What to Expect in the First Therapy Session (A Guide for Anxious Perfectionists)
If you haven’t been to perfectionism therapy before (or if it’s been a while), you might feel hesitant or even a little on edge about starting. That initial reach-out to a therapist can sometimes be the hardest step, especially when your anxious brain is already running through every possible scenario of what could happen in that first session.
As an online therapist for perfectionism in New York who works with anxious perfectionists, a really common question I get is: “What should I expect in the first therapy session?”
So, if you're the type who likes to be prepared (because, same), or you just want to feel a little more grounded before getting started, this guide is for you.
While every therapist has their own approach, I’ll walk you through what generally happens in a first session—with some insight into how I personally handle it in my own practice.
Expect to Feel a Mix of Emotions (and Know That’s Normal!)
It’s totally normal to feel anxious coming into your first therapy session. You’re about to share personal things with someone new, and that can bring up all kinds of feelings. On top of that, if you’re a perfectionist, you might feel internal pressure to “do therapy right,” be self-aware enough, or make a good impression.
All of that is really common. It might not feel great, but it makes a lot of sense. Plus, that tends to fade as you get more comfortable with your therapist and with the process itself.
Alongside that anxiety, though, you might also feel relief—that you’re finally getting things off your chest. Maybe excitement, too—about starting to work toward the life and mindset you really want. Maybe you’re feeling motivated to dig into things that have been weighing on you, or to finally get support with tools that have been tough to figure out or practice on your own.
You might feel hopeful, overwhelmed, energized, uncertain… sometimes all in the same session. And yes, sadness or overwhelm can come up too, especially if you start talking about painful things you haven’t shared out loud in a long time (or maybe ever). That’s okay. You can always tell your therapist if you need to slow down or pause—and ideally, they’ll be attuned enough to check in and offer that themselves.
Basically, whatever you're feeling in that first session is okay. There's no “right” way to do it. You’re not supposed to have it all figured out. Just showing up is enough.
The First Few Minutes of a Therapy Session: What Actually Happens
By the time the session comes, you’ve probably already had a free consult call (basically, the vibe check) and filled out your intake paperwork. At the beginning of the session, your therapist might review a few of the logistics—confidentiality, cancellation policies, payment, etc.—just to make sure everything’s clear. This part is usually pretty quick, but you can always ask questions if anything doesn’t make sense or you’d like more clarity.
Even though it’s just covering logistical details, making sure you’re both on the same page can be helpful, and it’s a nice way to ease into the session before going too deep.
The Focus of the First Perfectionism Therapy Session
Most first sessions are what's called an intake session. It tends to be a little more structured than future sessions and is really meant to get context about what you’re struggling with, how it’s affecting you, and where you want to go from here. It also gives you a chance to start getting to know your therapist and ease into the process.
Your therapist for perfectionism will probably ask a bunch of questions and might take some notes (even if they don’t usually do that in later sessions). There may be some natural conversation, but it’s not typically the session where you’re doing deep therapeutic “work” yet. You're easing in, because you really can’t jump in without some background, trust, and context first.
Some therapists are more structured, while others are more conversational. Personally, I try to balance both: guiding the session through certain key areas, but also letting clients share at their own pace, following what feels most important in the moment.
And if you’re wondering, “Is the first therapy session awkward?”—it might feel that way at first. Your therapist knows it can feel a bit weird in the beginning (and they’re not fazed by it). It usually gets easier as the session goes on—and as you get more comfortable just being yourself.
You’re not expected to have it all figured out or come in with a script. The first session is mostly about starting to explore and share a little—not performing or solving everything right away.
What Do You Actually Talk About in the First Therapy Session?
Great question 😊 In a typical intake session with me, here’s what we often cover:
More details about the issue(s) you’re coming in with—what symptoms or struggles you’re experiencing, how long they’ve been happening, how they’re impacting your life
Any previous experience with perfectionism therapy, or mental health diagnoses
Current routines and habits (like sleep, eating, and other lifestyle habits or coping strategies)
Medical or medication history (just briefly)
Family background and important relationships
Anything else you’d like to bring up or that comes up naturally in conversation!
We don’t go super deep into everything right away—the first session is more of a starting point. There’s no pressure to share your entire life story in one session (and honestly, it’s often more helpful to ease into some of those details over time). If something important comes to mind later, you can always bring it up next time.
A Few Other Things That Might Happen
Assessments – Some therapists send symptom checklists ahead of time (for things like anxiety or depression), and they might briefly go over them during your session.
Emotional Check-ins - Your therapist for perfectionism might pause at a few points to ask how you're feeling. This is also your chance to say if something feels off or overwhelming.
Talking About Fit - Toward the end, your therapist may ask if it feels like a good fit, and whether you’d like to schedule another session. If it doesn't feel right, that’s okay! A good therapist will support you in finding someone who might be a better match.
How Does the First Therapy Session End?
Usually, you’ll spend the last few minutes:
Talking about whether you’d like to continue
Scheduling your next session (and making sure the day/time you chose still works for you)
Briefly discussing your goals or what you'd like to focus on moving forward
Sometimes people feel unsure after a first session—and that’s totally okay. You don’t have to decide everything right away. You’re allowed to take time to feel it out, whether that’s trying out another session, scheduling one and changing your mind later, or holding off on scheduling as you think about it.
You Don’t Have to Be “Ready” to Start Perfectionism Therapy
Even after reading this, you still might not feel 100% ready—and that’s okay! Starting therapy is a big step, especially if you’re used to managing things on your own (or trying to get it all “right”).
But the good news is, you don’t have to plan everything out or show up perfectly. You don’t have to impress your therapist. You just have to show up.
Starting therapy is one of the most self-compassionate things you can do. And your first session is just the beginning. You’ll get to take things one step at a time, with support.
Starting Perfectionism Therapy in New York Doesn’t Have to Feel So Intimidating
If you’re feeling a little anxious about what to expect in your first therapy session, you’re not alone—and you’re not doing it wrong. From my Garden City–based practice, I support anxious perfectionists who want to feel prepared but aren’t totally sure how to begin—and that’s completely okay. In perfectionism therapy, we go at your pace, starting with support and curiosity—not pressure. You don’t have to have it all figured out to get started. You just have to be open to taking the next small step.
Learn more about how I support anxious perfectionists like you
The first session isn’t a test—it’s just a beginning. You’re allowed to feel uncertain and show up anyway.
Other Therapy Services at Balanced Connection Counseling
If starting therapy feels like a lot—and perfectionism isn’t the only thing showing up—you’re not alone. Patterns like anxiety, burnout, and people-pleasing often go hand-in-hand, adding more pressure to already-full plates. That’s why I offer therapy not just for perfectionism, but also for the things that tend to make getting support feel harder than it should. If you're quietly wondering what it would be like to have space to focus on you for once, therapy can be a good place to start.
About the Author
Adina Babad, LMHC-D, is a Licensed Mental Health Counselor who offers online therapy for anxious perfectionists throughout New York. She works with women who are used to thinking things through from every angle—trying to be prepared, trying to do it right, and still feeling unsure where to begin. With compassion, clinical grounding, and lived understanding, Adina helps clients quiet the pressure to have it all figured out and start therapy in a way that actually feels manageable. In perfectionism therapy, she offers space to be human—not perfect—so you can begin showing up for yourself with care and curiosity.