Journal · Practical · 7 min read
What to expect in your first therapy session
Most people arrive at their first session nervous and leave surprised by how ordinary it was. Here is what actually happens, what confidential really means, why sessions are 50 minutes and what you are allowed to ask.
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Harjeet Hayre
Integrative Psychotherapist · BACP Registered Member · NHS-experienced Reviewed September 2026 · About Harjeet
Before the first session
With me and with many therapists, there is an optional free introductory call first to talk about what has brought you to therapy and to get a feel for each other. UKCP's advice is worth taking: ask about training, professional membership, approach and how they work, because the strongest predictor of effective therapy is the quality of the relationship between you.
What happens in the session itself
BACP describes the first session in three parts: introductions, an initial assessment and contracting. In practice that means I will ask what has brought you now, what you hope might be different and a little about your life and history. You can answer as much or as little as you like. Then we agree the practical terms and then the time is yours.
You do not need to prepare, to have a clear story or to know what to say. "I don't know where to start" is a perfectly good first sentence. Crying is fine. Silence is fine. It is a conversation, not an examination.
The agreement
BACP guidance says the written agreement should cover session length, cost and frequency, cancellation terms, whether notes are kept and confidentiality and when it might be breached. You should receive a copy. If a therapist does not offer one, ask.
What "confidential" really means
Almost everything you say stays between you and your therapist. BACP's Ethical Framework requires us to tell you in advance about the foreseeable limits: discussion in supervision (anonymised), serious risk of harm to you or others including safeguarding duties and situations where the law requires disclosure. BACP is candid that total confidentiality cannot be guaranteed and that a good therapist will explain these limits at the start rather than spring them on you later. That is what I do.
Why 50 minutes?
Nobody is entirely sure. The archival evidence suggests Freud's sessions were around 55 minutes and the 50-minute convention probably emerged for pragmatic reasons, letting sessions start on the hour with a break between. Research has found no relationship between session length and outcome. Fifty minutes is a useful container, not a magic number.
How many sessions?
NHS courses of CBT usually run 5 to 15 sessions. Private therapy is more often open-ended: we agree a rhythm, usually weekly and review together. Some people come for a couple of months around a specific difficulty; others stay longer for deeper work. You are never committed beyond the next session and BACP is clear you do not have to continue with a therapist you cannot relate to.
Questions worth asking
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What is your training and which professional body are you registered with?
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How do you work and how would you approach what I have described?
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What are the limits of confidentiality?
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What is your cancellation policy and how do I pay?
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How will we know if it is working and how do we end?
Answers to all of those for my own practice are on the fees and FAQ page and the my approach page. If you are wondering whether what you need is counselling or psychotherapy, that guide is here. And when you are ready, the free call is the easiest place to start: contact me.
Introductions, a gentle initial assessment and agreeing the practical terms, then talking about whatever brought you.2
Almost. The limits are supervision, serious risk to you or others and legal requirements, all explained at the start.4, 5
Largely a scheduling convention; Freud's sessions were closer to 55 minutes and outcome does not depend on length.6
Sources
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BACP. What is counselling? and What happens in therapy.
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BACP (2026). Contracting between client and counsellor.
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Kahr, B. (2023). Time to flex? Therapy Today, BACP.
This article is general information from a registered psychotherapist, not medical advice or a diagnosis. If you are in crisis, call 999, NHS 111 and select the mental health option or the Samaritans free on 116 123.
Ready when you are.
A free introductory call, no forms and no obligation. Just a quiet conversation to see whether working together feels right.