Your first online therapy session: preparation checklist and questions to ask

By CBT Guide USA editorial team · Updated 2026-11-08 · Editorial policy

A first therapy session is mostly about getting to know each other and agreeing what to work on. A little preparation helps you use the time well.

Short answer: Before the session, test your tech, find a private spot and jot down why you are seeking help now and what you want to change. During it, expect questions about your current difficulties and background, an explanation of confidentiality and a rough plan. Ask about the therapist's license, approach, how progress will be measured and what happens in an emergency.

Preparation checklist

The day before

Confirm the session time and time zone, and whether it is video, phone or text.
Test the app or link, camera, microphone and headphones.
Plan a private space where you will not be overheard or interrupted for the whole session.
Have a backup: a phone number to call if video fails.

Notes to bring (a few lines is enough)

Why now: what made you look for help at this point.
The two or three main problems, with one concrete example of each.
How they affect sleep, work or study, relationships and daily routine.
One or two goals, written as things you would do differently, for example "answer emails without putting them off for days".
Any past therapy: what helped, what did not.
Current medications and any health conditions.
Anything you are not ready to talk about yet (you can say so).

Ten minutes before

Close other apps, silence notifications, have water nearby.
Know the address where you are, in case your therapist asks for your location.

What usually happens

Most first sessions follow a similar pattern, though every therapist works differently:

Housekeeping. Confirming your identity and location, how sessions and messaging work, fees and cancellation. For telehealth, rules in some states require this. California's Board of Behavioral Sciences, for example, requires its licensees to obtain consent to telehealth, explain its risks and limitations, give their license number and confirm the client's location at the start of each session.
Confidentiality. What stays private and the limits, such as a serious risk of harm.
Assessment. Questions about what is going on now, your history, health, relationships and safety. You may be asked about thoughts of self-harm. This is routine and helps keep you safe.
Questionnaires. Many therapists use short symptom scales to track progress over time.
Goals and next steps. A first idea of what you will work on and how often you will meet. In CBT you may leave with a small task, such as noting moods during the week.

Do not expect to tell your whole story or feel better in one session. The aim is a shared starting point. For a picture of the weeks after, see online therapy week by week.

Questions to ask your therapist

The National Institute of Mental Health suggests asking therapists about their credentials, approach, goals and how progress is measured. Here is a practical list built around those topics:

Topic	Questions
License	What is your license type and number? Which states are you licensed in? Can I see you if I travel?
Experience	Have you worked with people with problems like mine? What training do you have in CBT or other approaches?
Approach	What approach do you use and why? What does a typical session look like? Will there be homework?
Progress	How will we know if this is working? When will we review progress? What happens if it is not helping?
Length	Roughly how many sessions do you expect? How often will we meet?
Between sessions	Can I message you? How quickly do you usually reply? Do you reply on weekends?
Emergencies	What should I do in a crisis? Who do you contact if you are worried about my safety?
Medication	Can you prescribe, or work with someone who does, if I need it?
Privacy	Are sessions recorded? Who can see my messages and notes?
Costs	What does it cost after any introductory price? Can I get receipts for insurance or an HSA/FSA?

Many of these are worth checking before you even book. Our guide on how to choose a therapist covers how to look up a license with your state board.

Hypothetical example. Sam, 34, signs up for online therapy because of low mood and poor sleep since a job change. Sam's notes say: "Why now: I've called in sick twice this month. Goals: get to bed before midnight on work nights; see a friend once a week. Past: saw a counselor in college, liked the practical stuff." In the session, Sam asks how progress will be measured. The therapist suggests a short mood questionnaire every two weeks and a review after the first month. Sam leaves with one task: write down what they did each evening and rate their mood from 0 to 10.

After the session

Write down two or three things you took away and any task you agreed to.
Notice how you felt with the therapist: heard, rushed, judged, comfortable? Fit matters.
Expect to feel a little drained. That is common after talking about hard things.
If it did not fit, say so next time, or switch. Online-Therapy.com, for instance, says you can switch therapist at any time from your dashboard.
Check that progress gets reviewed. For depression, NICE guidance recommends reviewing how well treatment is working between 2 and 4 weeks after starting.

Online therapy is not an emergency service. If you are thinking about suicide or self-harm, call or text 988 (US) or call 911. See crisis resources.

If you are starting therapy for low mood, our online therapy for depression guide explains what to expect and when other care is needed. New to CBT? Read what is CBT and see CBT techniques with worked examples.

Frequently asked questions

What happens in the first therapy session?

Usually an assessment. The therapist asks what brings you to therapy, how it affects daily life, your history and what you want to change. They explain confidentiality and how sessions will work. You may fill in short questionnaires.

What should I say in my first therapy session?

Start with what made you look for help now, and one or two things you want to be different. You do not need a polished story. It is fine to say you do not know where to start.

Do I have to talk about my childhood?

Not unless it is relevant and you are ready. CBT focuses mainly on current problems, though past experiences may come up. You can tell your therapist if a topic feels like too much for now.

Is it normal to feel worse after the first session?

Talking about difficult things can leave you tired or stirred up for a day or so. Tell your therapist next time. If you feel unsafe at any point, call or text 988 in the US, or 911 in an emergency.

What if I don't like my therapist?

Give it a couple of sessions unless something is clearly wrong, and say what is not working; good therapists welcome feedback. If it still does not fit, switching is normal. Many online services, including Online-Therapy.com, let you switch from your account.