What to Expect at Your First Therapy Session

By Rachel Tombaugh | April 7, 2026

Starting therapy is often a process that involves fear, anxiety, and worry for many people. Even those who think that therapy might help them may find themselves scared to start the process. There are so many factors that can contribute to this, and one of those is the “unknown” about what it’s like to attend therapy.

For people diagnosed with or suspected of having certain mental health conditions, such as OCD, there can be an even greater sense of anxiety due to the nature of obsessions that can include distressing and taboo content. Sufferers of PTSD may fear that they’ll be asked to describe their traumatic experiences in detail right away to a stranger or that they will be stuck reliving the traumas they’ve worked so hard to silence. These anxieties may serve as an additional barrier to seeking care. Please know that you are not alone. 

Starting therapy can feel overwhelming, but it should not be retraumatizing or serve to worsen stigmas. With a qualified professional, beginning therapy can be a gentle process taken at a pace that feels safe and supportive of healing. Mental health professionals want to help you feel comfortable and hopeful about this process. Knowing what to expect from your first appointment can lessen anxiety, increase feelings of safety and comfort, and allow you to gradually build trust with your therapist. 

Sunset over a beautiful, plant-filled patio.

What to expect at your first therapy session

Many people who come to therapy for the first time are understandably nervous and don’t know what to expect. Choosing a provider to meet with can be difficult, too. It’s hard to guess if someone will be a good fit based on a photo or an online biography page.

In many cases, a telephone or virtual consultation can help introduce you to the therapy process and your prospective therapist. Some therapists provide these for free (including Epiphany Center). These brief consultations allow both of you to make sure that you are a good fit for one another and that the problems you are facing are ones your potential therapist is equipped to help you overcome.

While an initial consultation is not designed to offer a diagnosis, this is a good time to ask questions of your prospective therapist, such as: 

  • Does your practice use evidence-based treatment methods for treating mental health disorders?
  • Is there a specific approach you think could be most helpful for me?
  • Do you have experience treating the condition(s) I am struggling with?
  • What will sessions look like if I decide to move forward?

When you attend your initial consultation or first therapy appointment, your therapist will help to set you at ease and get to know you as a person. Building a trusting and warm rapport is an essential element of the therapeutic process and will help you feel a sense of hope and confidence that your therapist can help you get better.

Therapy intake appointment

Every therapist is unique, taking their own specialized approaches to therapy. This is good news because it means that even if one therapist isn’t a good fit for your needs, there is another one who will be better suited to you. In general, intake appointments are often quite different from what people expect. Instead of diving headfirst into what people think of as therapy, intake is usually conversational, focusing on the big picture rather than zooming in on specific issues.

By the end of your intake, your therapist will give some recommendations based on what you have discussed. Although a formal plan of treatment may not be established by the end of your first visit, you will have a much clearer path forward than before starting.

A butterfly stops at a flower.

Therapy intake questions

Depending on your reasons for starting therapy, your new therapist may ask questions like:

  • What are you hoping to achieve through therapy?
  • What symptoms are you noticing that impact your daily life or your ability to be present in your life?
  • What is the structure of your life like? Do you work, have friends, a family? 
  • What, if any, medical conditions do you have? (This may include any mental health diagnoses you have, though your therapist will complete a diagnostic evaluation as part of intake.)
  • Do you have any hobbies or interests you’d like me to know about? Do you practice a faith or have access to other forms of support? 
  • What does your day-to-day life look like?

This is a great time to ask any questions you may have about therapy, too. Your therapist will likely leave time at the end for any questions you may have, or you can ask as questions come up.

Some questions you may want to ask the therapist include:

  • What will treatment look like? 
  • How often do you recommend we meet? 
  • Will I need to be in therapy for a long time, or is a short term treatment plan likely sufficient? 
  • How will we know that I am getting better? 

The first appointment is a great opportunity to get more comfortable with this new, sometimes overwhelming experience. Remember that you are hiring a therapist for a service, and you are allowed to interview multiple therapists before deciding who to work with.

You also have the right to change therapists if you feel that treatment is not working or that your therapist isn’t a good match for you. Additionally, you can choose to find a new therapist if you think would feel more comfortable elsewhere. In fact, you are not obligated to stay with a therapist for any reason.

A good therapist will welcome your questions, explain their approach clearly, set realistic expectations, and challenge you rather than just comfort you. Therapy is hard work, but you are worth the work, and you deserve to heal. Deciding to learn more about therapy is a step toward healing.

Your first visit at Epiphany Center

At Epiphany Center, our team of experienced clinicians are here to help clients heal through OCD, PTSD, anxiety, panic disorder, phobias, insomnia, and traumatic grief. We provide evidence-based treatment to clients in Arizona and New Mexico. Learn more about our services here. We look forward to working with you.

Rachel Tombaugh

Rachel Tombaugh

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Rachel has devoted her professional life to helping others heal and reclaim their true potential, working as a psychotherapist and Licensed Professional Counselor in Arizona since 2011. Her therapy approach utilizes a unique combination of compassion, warmth, humor, and clinical excellence. Rachel believes that therapy should feel hopeful and connected, yet maintain focus on clinical sophistication and excellence. Equipped with a Bachelor of Arts degree in Psychology from Arizona State University and earning her Masters of Professional Counseling from Ottawa University, Rachel’s education inspired her to build a career devoted to helping people live with purpose, confidence, and joy. An accomplished writer and editor, Rachel has contributed to several publications devoted to education and advocacy with respect to OCD and anxiety. Rachel has extensive experience working in renowned treatment facilities in both the public and private sectors of healthcare, serving as Primary Therapist at an inpatient treatment facility for eating and anxiety disorders, developing specialty trauma and anxiety programs as a Clinical Director, and training and developing other therapists as Clinical Supervisor. Most recently, Rachel has worked within the private practice setting and has dedicated her efforts exclusively to the treatment of OCD, anxiety disorders, and PTSD. Offering a clinical repertoire that creates change and ensures meaningful results, Rachel has achieved advanced training in Cognitive Behavioral Therapy (CBT), Exposure and Response Prevention (ERP), and Inference-Based Cognitive Behavioral Therapy (ICBT) for the treatment of OCD and anxiety, and extensive training in trauma-focused modalities including Eye Movement Desensitization and Reprocessing (EMDR). Each of these treatment approaches benefits from substantial evidence that it is effective, efficient, and creates positive change that can be trusted. Rachel brings great compassion, warmth, enthusiasm, humor, fun, and innovation to her therapy for each client and is passionate about working with people who have suffered from the traps of anxiety and trauma. Rachel is licensed in both Arizona and New Mexico and offers therapy in person and virtually in Arizona, and via telehealth in New Mexico. When not working with her clients, Rachel loves spending time outdoors with her family, her horse (“Gabriel”), several rescue pets, and a family of screech owls who live at her home in north Phoenix.

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