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What to Expect at Your First Psychotherapy Appointment?

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The first visit to a psychotherapist triggers anxiety in many people; they don’t know exactly what to expect and how to behave. We would like to prepare you a little and give you an idea of how an initial consultation with a psychiatrist works.

First things first: There’s no need to be nervous or anxious. Even if the reason for the visit may be uncomfortable and problematic, the conversation will usually be friendly and relaxed.

Talking to your psychiatrist isn’t fundamentally different from talking to any other doctor – just that the psychiatrist usually takes more time. So that you can look forward to your appointment with optimism, let’s take a quick look at what awaits you there.

Something to consider: you may think that some of the advice isn’t even necessary. In fact, that may be true, because your visit to the psychiatrist will go well without reading this article.

But sometimes it feels better to have informed yourself beforehand. It is actually not necessary to ‘prepare’ for your therapy session. Just think about what you would like to discuss; this helps not to forget anything in the course of the conversation.

Duration of the first consultation

An initial consultation takes about 50 minutes. You will have enough time to discuss all important issues in peace. Sometimes, however, it takes several conversations before the psychiatrist understands the client, his situation and the problem in every detail.

Some clients find it difficult to talk about certain topics during the initial consultation. It is therefore quite possible and also common to have more than one therapy session with the psychiatrist that are ‘starters’ in their nature.

Personal issue

There is probably a specific reason you are seeing a psychiatrist. These are often very personal things that one would not normally talk about openly. It is therefore difficult for many to formulate and get to the heart of their problem – almost at the push of a button. You may also feel ashamed and do not want to address some things directly.

Remember: the clause of confidentiality applies always to all medical professionals. You can talk openly about anything and not be afraid that someone else will learn anything from what you to your therapist.

If you’d rather avoid getting specific about your problem or have reservations about confiding it in a stranger: no shame in this. There’s probably nothing your psychiatrist hasn’t heard of in one form or another. So, there is no reason not to say unpleasant things as well. Everything that is said remains confidential. You also don’t have to feel embarrassed; your psychiatrist has probably known about these problems for many years.

Patients usually feel heavily burdened by their problems. So, it makes sense to talk about it right from the first contact. Just tell them what’s on your mind. If the psychiatrist has any questions afterwards, they will ask them carefully and empathetically. His goal is to get as complete a picture of your situation as possible.

Your personal background

Mental illnesses can have very individual aspects. For this reason, you should also address your personal history. If you feel it might be helpful, talk calmly about things like your life situation, family background, relationship, medical history, or occupations.

A good point to remember: when in doubt, it is better to say too much than too little.

If you are unsure whether you should mention a certain topic at all: yes, if it bothers you, it should also be considered. This will help the psychiatrist to better understand your needs and desires. You should address anything that seems important to you. When talking to the psychiatrist, you cannot say anything wrong.

Physical complaints

Your psychiatrist is also a medical doctor. You should therefore also report on your physical ailments, even if at first glance they do not appear to be related to your psychological problems. For the psychiatrist, these side effects are just as important as your thoughts and feelings.

Typical questions

What are the typical questions you get asked? First and foremost, of course, they will deal with your specific problem. Since these questions can vary depending on the type of complaint, here is an example:

Suppose you’ve turned to therapy due to continuous feelings of depression. 

  • How well do you sleep?
  • How are you doing with the energy for the daily tasks of everyday life?
  • Are you feeling sad often?
  • What are you feeling sad about?
  • What are you worried about?

You don’t have to talk about something you’re not comfortable with. Of course, if a question makes you uncomfortable or seems strange, you don’t have to answer it. Instead, simply state why you prefer not to answer the question.

In addition, the following topics are often discussed:

  • Addictive substances. Questions about alcohol, nicotine and drug consumption are asked at every initial consultation. They help to understand the problem or the way someone deals with their problems. In addition, it is important to know the client’s substance use in the event that medication needs to be prescribed. Questions about substance use are never meant to be judgmental.
  • Sexuality. Sexual issues are also common in mental health problems. A good psychiatrist should address potential sexual problems during the initial consultation. The side effects of some psychiatric drugs can also affect sex life. It may therefore be necessary to ask about any existing sexual problems. This has nothing to do with curiosity – this is the only way for the psychiatrist to be sure that he is prescribing the right medication (if necessary).
  • Children/family. Questions about children or family are part of understanding the client’s overall situation and therefore come up regularly.
  • Medical history. What medications are you currently taking? Does the client suffer from chronic diseases? Were there similar illnesses in the family?

After the first consultation

Many clients already feel relieved after the first conversation. It’s a good feeling to have talked about stressful things and heard an expert’s opinion. Already during the first consultation, you should plan how the therapy will continue. This prospect of an early improvement is often found to be helpful.

Your treatment plan can be customized. Visiting a psychiatrist does not always mean being prescribed a drug. Your psychiatrist may recommend seeing a therapist.

The number of necessary visits can vary greatly from person to person. Sometimes a conversation is enough for clarification, but sometimes you need several (then shorter) appointments.

Many psychiatrists are also psychotherapists or ‘specialists in psychotherapeutic medicine’. They can and may then also offer psychotherapeutic treatment. In this case, the psychiatrist can take over the psychotherapy with regular appointments over a longer period of time.

As a rule, the therapy plan and the number of appointments that are likely to be required are discussed at the initial consultation and determined together with the client.


If you feel like you need help from a therapist. Go and find a therapist that you think would suit you best, get that first appointment, and break the barrier of going to therapy for the first time. It’s not that scary after the first time! Additionally, you’ll see for yourself that therapy is a completely safe space where you can talk about anything and express any feelings. After a few visits, you’ll find out how liberating these therapy sessions really are.

Robert Haynes did his degree in psychology at the University of Hertfordshire. He is interested in mental health, wellness, and lifestyle.

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