3 Best Ways to Start a Therapy Session

Looking for tips for first therapy session for therapist? It’s common to feel worried when starting therapy sessions with a new client, or feel stuck in a rut with years-long clients. Actually, it’s pretty easy to feel stuck in general on how to begin in person and online therapy sessions. Once a client is going, it can be a lot easier following trains of thought or pulling at strings to dive deeper into specific events, moments, feelings, and mental health. But how do you get the ball rolling? Here are some of the best ways to start a therapy session, whether with a brand new client or one with whom you’ve already established a healthy therapeutic relationship.

1. Starting with a New Client

For newcomers, make sure your client has filled out any necessary intake paperwork via email or in-person for the therapy appointment. Some therapists choose to have an initial phone screening, so if you do, make sure that’s scheduled. Be sure to review all the logistics in advance. If they’re meeting you online, give them the links or other pertinent info so they can log in and have their camera ready before starting therapy. If it’s an in-person individual therapy session, make sure they have all the relevant info beyond the address, like parking or whether you will come to the waiting room to greet them yourself.

After settling into the space, start by striking a balance between professionalism and informality. You want your client to relax and feel safe in the space. At the same time, it’s best to explain specific protocols, such as what to expect in their initial session, and what they can expect if you continue working together. For example, many therapists will not acknowledge clients out in public, so they state that upfront in the first session just in case you two bump into each other later that week. Other therapists offer the client to make themselves feel at ease, or provide coffee, tea, or water so they feel refreshed. 

Start by going over their client questionnaire and asking any individual therapy questions you might have that are relevant to the initial session. If they said they’re here to cope with feeling depressed, ask more about that – how long have they felt that way, did anything recent happen, and so on. Don’t worry if it’s one word or short answers to start, as you’re both just getting acquainted.

Take note of the kind of impression you’re left with when first meeting the therapy client. Do they have low energy, poor or no eye contact, or a fidgeting problem? Does the therapy client disparage themselves in conversation or exhibit low self-esteem? Conversely, are they too chipper or nonstop talking? Are they bragging, loud, or seemingly? Are they angry or come off as such? Do they seem to be trying to read you instead?  

2. Before Session Starts

Read your notes from the last counseling session so their issues and what you last discussed is fresh in your mind. Greet the client with a smile and, if you feel comfortable, small talk, but keep it very brief. They may have something big on their mind they want to discuss, so avoid distractions by keeping it light and simple. 

Once you’re back in the office space where you’re holding the counseling session, and even beforehand, try your best to observe your client’s current state. Do they seem happy or sad? Frustrated and angry, or lethargic and depressed? Are they excited and bubbly, and is that normal for them? By inferring their mood at the moment, you can open up to them with a substantive question like, “You seem in good spirits today. What’s going on?” Thus, you lead the beginning of the treatment session following their emotions instead of prying them for information.

3. Starting Off Sessions 

There are good reasons to evaluate yourself and how you’re interacting right off the bat with clients. Your habits might be affecting how they treat sessions. Opening therapist questions that are casual greetings or brief catch ups versus relational interactions aren’t going to yield the same kinds of results. Not all our therapist-client processes are the same, but the more you begin sessions by talking about goals, relationships, or evaluations, the more likely you’ll end up making progress with them. 

Goal questions ask clients to focus on what’s right in front of them. This way, therapists can begin sessions by setting specific topics or goals, and continue the conversation for the whole session – or potentially into the next one. Try asking:

  • What are you hoping for in our talk today?

  • What’s your main concern today?

  • What’s on your mind right now?

  • What are you thinking the most about today?

  • What would you like to be different when you finish our session? 

You can also open by asking relationship-based questions. You’re inviting reality into the room and conversation by addressing the influences happening outside in the client’s life. 

  • Figuratively speaking, who’s in the room with you today? 

  • Is there anyone in your life you want to talk about?

  • How are you feeling about your relationship to… ? 

  • What’s come up between you and ….. since last time?

Other opening questions may focus on solutions or change, which let the therapist evaluate how the client is doing outside of sessions, along with what their experience and relationship is to the therapeutic process. 

  • So, what’s been going well?

  • What’s different today from the last time you were here?

  • Anything happened from the last treatment session that impacted you this week?

  • How’s the week been so far?

How you start a conversation at the beginning of a session gives clients hope, enhances their own motivations, and helps further bolster the established therapist-client relationship. Consequently, it’s important to continue building that relationship with ongoing interest and offering exercises or ways the client can help themselves between sessions. Rather than risk an unstructured or meandering session, try asking a new question to start off and see where it takes you and your client. Follow up the end with concrete therapy goals, agendas, or evaluations, and your clients will likely respond with encouraging emotional and behavioral change.