YOUR FIRST THERAPY CONSULTATION

Clinical examples in this article are fictional composites created for educational purposes and do not describe any one client.

You’ve done the research. You’ve found a therapist. You’re about to book a first consultation, and you have no idea what to expect. Here’s the first thing to understand: your whole life won’t fit into 20 minutes, and it doesn’t need to. You’re not there to tell the whole story. You’re there to find out whether this person can help with it.

The therapist is checking whether what you’re dealing with fits their practice and their expertise. You should be doing exactly the same in reverse. Most people go in passive, waiting to be evaluated, hoping to make a good impression. Flip it. You’re the one deciding whether to put your time and money here. It’s like hiring a personal trainer: you’d want to know they’ve actually coached the lift you’re trying to learn.

What Happens in a First Therapy Consultation?

You say briefly what brings you in, the therapist checks whether it fits their work, and then you ask your questions. Ours is 20 minutes. Some therapists run it as a structured intake call with a set list of questions. Others keep it conversational. Either is fine. What matters is what happens in that window.

Start with the short version. You don’t need to give a complete history. One or two sentences is enough: “I’ve been struggling with intrusive thoughts about harm for about two years. They’ve gotten worse recently and I’ve started avoiding certain situations.” That’s enough for a therapist to tell whether your concern is in their wheelhouse. On my calls, I’m listening for a shape: a thought that shows up uninvited, then something you do, out loud or in your head, to make the feeling go away. If that shape is there, the next question is whether ERP fits you.

Then it should turn into a real exchange. They might ask a clarifying question or two. Then it’s your turn. If a therapist talks through the whole call without leaving room for your questions, that’s data about how sessions will feel.

Which Two Questions Matter Most?

How you feel with this person, and whether they know your specific concern. You can walk in with a long list of questions, but if I had to narrow it down, I’d pick those two.

Question 1: How do I feel with this person? This isn’t about feeling perfectly relaxed. That’s an unrealistic standard for a 20-minute call with a stranger. You’re noticing something subtler. Are they curious? Are they actually listening, or just waiting to talk? Could you say the hard thing to this person? The working relationship between you and your therapist is one of the most consistent predictors of outcome across different kinds of therapy (Flückiger et al., 2018). In OCD treatment the link is more modest, and agreeing on goals and tasks matters (Strappini et al., 2022). In the consultation, you’re getting your first look at that relationship.

Question 2: Do they have experience with my specific concern? This is the question most people are too polite to ask directly. Don’t be. If you’re dealing with OCD, you want a therapist who knows ERP, not just general CBT. OCD work and general anxiety work aren’t the same job, so this isn’t a small detail. Ask directly: “How much of your practice is OCD? How many clients are you currently seeing with this?” A therapist who works with OCD will answer with specifics. Vague answers are an answer too. Knowing OCD is a different question from having lived it, and here’s whether your therapist needs to share your experience.

What Questions Do Most People Forget to Ask?

Price, when therapy ends, how they handle feedback, and what their own jargon means. People routinely skip these and later wish they hadn’t.

Does the price work? Ask this directly. Ask about sliding scale if the rate is a stretch. It’s a practical question, and most therapists expect it. If they don’t have sliding scale available, they’ll tell you. If they do, asking is the only way to find out. Our own rates are on the fees page.

When is therapy over, in your view? This question reveals a lot about a therapist’s philosophy. A good answer involves some version of: named goals, observable progress, and a point at which you’ve built what you came to build and don’t need to keep coming. A vague answer, like “it’s different for everyone, there’s no fixed timeline,” isn’t necessarily wrong, but push for more. You want to know whether they’re working toward an ending or toward ongoing support. That often comes down to which of the two types of therapy they practise. My answer is always the same: the goal is that you fire us for the right reasons.

What’s your philosophy on feedback? Do they routinely ask clients how sessions are going? Do they adjust when things aren’t working? Research shows that regularly tracking progress and feeding it back into therapy gives a small but real improvement in outcomes (de Jong et al., 2021). How they answer tells you whether they check their own work.

What does [something from their website] actually mean? If their website mentions “somatic approaches” or “parts work” or “trauma-informed care,” ask them to explain it in plain language. How clearly they explain it tells you something about how they’ll communicate in sessions. If it comes out as jargon, that’s a signal.

What If You’re Not Sure?

You don’t have to decide at the end of the consultation. “I’d like some time to think about it” is a completely reasonable thing to say. A therapist who pressures you to book immediately after a 20-minute call is not starting well.

If you’re genuinely uncertain after one consultation, see another therapist. It isn’t disloyal and it isn’t wasteful. Booking a first paid session with two or three therapists before committing is not uncommon, and often it’s the right call. Treat it like any other important hire: you’d want to compare candidates before you choose.

Pay attention to what your uncertainty is about. Is it that you liked the therapist but have some logistical concerns about price or schedule? That’s one thing, and worth working through. Is it that something felt off about how they responded to your questions, or you got a sense they were more interested in booking a session than actually understanding your situation? That’s different information, and it deserves weight.

For OCD specifically: if you’ve found a therapist who clearly knows ERP and the fit feels reasonable, that combination is worth a lot. In my view, with OCD, a structured, goal-directed approach from someone who knows the work often matters more than perfect rapport. Ideally you get both.

What Practical Details Should You Sort Out?

Format, frequency, cancellation policy and contact between sessions. Get these clear during or after the consultation.

Format. Are sessions in-person, virtual, or both? Research on video-delivered mental health care finds outcomes broadly comparable to in-person care (Batastini et al., 2021). If you have a strong preference either way, or if your concern specifically warrants in-person work (some ERP exercises may benefit from it), clarify this early. For OCD specifically, here’s how online and in-person ERP compare in Ontario.

Frequency. Weekly sessions are standard, particularly early in treatment. If a therapist immediately proposes biweekly sessions without a clear rationale, ask why. Early phase of treatment generally benefits from higher frequency.

Cancellation policy. Most therapists have a 24 or 48-hour cancellation window with a fee for late cancellations. This is reasonable and standard. Know it before you start.

Communication between sessions. Can you reach them between sessions if something comes up? What’s the expected response time? What’s the policy on this? Clarity here prevents a lot of frustration later.

Once you’ve found someone who clears the bar, read about what should actually happen in your first full therapy session. And know that if, after several sessions, something doesn’t feel right, it’s entirely legitimate to revisit the question of when to leave your therapist.