What happens during your first therapy session in St. Louis?

Your first therapy session focuses on getting to know you, discussing your concerns, reviewing history, and setting goals for treatment in a supportive environment.

How long is a first therapy appointment?

Most first therapy sessions last between 45 and 60 minutes depending on the therapist and the type of counseling provided.

Do I need to prepare for my first therapy visit?

You can prepare by thinking about your goals, symptoms, and any questions you want to ask your therapist during the session.

Is therapy confidential in Missouri?

Yes, therapy sessions are confidential with limited legal exceptions such as safety concerns or court orders.

What Happens in Your First Therapy Session in St. Louis?

Dr. Debra Zand
9 hours ago
3 min read

Starting therapy can feel intimidating. You may wonder:

What will they ask me?
Do I have to share everything?
What if I get emotional?
What if it feels awkward?

If you're considering therapy in St. Louis, you’re not alone. Many people delay getting support simply because they don’t know what to expect in that first session.

Here’s exactly what typically happens, so you can walk in feeling prepared, not anxious.

1. It’s a Conversation — Not an Interrogation

Your first therapy session is not a test. It’s not an evaluation where you can fail.

It’s a conversation.

Your therapist will ask gentle, open-ended questions to understand:

What brought you in
How long you’ve been feeling this way
What’s currently causing stress
Your goals for therapy

If you're coming in for anxiety, depression, trauma, or relationship concerns, your therapist will explore how these issues are affecting your daily life.

You’re always in control of what you share.

2. You’ll Talk About What You Want to Work On

Most first sessions focus on identifying goals. For example:

“I want to stop overthinking.”
“I feel overwhelmed all the time.”
“My relationships keep falling apart.”
“I can’t manage my stress at work.”

If you’re unsure what you need, that’s okay too.

Many clients seeking anxiety therapy in St. Louis or stress management counseling begin with, “I don’t even know where to start.”

Your therapist will help you clarify what’s most important. If anxiety has been interfering with your work or relationships, you can learn more about our Anxiety Therapy Services in St. Louis.

3. You’ll Review Confidentiality and Policies

Before diving deeper, your therapist will explain:

Confidentiality rules
Privacy protections (HIPAA)
When confidentiality may legally be broken (rare situations like safety concerns)
Cancellation policies
Insurance or payment details

This helps create a safe, transparent environment.

4. You May Complete Some Brief Assessments

Depending on your concerns, your therapist may use short questionnaires related to:

Anxiety
Depression
Trauma symptoms
Stress levels

These are not labels. They simply help guide treatment.

For example, if you’re experiencing symptoms related to trauma, your therapist may suggest approaches like CBT or trauma-focused therapy.

Learn more about our approach to Trauma & PTSD Therapy in Missouri.

5. You Don’t Have to “Go Deep” Right Away

A common fear is:“Are they going to make me talk about my childhood immediately?”

Not unless you want to. Some people cry in their first session. Some feel relief. Some feel unsure. All of that is normal. Therapy moves at your pace.

6. You’ll Leave With a Plan

By the end of your first session, you should have:

A clearer understanding of what you’re working on
An idea of how therapy can help
A sense of whether you feel comfortable with your therapist
A plan for next steps

Therapy is collaborative. If something doesn’t feel right, you can discuss it openly.

7. What If You Feel Nervous Before Your Appointment?

Feeling nervous before your first therapy session is extremely common, especially for adults who have never spoken to a therapist before.

Many clients in St. Louis say:

“I should’ve done this sooner.”

Seeking support is not a weakness. It’s a sign of self-awareness.

If you’re searching for a therapist near St. Louis who understands anxiety, depression, stress, or life transitions, your first step is simply showing up.

Who Typically Seeks Therapy?

People come to therapy for many reasons, including:

Chronic stress
Workplace burnout
Anxiety and panic
Depression
Relationship struggles
Grief
Trauma
Major life transitions

At Midwest Psychological Services, we work with adults, teens, and families throughout St. Louis and Sunset Hills.

Quick FAQ

Is the first therapy session awkward?

It can feel unfamiliar, but most clients quickly realize it’s just a conversation in a safe space.

How long is a first therapy session?

Most sessions last about 50–60 minutes.

Do I need to prepare anything?

No formal preparation is required. Just come as you are.

Will I be diagnosed in the first session?

Not necessarily. The first session is primarily about understanding your concerns and goals.

Taking the First Step

You don’t have to have everything figured out before scheduling an appointment.

If you’ve been wondering whether therapy might help, that curiosity alone is often enough reason to explore it. Whether you’re dealing with anxiety, depression, trauma, or ongoing stress, support is available in St. Louis.

If you're ready to talk, you can contact Midwest Psychological Services to schedule an appointment and take the first step toward feeling more balanced and supported.