The initial therapy session is one of the most essential stages of psychological treatment. It sets the tone for the therapeutic relationship, establishes trust, and gathers essential information to guide treatment planning. A well-structured first session ensures that therapy is tailored to the client’s unique needs while maintaining a strong clinical foundation. This guide will walk you through:
✅ How to structure an effective first session
✅ Key information to gather for case formulation
✅ Best practices for building rapport and assessing risk
I used to tell my clients that initial sessions are not like regular therapy sessions. They are about me getting to know you and the problem better so I can go away and devise a plan to best assist you. My first sessions are very structured, with a set of questions that I deem 'essential' to know, and others that are 'nice to know' if time permits.
The point of an initial session is to gather enough information to develop a case formulation and treatment plan. This ensures we are using evidence-based methods, taking the time to consider the person and the problem, and tailoring treatment to suit them as an individual.
How to Structure an Initial Therapy Session
Here are some key elements that I include in every first session.
1. Establish a Therapeutic Alliance
The initial session is more than just an assessment—it is our first opportunity to build rapport and set the foundation for the therapeutic process. This means:
✔ Creating a warm and welcoming environment so the client feels safe.
✔ Explaining my approach to therapy in a way that is clear and engaging.
✔ Letting the client know that this session is about me understanding their concerns so I can help them in the best way possible.
💡 Tip: Don’t lose sight of this while conducting your clinical interview! If the client doesn’t feel comfortable or connected in this first session, therapy may not progress effectively.
2. Gather Key Clinical Information
This session is not just a conversation—it is an opportunity to gather relevant clinical information to guide treatment. I use this time to explore:
✔ Presenting Problem – What brought them to therapy? What symptoms are they experiencing?
✔ Mental Health & Medical History – Any prior diagnoses or medications?
✔ Substance Use – Past or current issues with drugs/alcohol?
✔ Previous Therapy Experience – Have they seen a psychologist before? What worked or didn’t work?
✔ Cognitive, Emotional & Behavioural Symptoms – What thoughts, feelings, and behaviours are associated with the issue?
✔ Triggers & Maintaining Factors – What worsens or reinforces the problem?
✔ Risk Assessment – Any suicidal ideation, self-harm, or risk to others?
I ensure that I balance structure with flexibility—capturing the most critical information without overwhelming the client.
3. Assess for Urgency & Risk
One of the most important components of an initial assessment is identifying whether the client is at risk of harm to themselves or others.
I always assess for:
✔ Suicidality & self-harm – Has the client had thoughts of harming themselves? Any history of attempts?
✔ Harm to others – Any concerns about aggression or risk of harm to others?
✔ Other high-risk factors – Substance use, disordered eating, or significant distress.
💡 Tip: Being competent in risk assessment and safety planning is not optional—it is a critical skill that all psychologists need to have as it saves lives. I have a comprehensive CPD training program designed for allied health professionals which will provide you with the knowledge of how to conduct a thorough risk assessment and create a safety plan here.
4. Explain the Therapy Process & Obtain Consent
Many clients don’t know what to expect from therapy. I always make sure to:
✔ Explain the therapy modalities I intend to use for their presenting problem (e.g., CBT, ACT, IPT).
✔ Clarify session frequency and estimated treatment duration.
✔ Discuss confidentiality and its limitations (e.g., mandatory reporting laws).
✔ Obtain informed consent before proceeding with treatment.
💡 Tip: Clients who understand the therapy process from the start are more likely to stay engaged in treatment.
5. Develop an Initial Case Formulation
By the end of the session, I want to have a working hypothesis of what is going on for the client. I use case formulation to understand:
✔ Predisposing factors – What long-term issues may have contributed to this problem?
✔ Precipitating factors – What triggered it or made it worse recently?
✔ Perpetuating factors – What is keeping the problem going?
✔ Protective factors – What strengths does the client have to support change?
This helps me develop a tailored treatment plan that considers both the client’s challenges and their strengths.
6. Set Therapy Goals
I ask the client: “What do you hope will improve with therapy?”
We work together to set realistic and meaningful goals. It is important to be guided by the client's priorities for therapy. The only exception to this is where the client is considered 'high risk' and that would need to be the pririty for treatment before moving to their other goals.
💡 Tip: Goal setting increases motivation. When clients see progress, they are more engaged in therapy
7. Schedule the Next Session & Provide Next Steps
Before the session ends, I make sure to:
✔ Schedule the next appointment.
✔ Provide any psychoeducation or homework if relevant.
✔ Address any final concerns the client has.
Final Thoughts: Why the First Therapy Session Matters
In the initial session, the goal is to gather enough information about the presenting problem and the perpetuating factors so that you can develop an effective treatment plan. I want my first session to be thorough but efficient—capturing the most relevant details without turning the assessment process into multiple sessions. Our clients often come to us in distress, so I aim to start treatment as soon as possible—ideally by the second session.
A well-conducted initial session is more than just an information-gathering exercise. It is where we build rapport, gain trust, and set the stage for meaningful therapeutic work. Getting this session right can determine how engaged a client remains in therapy and how well the treatment progresses.
💡 Want to refine your initial session skills? My self-paced CPD training, Elements of a Good Initial Assessment, provides structured guidance on making your first session effective, client-centred, and clinically sound. Check it out here.
You may also find my clinical templates for note taking in initial assessments beneficial. You can look at those here.