What happens in a first session

A first session runs about 50 minutes to an hour. Most of it is your therapist getting the picture, and the two of you working out whether you can work together. They’ll ask a lot of questions, many of them practical. You won’t be given a diagnosis, you won’t be asked to tell the whole story at once, and anything decided can be changed later.

What to bring

Not much.

Your Medicare Australia's public health insurance scheme. For mental health, it gives rebates on sessions with psychologists and some other professionals, usually through a Mental Health Treatment Plan. More in the jargon decoder card, if you have a Mental Health Treatment Plan.
The Referral A letter from a GP, psychiatrist or paediatrician that you need for the Medicare rebate. You can see a psychologist without one if you pay the full fee. More in the jargon decoder and the plan itself, if your GP (general practitioner) For most people, where getting help starts. A GP can write a Mental Health Treatment Plan, prescribe medication and refer you on, and some are trained to deliver a small number of structured therapy sessions themselves. More in the jargon decoder gave them to you rather than sending them straight to the practice. Plenty of GPs email them ahead — worth checking, so you don’t arrive and find the Rebate The amount Medicare pays back towards a session. It comes back to you after you've paid, so what you pay yourself is the fee minus the rebate. More in the jargon decoder can’t be claimed.
A list of any medications you take, including the doses if you know them.
Your GP’s name and practice, in case your therapist writes back to them.

You don’t need to have worked out what to say. “I don’t really know where to start” is a normal opening and your therapist will take it from there.

The forms

Most practices send an intake form ahead of the appointment, or hand you one in the waiting room. It asks for contact details, your GP, medications, and a short description of what’s bringing you in.

You’ll also sign a consent form. It’s worth reading rather than skimming, because it sets out three things you’ll want to know:

What’s confidential and what isn’t. Your therapist should also explain this out loud. Broadly, the limits are a serious risk to someone’s life, a court order or subpoena, and in some states and professions a duty to report concerns about a child’s safety.
What it costs, including the cancellation policy. Most practices charge a fee for cancelling inside 24 or 48 hours, and Medicare doesn’t pay a rebate on a session you didn’t attend.
How your information is stored, and who else in the practice can see it.

Ask about anything in it you don’t understand.

What your therapist will ask

The first part is a wide sweep rather than a deep dig. Expect questions about sleep, eating, alcohol and other drugs, work or study, and who you’ve got around you. Then how long this has been going on, and whether anything like it has happened before. What therapy actually is sets out that ground in more detail.

Three questions are worth thinking about beforehand, because your answers shape the sessions that follow.

What would you like to be different? Your answer doesn’t have to be tidy. “I want to stop dreading Sunday nights” is a better starting point than a diagnosis.

What have you already tried? Therapy you’ve had before, what helped in it, what didn’t, medication, courses, anything you worked out for yourself. This is the single most useful thing you can bring, and it stops you being offered the thing that already failed.

How would you like to work? Some people want exercises and structure. Some want to talk and be listened to closely. If you have a preference, say it — it’s a reasonable thing to want and it’s easier to act on in session one than in session six.

The questionnaires

Many therapists ask you to fill in a short questionnaire at the start, and again every few sessions. You’ll see forms with names like the K10 or the DASS-21, which are short lists of questions about how you’ve been feeling lately.

They exist to track change over time, so that “I think things are a bit better” has something behind it. They aren’t an exam, they don’t decide whether you’re eligible for anything, and no number on them is a verdict about you. If you’d rather not fill one in, say so.

The question about safety

Your therapist will usually ask whether you’ve been having thoughts of hurting yourself or of not wanting to be here. It’s asked of most people, in the first session, as a matter of routine.

People are often cautious about how they answer this question, usually out of a fear that a truthful answer sets off something they can’t stop. Most of the time it doesn’t. Your therapist asks more about it, you talk through what helps and what makes it worse, and you agree what you’d do on a bad night.

Sometimes a therapist does need to involve someone else, for example when they believe your safety, or someone else’s, is at serious risk. Where they can, they’ll talk it through with you first. If you’re under 18, that can include a parent or carer. Your therapist should explain their limits at the start, and it’s fine to ask before you answer: “When would you have to tell someone?”

If you need support before the appointment, Lifeline is on 13 11 14, the Suicide Call Back Service is on 1300 659 467, and Kids Helpline is on 1800 55 1800 for anyone aged 5 to 25. In an emergency, call 000. Crisis and emergency support has the full list.

What you can ask them

A first session goes both ways, and these are ordinary questions that therapists are used to being asked.

What Approach (modality) The kind of therapy someone uses, such as CBT or psychodynamic therapy. You'll also see it called a modality. More in the jargon decoder do you mostly work with, and what would that look like for me?
Have you worked with this kind of thing before?
Roughly how many sessions do people usually need for something like this?
How often would we meet, and would that change?
What happens if I don’t think it’s working?
What do you charge, and what’s the cancellation policy?

Questions to ask a therapist before you book has a longer list you can take with you.

Paying, and claiming

You generally pay at the end of the session. If you have a treatment plan and the practice has the terminal for it, they’ll process the Medicare rebate on the spot. It lands in your bank account within a day or two. Otherwise you pay the full fee, they give you an invoice, and you claim it yourself through the Medicare app or online.

You pay the whole amount either way. The rebate comes back to you afterwards — it isn’t taken off at the counter.

If the fee is a problem, say so in the first phone call rather than in session one. Some practices keep a small number of reduced-fee places, and some will space sessions out to make them affordable.

If the session is by video or phone

Telehealth A session by video or phone instead of in person. Medicare gives the same rebate for a session by video as in person. More in the jargon decoder first sessions work much the same as in-person ones, with a few practical differences.

Find somewhere you can’t be overheard, and use headphones if anyone else is home. Your therapist will ask where you’re calling from, and for a phone number they can ring if the connection drops. That’s a standard safety step.

If you have the option and aren’t sure which to choose, do the first session face to face.

Afterwards

People come out of a first session feeling all sorts of ways. Lighter, because someone finally has the whole picture. Tired, because talking for an hour is more work than it sounds. Exposed, if you said more than you meant to. Sometimes flat: nothing was solved, and you knew most of what you said already.

All of those are ordinary, and none of them tells you much yet about whether the therapy will help.

Deciding whether to go back

Early sessions are awkward for nearly everyone, and it usually takes three or four before you can tell whether this is someone you can work with. Why who you see matters more than what they do explains why how you get on with them matters so much.

Some things are worth acting on straight away, though. If you felt judged, talked over or rushed, or if the therapist seemed uninterested in what you came for, you don’t have to go back. You don’t owe anyone an explanation either. Ringing to cancel is enough.

If you’d like to keep going with someone else, how to find a therapist covers where to look. If you’re partway through a treatment plan, ask your GP or the new practice how the referral transfers.

If you’re under 18

The shape of a first session is much the same. What can differ is whether your parents are involved, and how. That depends on your age, on the service and on the state you’re in. When you book, ask the practice what applies to you.

headspace and services for 12 to 25s sets out the services built for younger people, including what they cost and how to get in.