If you haven’t tried therapy before, you might wonder what the experience will be like. It’s normal to have worries, including that you won’t know what to say, that you will be judged or that it will be upsetting. Let me reassure you.

When I trained as a psychotherapist, me and my fellow students were given the assignment of doing something we’d never done before. The course tutors wanted us to get in touch with how scary it can be to do something new, to feel the fear of the unknown. I chose to jump out of a plane, which seemed a little excessive when I found out that a fellow student had chosen to bake their first cake! But actually, when I consider the fear that some people feel around coming for their first counselling session, I think it was a good choice.

New clients generally come for their first sessions full of anxious questions.

  • What will happen in counselling?
  • Will you give me a diagnosis
  • What should I talk about?
  • Where should I start?
  • Do I lie on a couch?
  • Is it ok to cry?
  • Or to swear?
  • What will the therapist think of me?
  • Can they fix me? And so on.

I hope that by answering some of these questions here, I can make it a little less scary for you to embark on counselling.

In this post, I focus on individual therapy. If you are considering couples counselling or relationship therapy, read my blog post on What to expect in couples counselling.

Woman having an individual counselling session

What actually happens in a counselling session?

First, let me paint a picture for you of what happens in the counselling room. You and the therapist sit across from each other and for 50 minutes you talk about whatever you want to talk about. That’s all. In your first session, the therapist may take notes. After that, they probably won’t.

What counselling is NOT

Many people’s expectations of counselling or therapy are based on what they’ve seen in films or TV series and are unrealistic. Let me put some of those myths to bed:

  • You’re unlikely to be lying on a coach while a stern-looking man sits behind and analyses you.
  • Your therapist is not going to get involved in your life outside of the therapy sessions.
  • Everything is not going to be blamed on your mother.
  • Your therapist is not going to tell you what to do.
  • Counselling is not only for those with major issues.

These days, the therapy relationship is much more equal, with the therapist and client working collaboratively. We sit across from each other, on sofas or armchairs. The therapist may ask you questions or give their thoughts on what you’re talking about, but we don’t judge, we don’t diagnose and we don’t tell you what to do.

Our job is to be alongside you as you work out who you are, what you want from life and how you might get it. Therapists support and guide their clients, and together the therapist and client can create amazing change, but it’s not a case of the therapist telling the client what to do or prescribing a magic pill.

What therapists do and don’t do

Therapists do:

  • listen
  • empathise
  • understand
  • support
  • challenge
  • explore.

Therapists don’t:

  • judge
  • diagnose
  • tell you what to do
  • pressure you into talking about anything you don’t want to talk about
  • share confidential information
  • prescribe medication (unless they’re also a psychiatrist).

What should I talk about in counselling?

So, what to talk about and where to start? Every client’s experience of therapy is unique and there is no right or wrong subject matter. It is very much individual, as it is about your personal experience and feelings. It goes at your pace, and you talk about whatever you want to talk about in each session.

Sometimes you might not know what to focus on. That’s fine. Your therapist will help you to get to the heart of the matter, whichever point you start from.

Some clients start in the past, some in the present, some talk about the same issue each week, some bring something new each week. It all works.

To give you an idea, here are just some of the things clients talk about in therapy:

Read our blog post on What should I talk about in counselling?

What a first therapy session might look like

If you book an initial consultation at One Therapy London, this is what to expect.

Your chosen therapist will greet you and invite you to sit on a sofa across from them in a quiet, private room. They will briefly explain what’s going to happen and will invite you to fill in a client registration form. This form takes just a couple of minutes to fill in. It includes some questions that might prompt further discussion, such as whether you have a mental health diagnosis and whether you have had therapy before.

Once the therapist has asked all they need to ask about the information on the form, they will invite you to tell them what’s bringing you to therapy, starting wherever you’d like to start. This is the main part of the session – you talking about what you want to work on in therapy and giving the therapist some background to your life. Your therapist may or may not take notes (and will only do so if you’re comfortable with that) and may ask you questions, for example about your work, your family, and so on.

Towards the end of the 50-minute session, the therapist will ask you if you would like to continue with therapy. If you want to, they will find you a regular weekly appointment. They will offer you the choice of continuing with them or being referred to a colleague (so if they don’t feel like the right therapist for you, you can continue with someone else).

They will give you our policies document, so that you know how we manage things like confidentiality and cancellations. Then they will explain our fee structure and agree your ongoing fee with you. Finally, they will take any payment due.

Do I need to prepare for counselling?

It isn’t necessary. If you turn up without having thought about what you’d like to talk about, we still find something helpful to talk about. That said, you will probably find your therapy more effective if you give it some thought before your session. You don’t need to plan what you’re going to say – just having an idea of the main topic you want to discuss is enough.

Your therapist will help you along the way

There are ways to use individual counselling sessions effectively and your therapist will support you to find what works well for you. Good therapists recognise that new clients may need a bit more help. For example, with a new client who doesn’t know what to talk about, I ask questions to help them in their early sessions. As clients become more comfortable in therapy, they tend to need less of this.

Man having individual therapy session

Many clients want to be “good” at therapy and for their therapists to think well of them. That’s only natural and the client’s desire to be good can be valuable to explore in itself. But sometimes it gets in the way of the therapy. The more you can be yourself with your therapist, the better. That might mean showing parts of yourself that you usually hide, parts that are vulnerable, messy, dark and so on.

Read our blog post on How to get the most from therapy.

Is counselling emotional?

In short, yes, it can be. Getting in touch with our emotions and expressing them is an important part of how we process difficult experiences. So, clients sometimes cry or get angry or swear. People are sometimes worried about this, fearful that they won’t be able to stop crying if they start, but they are always able to.

Sometimes clients worry that the therapist won’t be okay with them crying, getting angry or expressing other emotions. It’s all okay; therapists are used to all sorts of emotional expression. In fact, it’s one of the most precious things about counselling, that you can be yourself and be accepted just as you are by your therapist. Dwayne Jackson, who founded One Therapy, says, “There is something unique about the open, non-judgemental relationship between client and therapist that’s unlike relationships you get anywhere else. There is a unique type of honesty in therapy, shared only by the client and the therapist.”

So what to expect in counselling is on the one hand mundane – just two people talking – but on the other hand exceptional – a relationship unlike any other, which will support you to create what you really want for your life.

Are you ready to experience that exceptional relationship and transform your life? Book an initial consultation.

Kate Crawford is Head of Therapy Services at One Therapy London.

Last updated: 2 June 2026

Published: 9 March 2019