If you’ve never done therapy at all, or never done it over video, the uncertainty about the first session is often bigger than any uncertainty about the therapy itself. Will it feel like a job interview? Do you need to have your whole life story ready? What if the connection drops halfway through something important? These are reasonable questions, and the honest answer to most of them is that a first online session is less formal, and less high-stakes, than people expect.

Before the Session

A few practical things are worth sorting out ahead of time, mostly so they’re not competing for your attention during the session itself:

• Test the connection once, in advance. A short test call, even with a friend, tells you more about your actual setup than assuming your usual video-call app will behave the same way it always does.
• Find a space with a door. It doesn’t need to be a home office — a bedroom, a parked car, a quiet corner works. What matters is that you won’t be interrupted and won’t be worried about being overheard.
• Headphones help more than people expect. They reduce the chance of sound issues and make the conversation feel more contained and private, especially in a shared living space.
• Have water nearby, and give yourself a buffer afterward. First sessions can bring up more than people anticipate; walking straight into a work call five minutes later isn’t ideal if you can avoid it.

How the First Session Actually Starts

Most first sessions open with something close to ordinary conversation, not a formal interview. A therapist will typically ask what’s brought you to therapy now, in your own words, and let you take that wherever feels natural rather than working through a rigid checklist. You don’t need a polished summary of your life prepared in advance — a rough, honest starting point (“things have felt harder than usual since I moved” or “my partner and I keep having the same argument”) is entirely enough to begin.

There’s usually some practical housekeeping too — confirming confidentiality and its limits, how scheduling and cancellations work, and answering any logistical questions you have about the format itself. This tends to take a few minutes, not the whole session.

What Actually Gets Covered

In our practice specifically, a first session generally moves through a few things, though not in a rigid order:

1. What’s brought you to therapy now — the immediate concern, in whatever form it takes.
2. Relevant background — not your entire history in one sitting, but enough context to understand the present concern.
3. What you’re hoping for — sometimes this is clear (“I want to stop feeling anxious all the time”), sometimes it’s vaguer (“I just know something needs to change”), and both are workable starting points.
4. Whether the fit feels right — from both sides. A first session is also, quietly, an assessment of whether this particular therapist and approach seem like a good match for what you need.

It’s rarely a full diagnostic interview, and it’s not supposed to solve anything in one sitting. Its main job is to open the door wide enough that a second session makes sense.

What a First Session Is Not

• It’s not a test you can pass or fail. There’s no “wrong” way to answer a question or describe what’s going on for you.
• It’s not a full commitment. Most practices, including ours, treat the first session as exploratory — a chance to see whether it’s a good fit before either side commits further.
• It’s not going to look dramatically different because it’s on a screen rather than in a room. The content and structure of the conversation are largely the same; what changes is the medium, not the substance.

Common Concerns About the Video Format

What if my internet cuts out?

It happens occasionally, and it’s rarely a crisis. Most therapists will simply reconnect and pick up where you left off, or switch briefly to a phone call if the connection is genuinely unstable. It’s worth agreeing on a backup plan (a phone number, for instance) at the start of the first session so neither of you is scrambling if it happens.

What if I get emotional on camera?

This is one of the most common worries, and in practice it tends to matter far less than people expect. A well-framed camera still shows enough — your face, your posture, your voice — for a therapist to notice and respond to what’s happening, and most people report that after the first few minutes, the fact that it’s a screen fades into the background.

What if it feels awkward or stilted at first?

Some initial awkwardness is completely normal, in person or online — it’s a first conversation with a stranger about difficult things, which is inherently a little strange no matter the format. Research on therapeutic alliance in video-based therapy consistently finds that a genuine working relationship forms over video about as readily as it does in person, once past that initial adjustment.¹

If It’s a First Session for Couples, Not Just Individuals

A first online couples session has a few of its own practicalities worth planning for. Both partners generally need to join from the same call, which usually means being in the same room together, sitting where both faces are clearly visible to the camera rather than one partner half out of frame. If you’re joining from two different locations — one of you traveling, for instance — that’s workable too, but it’s worth mentioning to the therapist beforehand so they can set the session up accordingly.

Content-wise, a first couples session usually spends time hearing from both partners individually about what’s brought them in, alongside observing how the two of you interact in the moment — which is often at least as informative as anything either partner says directly. If one partner is more hesitant about therapy than the other, a good first session makes room for that too, rather than assuming equal enthusiasm from both sides.

After the First Session

Most people leave a first session with a fairly clear sense of whether the fit feels workable, even if the specific issue they came in with is far from resolved (it usually is, and that’s expected). If it feels right, the natural next step is simply scheduling a second session and continuing from there — most ongoing work then settles into a regular weekly or biweekly rhythm, and a small proportion of people start weekly before spacing sessions out further apart as things stabilize. If it doesn’t feel right, a good therapist would rather hear that directly and, where possible, help point you toward a better fit than have you disappear without feedback.

One small, practical habit that helps more than people expect: block out a few quiet minutes immediately after the session, even just to sit with a cup of tea, before moving straight into whatever comes next in your day. First sessions can surface more than anticipated, and a small buffer afterward tends to make that easier to sit with.

How This Works With Us

Our own first sessions run through Google Meet, are exploratory by design, and are followed — if it’s a good fit — by regular weekly sessions with the same therapist going forward. You can read more about the full process, including pricing and how we approach ISTDP and EFT couples work specifically over video, on our online therapy for expats page. If you’re weighing us up against other options first, our honest comparison of online therapy options for expats is a reasonable place to start, and if you’d rather just ask a question before booking anything, you’re welcome to get in touch directly.

1. Simpson, S. G., & Reid, C. L. (2014). Therapeutic alliance in videoconferencing psychotherapy: A review. Australian Journal of Rural Health, 22(6), 280–299.