What actually happens in a first therapy session?

With my chest constantly tugging and a sorrow ingrained in each cell, I didn't stop to think about what would happen.

I was too busy worrying about doing it wrong. What if I missed something; an important detail of my life? How would she help me if I left something out? And then the thoughts I didn't say out loud: she's a therapist, her life must be so sorted. Her relationships. Her family. Herself.

None of that was what I walked into.

I was 22. Genuinely broken, lost, and clueless but with so much hope. I was prepared to share my entire life story. I had been recollecting details on the way there, making sure I wouldn't forget anything. My mother and sister waited in the corridor. I walked in feeling a little intimidated but carrying a lot of hope. I was ready for the magic wand.

I sat there and spoke hastily, extra conscious of the time, looking downward, not able to meet her eyes. I opened my mouth and said I had been getting panic attacks. I wasn't sure if that's what they were, but I was. I had resisted coming for a long time because I was afraid of change. What if I lost something by getting better?

She listened. Curiosity building on her face, hope in mine. I felt heard. She kept nodding, kept validating. I don't remember much of what she said. But I remember the space. A space to come unprepared.

I left the room crying, not because I didn't like her, but because something in me had released.

That was 2019. My first of many.

Six years passed. The relationship that brought me so much wisdom, clarity, and perspective ended and I didn't see it coming. I thought I was fine. I was talking, thinking clearly, being very sound. But something was happening in my body that I hadn't let myself feel.

I had been with her, happy, fan-girling a little, but also quietly longing to know if she was really this perfect. Wanting to know that despite becoming a better version of myself, I was still allowed to be irrational. Still allowed to get angry. Still allowed to be who I used to be.

In May 2025, in one of our last sessions, I remember asking her, "how are you so perfect? I wish I could see some imperfection in you." She said she wasn't perfect. It wasn't enough. The words weren't landing in my body. I needed more than a sentence. I didn't know what I needed.

I took the decision to find someone new. I was unhappy. I chose to be practical. And then mid-January came, and I saw it all come crashing down. Breaking down, not feeling safe, not feeling the connection. It was grief. The grief I had never allowed myself to acknowledge or anticipate. Because endings didn't land in my body either.

In 2026, I started with someone new.

I had my breakfast, cleaned my room, drew my curtains and switched on my AC. I sat with my laptop, shaking my legs, watching the clock. I could see the words, "Join now". I was prepared to share, not everything this time, but practically. Bracing myself for a composed, sorted therapist voice on the other end.

She joined and greeted me. Six years into therapy, I still walked in with the same urgency I felt in 2019. Hoping for the same magic wand.

But something was different.

I found myself asking her something I hadn't planned to say, "when other people have a disagreement with their therapist they just leave. Why am I like this?" She smiled. I cried. And I heard myself say, "maybe my need for this space is bigger than the feeling of betrayal?" Her eyes softened. A look of concern, but also something like pride.

I gave her the backstory. My journey, my misery. She said, "it must be heavy to carry all of this. So much pressure to just be you." A tear dropped down my face. But this time it wasn't cathartic. This time it felt like I was allowed to slow down. Like I could feel safe.

I still don't remember much of what she said. But I remember her presence. I remember being asked what felt okay to me. I remember knowing my misery wasn't going anywhere soon and feeling okay about that, because there was another human in the room who wasn't trying to fix it or explain it into something logical.

At some point I told her about my disappointment in my previous therapist. That I wished she had shown me she wasn't perfect rather than just saying it. I showed her my desperation to feel safe, the longing I had carried the entire journey towards her. She waited. She acknowledged what I said. And then, very gently, I see the words coome out of her lips, "It feels like you are trying to tell me something in here?"

Without any intention of expecting so, I felt heard.

After that session I still carried the longing for that messy human across from me. I kept asking her to show me her flaws. She heard me. She got curious. But it still wasn't landing.Until one day, sitting with her, I realised, the fact that it wasn't landing, and her helplessness about how to make me see it, was itself the messiness. That was it. That was what I had been looking for. That was the work of the session.

I was relieved.

I still don't have an answer for what happens in a first therapy session, despite having had almost five of them.

Perhaps what happens in the first session is mine. To be allowed. To be unprepared.

If you've been putting it off, waiting to feel ready, waiting to know what to say, waiting to have a good enough reason; you don't have to.

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Written by Tanisha Sanghavi

Tanisha is a counselling psychologist and co-founder at Therapea, working with young adults on food-body relationships, attachment, and complex trauma. Work with Tanisha →