First Session FAQ: Everything You Need to Know Before Starting Therapy

By Liz Fava, LPC | Licensed Professional Counselor, Georgia | Fava Counseling Associates, Atlanta, GA

So you’ve decided to try therapy. Maybe you’ve been thinking about it for a while. Maybe something finally pushed you to pick up the phone. Either way — you’re here, and that already says something important about you.

But I know what often comes next: the questions. The second-guessing. The vague, slightly uncomfortable feeling when you try to picture what’s actually going to happen when you walk into that room (or log on to that video call). What do I even say? Will it be awkward? Will she judge me? Will I have to cry?

I hear these questions all the time, and they’re completely normal. In over a decade of working with clients in Atlanta, I can tell you that most people who start therapy are at least a little nervous going into their first session — even the ones who seem totally put-together on the outside.

So let me answer the questions I get asked most often. By the end of this, you’ll know exactly what to expect — and hopefully feel a little more ready to take that first step toward individual therapy in Atlanta.

The Bottom Line

Starting therapy can feel intimidating, but knowing what to expect takes most of the uncertainty out of it. Your first session is a conversation, not an examination — you’re in control of what you share and when. Sessions are typically 50 minutes, once a week to start, and everything you say is confidential. The therapeutic relationship is the most important ingredient in the process, which is why Fava Counseling offers a free consultation before you ever book. Most importantly: research shows that simply making the decision to start therapy is often enough to begin seeing change. You’ve already done the hard part.

What actually happens in a first therapy session?

The short answer: it’s more of a conversation than an examination. The first session is unlike any other you’ll have — we call it an intake, and it’s really about getting to know each other.

Your therapist will welcome you, make sure you’re comfortable, and then ask some open-ended questions: What brought you in? What’s been going on? What are you hoping to get from therapy? You won’t be drilled with a checklist or asked to pour out your deepest secrets in the first 10 minutes. We’re not in a rush.

While you talk, your therapist is listening carefully — for themes, patterns, and what matters most to you. We’re learning about your history, your current situation, your relationships, and your goals. At the same time, you’re getting a sense of us. We also will cover some of the details you need to know – how to get a hold of us if there’s an emergency, what to do if you need to cancel a session, and what “confidential” really means. The first session is a two-way street where we are both giving and receiving information and getting to know each other.

One thing worth knowing: at Fava Counseling, all intake paperwork is completed through our secure client portal before your first appointment. You won’t be filling out forms in a waiting room. The session time is entirely yours.

Do I have to talk about everything right away?

Absolutely not. You are always in control of what you share and when.

People sometimes imagine therapy as a process where a therapist systematically unpacks every corner of your life in the first few sessions. That’s not how it works — at least not the way I practice, and not the way any of our therapists at Fava work.

We follow your lead. If there are things you’re not ready to talk about yet, that’s okay. Therapy is a process that builds over time, and trust deepens as the relationship does. There is no pressure to “go there” before you’re ready.

What I do ask for is honesty about where you are. I’d much rather hear “I’m not ready to talk about that yet” than spend weeks working around something important.

How long is a therapy session, and how often will I need to come?

A standard session at Fava Counseling is 50 minutes, scheduled on an hourly basis. Research supports that therapy is most effective when it happens once a week, especially early on — and that’s what we typically recommend when you’re just getting started.

That said, there’s flexibility. Some people need more intensive support at first and come more frequently. Others, once they’ve made real progress, drop to every other week or once a month as a maintenance check-in. We adjust as your needs change — and they will, because that’s the whole point.

As for overall duration: there’s no set answer, and anyone who gives you one isn’t being honest with you. Some people come for a few focused months; others stay longer. We talk about your goals early and revisit them regularly, so you’re never left wondering where you stand or what you’re working toward.

What should I say in my first therapy session?

This is one of the most common questions I get — and I love it, because it tells me the person asking actually wants to do the work.

Start with what brought you in today. It doesn’t have to be a perfectly organized narrative. Just start with whatever feels most pressing — the thing that finally made you pick up the phone, the situation keeping you up at night, the relationship that feels stuck. Start there.

It’s also completely okay to say: “I don’t really know where to start.” That’s a valid beginning, and a good therapist will help you find your footing. You don’t have to come in with an agenda.

If you want to be more intentional about preparing, our article How to Find a Good Therapist: 9 Questions to Ask Before Your First Appointment walks through useful things to think about in advance — your goals, your budget, and what to look for in a therapist.

Will my therapist judge me?

No. And I mean that not as a reassuring platitude, but as a genuine description of who we are.

Therapists have heard a lot. We’ve sat with people through their darkest, most complicated, most shameful moments. Whatever you bring into that room, it won’t shock us — and it won’t change how we see you as a person.

All of our therapists at Fava are real people with our own histories, challenges, and growth edges. When you sit across from your therapist, you’re not sitting across from a clipboard and a raised eyebrow. You’re sitting across from someone who genuinely wants to understand you.

My clients often tell me they expected to feel judged and were surprised that they didn’t. That they felt seen instead. That’s exactly what we’re going for.

Is everything I say in therapy confidential?

Yes — with a few specific, legally defined exceptions your therapist will explain clearly in your first session.

Confidentiality is the foundation of the therapy relationship. What you share stays between you and your therapist. We don’t discuss clients with family members, friends, employers, or anyone else without your written permission.

The exceptions are narrow and exist to protect safety: therapists are required by law to act if there is serious risk of harm to yourself or someone else, or if there is reasonable suspicion of child or elder abuse. Outside of those situations, what happens in session stays in session.

We cover all of this in detail in your first appointment — and the paperwork you complete beforehand addresses it as well — so you’ll never be left guessing about the rules.

