A first session — usually billed as an intake or assessment, code 90791 — is largely information gathering. You will talk more than you expect and feel less than you hoped, and that’s the normal shape of it rather than a bad sign.
Before it starts
Paperwork: consent forms, privacy notices, fee agreements, cancellation policy. Read the cancellation policy, because in this city a late-cancel fee is usually the full session rate and it catches people out.
Also confirm the fee, whether they provide superbills, and what the notice period is.
What gets asked
What brings you now, and specifically why now rather than six months ago. History of the problem. Previous therapy, what it was and what did or didn’t help — which is the most useful thing you can supply and the thing people most often skip.
Family history. Medical history and medication. Alcohol and substances. Sleep. And risk: whether you’ve had thoughts of harming yourself. That last is asked of everyone as a matter of routine, and answering honestly doesn’t trigger anything dramatic — clinicians are looking for a plan and intent, and thoughts without either are extremely common and get talked about rather than acted on.
What to bring
A sentence about what you want to be different. Medication names and doses. Previous therapy history. And, if you’ve one, the thing you’re most reluctant to say — because therapy that works around the actual issue doesn’t work, and week one is a better time than month six.
What to ask them
How do you work? What approach would you use for this and why? Roughly how long do you expect? How will we know if it’s working? What’s your experience with this specific difficulty?
A clinician who can answer those without discomfort is a good sign. One who deflects entirely to the relationship is telling you something too.
Judging fit
Not after one session. First sessions are awkward for everyone and the assessment format isn’t representative of the work.
By week three or four, you want: a formulation you recognise — an account of what is going on that fits your experience; some sense of a plan; the feeling that you can say difficult things; and, if you asked for a structured treatment, evidence that one is happening.
What you don’t need is to like them immediately. Some of the most effective therapy is initially uncomfortable, and warmth without direction is pleasant and frequently unproductive.
If it isn’t right
Say so. It’s a professional relationship and a good clinician won’t be wounded — many will help you find someone better suited, which is a considerably better route than starting the search again from scratch. How to actually say it.