The hours before a first therapy session can feel long. You may wonder what you will be asked, whether you will cry, whether you will say the right things, or whether you will freeze and say nothing at all. Many people almost cancel. If you are feeling some of that, you are in very good company.
In this article I describe what usually happens in the first sessions of individual therapy, what you can expect from the therapist and from yourself, and how change tends to unfold over time.
Before the first session
Most therapists in Berlin will have a short exchange with you first, by email or phone, to arrange the appointment and check practical things: the reason you are reaching out, your availability, your language and how sessions are paid.
If you have statutory health insurance and see a therapist with a statutory contract, the first contact is usually the psychotherapeutic consultation (Sprechstunde). It is followed by a few trial sessions (probatorische Sitzungen) before the actual therapy is applied for (Bundesministerium für Gesundheit, n.d.). In private practice, the structure is often more flexible, but the first sessions serve a similar purpose. I describe the routes in more detail in Finding psychotherapy in Berlin.
A little preparation can help:
- Write down a few notes on what brings you, since when, and what you have tried.
- Think about what you would like to be different in a few months.
- If you take medication or have seen other professionals, have that information at hand.
You do not have to prepare a perfect story. Notes are simply a support if your mind goes blank.
What happens in the first session
The first session is mostly about getting to know each other and understanding your situation. A therapist will usually ask about:
- What brings you now: the difficulties you are facing and how they affect your life.
- Your history: when things started, important events, earlier periods of difficulty.
- Your life today: relationships, work or study, sleep, health, daily routines.
- Your background: family, culture, migration, languages, identity.
- Your resources: what helps you, who supports you, what you are proud of.
- Your goals: what you hope therapy can change.
Depending on the situation, the therapist may also ask questions about your safety, for example whether you have thoughts of harming yourself. These questions are routine and asked with care. Answering honestly helps the therapist support you well.
The first session is also your chance to ask questions: How do you work? How often would we meet? How long might therapy take? What happens if I want to stop? A good therapist will welcome these questions.
About crying, silence and not knowing
Crying in a first session is very common. So is silence, or saying “I don’t know”. None of this is a problem. Therapists are used to all of it.
The next few sessions
The following sessions usually go deeper into understanding. Together you usually build a picture of what keeps your difficulties going, and agree on goals and a way of working. In cognitive behavioural therapy, for example, this often includes looking at the links between situations, thoughts, feelings, body reactions and behaviour, and trying small changes between sessions.
Building the relationship
Research consistently shows that the working relationship between you and your therapist is one of the factors most closely linked with good outcomes. This alliance includes trust, agreement on goals and agreement on how to work towards them (Koole & Tschacher, 2016). The first few sessions are when this alliance begins to form.
It is worth asking yourself after two or three sessions: Do I feel heard? Do I understand what we are working on? Can I say when something doesn’t suit me? Therapists also differ in how effective they are, even when they use the same method (Saxon et al., 2017), so if it really does not feel right, it is fine to try someone else. I write more about this in How to choose a therapist.
How change usually unfolds
People often expect steady improvement, session after session. In reality, change tends to come in waves. Some people feel a little relief soon, simply from having a place to talk. Others feel worse for a while, because painful topics are finally getting attention.
Research on so-called sudden gains shows that some people experience a marked improvement from one session to the next, often early in therapy. In a study at a training clinic for cognitive behavioural therapy, about a quarter of patients had such a sudden gain, while many others improved more gradually (Greenfield et al., 2011). Both paths are common, and both can lead to good outcomes.
Online or in person?
Many therapists offer both. In-person sessions give you a separate space, a journey there and back, and the full presence of another person in the room. Online sessions save time, work across cities and countries, and can feel easier if leaving the house is hard. For online sessions, find a private room, use headphones, and give yourself a few quiet minutes before and after, instead of jumping straight from a work call into therapy. Some people combine both, for example meeting in person at the start and continuing online. What matters most is that you feel able to speak openly.
How to get the most out of therapy
- Be as honest as you can, including about doubts and about therapy itself.
- Bring what is on your mind, even if it seems small or unrelated.
- Try things between sessions, if you have agreed on small exercises.
- Give feedback. If something helped or didn’t, say so.
- Be patient with yourself. Change takes time, and setbacks are part of it.
If you are in acute crisis, please do not wait for a therapy appointment. In Germany, call 112, or the Telefonseelsorge on 0800 111 0 111 or 0800 111 0 222 (free, day and night). In Berlin, the Berliner Krisendienst offers help around the clock; its regional numbers are listed at berliner-krisendienst.de.
More about therapy with me.
References
- Bundesministerium für Gesundheit. (n.d.). Psychotherapeutische Sprechstunde. Retrieved November 5, 2026, from https://www.bundesgesundheitsministerium.de/service/begriffe-von-a-z/p/psychotherapeutische-sprechstunde.html
- Greenfield, M. F., Gunthert, K. C., & Haaga, D. A. (2011). Sudden gains versus gradual gains in a psychotherapy training clinic. Journal of Clinical Psychology, 67(1), 17–30. https://doi.org/10.1002/jclp.20748
- Koole, S. L., & Tschacher, W. (2016). Synchrony in psychotherapy: A review and an integrative framework for the therapeutic alliance. Frontiers in Psychology, 7, 862. https://doi.org/10.3389/fpsyg.2016.00862
- Saxon, D., Firth, N., & Barkham, M. (2017). The relationship between therapist effects and therapy delivery factors: Therapy modality, dosage, and non-completion. Administration and Policy in Mental Health, 44(5), 705–715. https://doi.org/10.1007/s10488-016-0750-5
This article is exploratory and meant for information and reflection. It cannot capture the full complexity of any individual situation, and your own experience may be different. It does not replace a diagnosis or treatment.