What if I’ve been through trauma — will therapy make it worse before it gets better?

This is a question I hear often, especially from people considering trauma therapy in Atlanta, and it deserves a thoughtful answer.

The short answer: it depends on the approach, and a skilled therapist will pace the work carefully with you. At Fava, we use trauma-informed approaches that prioritize your safety and sense of control throughout. I’m trained in Brainspotting — a method that processes trauma without requiring you to re-tell your story in a detailed, linear way. Others on our team are trained in EMDR, which works in a similar way. Many clients find it gentler than they expected.

Some people do experience what’s called a “window of tolerance” challenge early in trauma work, where things feel more activated before they feel calmer. But a good therapist never pushes you past what you can handle — we go at your pace.

If you’re curious about how trauma therapy works and how different approaches compare, our article Brainspotting vs. Individual Therapy in Atlanta goes into detail.

A note on crisis support: If you are currently in crisis or experiencing thoughts of suicide or self-harm, please reach out to the 988 Suicide & Crisis Lifeline by calling or texting 988, or go to your nearest emergency room. Therapy is a powerful tool for healing — but it is not a substitute for immediate crisis care.

What if I don’t feel a connection with my therapist?

Then you tell them — or you find someone else. The therapeutic relationship is the single most important ingredient in good outcomes. Research consistently shows that the quality of the client-therapist relationship predicts results more than any specific technique or approach.

I encourage new clients to give it a few sessions before deciding. First sessions can feel awkward — you’re sharing personal things with a stranger, after all. But if after three or four sessions you still don’t feel comfortable, that’s meaningful information, and a good therapist will support you in finding a better fit rather than taking it personally.

This is part of why Fava Counseling offers a free phone consultation before you ever book. It’s a chance to ask questions, get a feel for your therapist, and confirm it seems like a good match — before you commit to anything.

If you’re still weighing your options, our guide to finding a good therapist covers credentials, fit, style, and the questions worth asking upfront.

Does therapy actually work?

Yes. And the research is clear — but what I find most compelling is what I’ve witnessed firsthand over the years.

Studies consistently show that psychotherapy produces meaningful, lasting change across anxiety, depression, trauma, relationship difficulties, and more. But here’s what the research also shows, and what I think is one of the most remarkable things about this work:

People often experience change based on nothing other than their decision to begin counseling.

I’ve seen this happen. Clients who report things starting to shift almost immediately — not because we’d done deep work yet, but because making the decision to start was itself the act of change. It gave them a sense of agency. It signaled to their nervous system that something was different now.

That’s not magic — it’s almost magic. And it’s why, after all these years, I genuinely believe your life and your relationships can get better. It takes work, and some time. But it absolutely is possible.

What about online therapy — is it as effective as in-person?

For most concerns, yes. Research on telehealth therapy shows outcomes comparable to in-person sessions for anxiety, depression, trauma, and relationship issues — a finding supported by multiple peer-reviewed studies.

At Fava Counseling, we offer online counseling to clients throughout Georgia. It works especially well for people with demanding schedules, those outside Atlanta proper, or anyone who prefers the comfort and privacy of their own space. The therapeutic relationship — the real engine of change — translates just as well over video as it does across a room. I’ve had some of the deepest sessions of my career through a screen.

What kinds of concerns do your Atlanta therapists work with?

Our team at Fava Counseling Associates works with a wide range of concerns. Here are a few of our core specialties:

• Anxiety — Anxiety therapy in Atlanta is one of our most sought-after services. Whether it’s generalized anxiety, social anxiety, or panic, our therapists use evidence-based approaches that work.
• Trauma — Our trauma therapy in Atlanta practice uses EMDR and trauma-informed CBT for adults navigating childhood trauma, relationship trauma, grief, and more.
• Relationships — Couples counseling, premarital counseling, marriage counseling, and dating therapy are all areas of deep focus for our team.
• Individual growth — Sometimes people come to therapy not because something is “wrong,” but because they want more: more clarity, more confidence, more alignment between the life they’re living and the one they want. That is a completely valid reason to start.

If you want a deeper look at what the first step in individual therapy looks like, our Individual Therapy in Atlanta: Your First-Session Guide walks through the process in detail.

About the Author

Liz Fava, LPC is a Licensed Professional Counselor in Georgia and the founder of Fava Counseling Associates in Atlanta. She holds advanced training in the Gottman Method (Levels 1, 2 & 3), Brainspotting (Phases 1 & 2), and Emotionally Focused Therapy (EFT). She is a Certified Prepare/Enrich Facilitator and a Certified Professional Counseling Supervisor (CPCS). Liz specializes in individual therapy, couples counseling, and trauma-informed care for adults. Learn more about Liz →

This article is intended for informational purposes only and does not constitute medical or clinical advice, diagnosis, or treatment. If you are experiencing a mental health emergency, please contact the 988 Suicide & Crisis Lifeline (call or text 988) or go to your nearest emergency room.

Ready to take the first step?

If you’re in Atlanta — Buckhead, Sandy Springs, Chastain Park, or anywhere in Greater Atlanta — our office is at 4840 Roswell Rd., Suite C202, Atlanta, GA 30342. We also serve clients throughout Georgia via online counseling.

The first step is a free phone consultation — no commitment, no pressure. It’s a short conversation where you can ask questions, get a feel for our team, and find out if we’re the right fit. Many people tell me it was the easiest part.

I started Fava Counseling because I genuinely believe people’s lives and relationships can get better. Every day I get to watch that happen. It starts with someone doing exactly what you’re doing right now — asking the questions, gathering the courage, and deciding that something has to change.

You’ve already done the hard part. The rest, we can do together.

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(404) 257-6474 | 4840 Roswell Rd., Suite C202, Atlanta, GA 30342