What to Expect When Starting Therapy or Counselling

Deciding to start therapy or counselling can feel like a really big step, especially if you’ve not had experience of one-to-one work before.  You might be unsure what you need to say, what you might be asked, or even whether now is the right time to start.

All of this is very normal.  Many people begin their search for a therapist not really knowing exactly what they need or why, just that something isn’t feeling quite right or isn’t working.

Not having a clear goal, not knowing how to “do” therapy, or feeling awkward are all okay. Your counsellor is there to help untangle things with you and offer reassurance along the way.

Choosing a Therapist

It’s a good idea to shop around, although if you live in an area with lots of choice this can feel quite overwhelming.

I’ve written a blog on choosing a therapist when you’re neurodivergent, but most of the advice applies more widely too.

A few things to consider:

• If you have a particular issue you want to address, you might want to look for a specialist in that area

• Make sure the therapist is qualified, insured, and a member of a professional body such as the BACP or NCPS

• Do they offer a free or low-cost consultation to assess fit?

• Are they accessible for you, either in person or online?

  
  

Your relationship with your therapist matters much more than the specific approach they use. If their profile or website “speaks to you” in some way, that’s often a good starting point.  A consultation can then help you get a better sense of whether they feel like the right fit.

Introductory or Consultation Meeting

This is often offered for free or at a reduced price.  I offer around 20 minutes free over a Teams call.

It’s an opportunity for both of you to see whether working together feels like a good fit and to ask any questions you might have.  It’s not designed to be a deep therapeutic session, more about comfort, connection, and practicalities.

Questions You Might Want to Ask

You can ask these by email before arranging a consultation, or bring them to the meeting itself. Therapists often have an FAQ page on their website like mine here.

Practicalities

• Price of sessions and how and when to pay

• Length of sessions and frequency options (weekly/fortnightly)

• Cancellation policies and flexibility when life happens

• Whether sessions are open-ended or for a fixed number

  
  

Accessibility & adjustments

• Any adjustments you might need (light, noise, sensory)

• Online vs in-person options

• Session and payment reminders

• Toilet facilities

  
  

Logistics

• Directions to the space

• Parking or transport options

• Payment methods

It’s okay to ask for what you need here, the arrangement needs to work for you. Working online can offer more flexibility, and experienced therapists are usually very able to build rapport this way.  It’s worth thinking about whether you have a private, uninterrupted space if you choose to work online.

Questions You Might Be Asked

Therapists will usually ask some questions to understand your situation.  This isn’t about judging you or looking for “right” answers, just building a picture of what might be going on for you.

Your past experiences

• Have you had therapy or counselling before?

• What helped or didn’t help?

  
  

What’s bringing you now

• What are you hoping for from therapy?

• Do you have specific goals, or do you need space to process?

  
  

It’s also completely okay not to know the answers to these, or even how you feel.

Your current world

• Your support network (friends, family, partner)

• Your living situation

• Work or study and how it’s affecting you

• Any dependents

Mental and physical health

• Thoughts of self-harm or suicide

• Contact with your GP or other professionals

• Medication

• Other health conditions

Often people will naturally share what feels most important, but sometimes other factors like health, environment, or support can be playing a bigger role than expected.  These can be gently explored together over time.

Paperwork & Practical Details

There’s usually a bit of administration at the start.  This helps keep things safe, clear, and consistent.

Your therapist may take:

• Contact details

• GP details

• Emergency or next of kin details (when appropriate)

  
  

You may also be given a contract.  Not all therapists use one, but it can be helpful to have something to refer back to for things like confidentiality, boundaries, and cancellation policies. You can take your time to read this and ask any questions, nothing needs to feel rushed.

Starting Therapy, the First Session

First sessions are often much gentler than people expect.  They’re not always a deep dive into difficult or painful topics, trust builds over time.

I usually try to cover most practical details before the first session, but sometimes we’ll spend a few minutes at the start checking the contract, getting it signed, and filling in anything missing. This can help you settle into the space.

I tend to begin with fairly low-stakes, everyday conversation to help you feel more comfortable, start building rapport, and get a sense of your communication style.   If you’re neurodivergent, you might find you need a bit more prompting at first, that’s absolutely fine.

Ending the First Session

At the end of the session, I’ll usually check how it felt for you and whether you’d like to continue. If so, we’ll look at frequency and try to find a regular slot, often the same day and time each week or fortnight.  This can help build a sense of consistency and commitment on both sides.

Therapy works best when it becomes a regular, reliable space.  That said, life happens, and I’m always happy to be flexible where I can.  Keeping communication open really helps with that.

What Therapy Feels Like Over Time

It’s important to remember that therapy is a process, and progress isn’t always linear. Some sessions might feel really helpful, with clear insights or a sense of relief.  Others might feel a bit stuck or less productive.  Both are a normal part of the process.

It’s also quite common for things to feel a bit worse before they start to feel better, especially if this is the first time you’re facing difficult experiences more directly.  Your counsellor should go at your pace, gently supporting you through this.

Final Thoughts

Hopefully this has reassured you enough to take those first steps in contacting a therapist and a bit of insight into how I work. 

You don’t need to have everything figured out before you start.  A good therapist will help you work that out and aim to create a space where you feel as comfortable and safe as possible. And if something doesn’t feel right, it’s okay to decide the fit isn’t there and look elsewhere. That’s part of the process too.

If you’d like to explore further, you can reach out to me by email and ask to schedule a free introductory call.

Karen Charman - BSc Hons Psych MBACP

karen@elephascounselling.co.uk

Counsellor Primarily Supporting ADHD and Autistic Adults 

• ICF Coach in Training.

• Diploma in Humanistic Counselling

• Registered Member of the BACP

• BSc Hons Psychology

• Practising face to face in South East Hampshire, near Portsmouth & Chichester and Online UK wide.