The First Therapy Session Isn’t About the Questions
By Dr. Virginia Chow
If you’ve never been to therapy before, it’s easy to imagine your first session as an interview. Many people worry they’ll be asked dozens of questions about their childhood, relationships, or medical history before anything meaningful can happen.
Although there is some truth to that, I’ve learned in my 20 years of practice that the first session isn’t only about gathering information. It’s about building enough trust for someone to finally say, “This is what I’ve been carrying.”
“The first session isn’t where therapy begins. Therapy begins the moment someone feels safe enough to tell the truth about what they’re carrying.”
Graduate school teaches therapists how to conduct a thorough intake. Those skills matter. But real life looks different. People don’t come to therapy because they’re having a good week. They come when they’re feeling anxious, grieving, burned out, overwhelmed, or simply exhausted from holding everything together.
In those moments, they don’t need to feel like they’re being interviewed. They need to feel heard.
One of the biggest lessons I’ve learned is that people rarely remember every question I asked during our first session. Instead, they remember whether they felt heard, understood, and safe enough to begin opening up.
That’s why I often slow the conversation down instead of rushing through a checklist of things I need to ask and do. Sometimes the most therapeutic question isn’t, “Tell me about your childhood.” It’s simply, “What’s been weighing on you the most lately?”
In my experience, listening and making them feel safe are often the first interventions.
I see this all the time in couples therapy. One partner may spend several minutes explaining why they’re hurt, while the other is already preparing a response or trying to defend themselves. I’ll often slow the conversation down and say, “Before we move on, can we stay with what your partner is feeling for a moment?” Or, I might add, “What you just said was so important. Let’s stay with that for a moment” while also slowing down my speech and softening my voice. It’s remarkable how often the tension begins to soften once someone feels truly heard instead of immediately corrected or challenged.
The same principle applies in individual therapy. Before we try to solve the problem, people first need to feel that someone genuinely understands what they’re going through.
That doesn’t mean assessment isn’t important. It is. Understanding a person’s history, relationships, and goals helps guide treatment. But there’s a difference between gathering information and building a relationship. A good therapist knows how to do both.
So, when new clients ask me what they should expect from their first therapy session, my answer is surprisingly simple.
“I would want to understand your story and get ot know you better. More importantly, I want you to feel heard, understood, and supported.”
About the Author: Dr. Virginia Chow is a licensed Clinical Psychologist and the Clinical Director of Theraspace, an online multidisciplinary mental health clinic serving adults across Quebec. With more than 20 years of clinical experience, she specializes in anxiety, depression, trauma, stress and burnout, grief, and relationship difficulties. Dr. Chow has been featured as a mental health expert in Newsweek, Real Simple, CBC, AOL, and is a regular contributor to Connectively, where she provides evidence-based insights on psychology, relationships, and emotional well-being.
info@theraspace.ca
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