.
