You’ve made the decision to seek therapy—a brave and important step toward taking care of your mental health. But now, as your first appointment approaches, you might be feeling anxious, uncertain, or even tempted to cancel. What will happen in that room? What if the therapist judges you? What should you say? What if you cry? What if you don’t know how to talk about what’s bothering you?

These concerns are completely normal. Walking into therapy for the first time feels vulnerable and unfamiliar. Understanding what to expect can ease your anxiety and help you get the most out of your first session and the therapeutic process overall.

This comprehensive guide walks you through everything you need to know about your first therapy session in the South African context, from practical preparation to what happens during the session and what comes next.

Before Your First Session: Practical Preparation

Finding the Right Therapist

If you haven’t already chosen a therapist, here are some considerations specific to South Africa:

Qualifications: Look for registered mental health professionals. In South Africa, this includes clinical psychologists (registered with the Health Professions Council of South Africa – HPCSA), counseling psychologists, psychiatrists (medical doctors who can prescribe medication), and registered counselors.

Specialization: Some therapists specialize in specific issues (trauma, anxiety, relationships) or populations (children, adolescents, LGBTQ+ individuals). Consider whether you want someone with specific expertise.

Language: South Africa’s multilingualism means you can often find therapists who work in your preferred language. Being able to express yourself in your home language can make therapy feel more comfortable and effective.

Cultural competence: Consider whether you’d prefer a therapist who shares your cultural background or has experience working with your community. Cultural understanding can be important in how mental health is conceptualized and addressed.

Practical factors: Location, availability, session fees, and whether they accept your medical aid are all important practical considerations.

Therapy approach: Different therapists use different approaches (CBT, psychodynamic, person-centered, etc.). Don’t worry if you don’t understand these yet—many therapists use integrative approaches and will explain their methods.

Understanding Costs and Medical Aid

Private therapy costs in South Africa typically range from R500 to R1500+ per session, varying by therapist experience, location, and session length (usually 45-60 minutes).

Medical aid coverage: Most South African medical aids cover a certain number of therapy sessions per year under your Prescribed Minimum Benefits (PMB) or mental health benefits. Check with your medical aid about:

• How many sessions are covered per year
• Whether you need a referral from your GP
• Whether pre-authorization is required
• Your co-payment amount if any
• Whether your therapist is on their provider network

Lower-cost options if cost is a barrier:

• University training clinics offer reduced-fee services provided by supervised intern psychologists
• Some community health centers provide mental health services
• NGOs and community organizations sometimes offer sliding-scale fees
• SADAG can help connect you to affordable options

Employee Assistance Programs (EAP): Many employers offer EAP services providing free, confidential counseling for a limited number of sessions.

What to Bring

For your first session, bring:

• Your ID document
• Medical aid card if applicable
• Any referral letters from your doctor if you have them
• A list of current medications if you’re taking any
• Your phone or a notebook if you want to take notes
• Payment method (check whether they accept cash, card, or EFT)

Optional but helpful:

• Notes about what you want to discuss if you’re worried about forgetting
• Any previous psychological or psychiatric reports if you have them
• Questions you want to ask the therapist

Mental Preparation

It’s okay to be nervous: Almost everyone feels anxious before their first session. Your therapist understands this and will help you feel comfortable.

There’s no “right” way to do therapy: You don’t need to have your thoughts perfectly organized or know exactly what to say. Part of the process is figuring things out together with your therapist.

You’re in control: You decide what to share and at what pace. You can say if something feels too difficult to discuss yet.

Set realistic expectations: The first session is primarily about getting to know each other and understanding your concerns. Major breakthroughs typically don’t happen immediately—therapy is a process.

What Happens During Your First Session

While every therapist has their own style, most first sessions follow a similar general structure:

Introductions and Paperwork (5-10 minutes)

When you arrive, you’ll typically be greeted by your therapist in a waiting area. They’ll introduce themselves and welcome you into their office or therapy room.

Paperwork: Before or at the beginning of your first session, you’ll likely complete some forms:

• Consent to treatment forms
• Privacy and confidentiality agreements
• Medical history questionnaire
• Emergency contact information
• Financial agreement
• Medical aid authorization if applicable

Take your time reading these documents. Ask questions about anything you don’t understand.

Setting the Frame (10-15 minutes)

Your therapist will typically start by explaining how therapy works, including:

Confidentiality: They’ll explain that everything you discuss is confidential, with limited exceptions required by law (risk of harm to yourself or others, child abuse, court orders). In South Africa, psychologists are bound by HPCSA ethical codes regarding confidentiality.

Session structure: How long sessions are, how frequently you’ll meet, how to schedule and cancel appointments, and payment arrangements.

Their approach: A brief explanation of how they work and what you can expect from the therapeutic process.

Your questions: This is a good time to ask any practical questions about therapy.

Collaborative agreement: Therapy works best when therapist and client work together toward shared goals. Your therapist should emphasize that you’re partners in this process.

Gathering Information: Your History (20-30 minutes)

The therapist will ask questions to understand you and your situation. This might feel like an interview, and that’s normal for a first session. They’re gathering information to help you most effectively.

Typical questions might include:

Presenting concerns: “What brings you to therapy?” or “What are you hoping to get help with?” You don’t need to have a perfect answer—just share what’s on your mind.

Current symptoms: Questions about what you’re experiencing now—your mood, sleep, appetite, energy levels, anxiety, stress, relationships, or any other difficulties.

History of the problem: When did you first notice these difficulties? What was happening in your life at that time? How have things changed over time?

Previous mental health treatment: Have you been in therapy before? Have you taken psychiatric medication? What helped and what didn’t?

Medical history: Current physical health, medications, major illnesses or injuries. Physical and mental health are interconnected.

Family background: Information about your family, your upbringing, family mental health history, and important family relationships.

Current life situation: Work or school, relationships, living situation, major stressors, support system.

Strengths and resources: What’s going well in your life? What are your strengths? Who or what supports you?

Goals for therapy: What would you like to be different? What does success in therapy look like to you?

Cultural Sensitivity

In South Africa’s diverse context, a culturally competent therapist should:

• Ask about your cultural background and beliefs
• Inquire how your culture views mental health and healing
• Respect traditional or religious practices
• Consider how issues like race, socioeconomic status, and historical trauma might affect your experiences
• Adapt their approach to fit your worldview where appropriate

If a therapist doesn’t ask about these factors and they’re important to you, feel free to bring them up.

Initial Assessment and Feedback (10-15 minutes)

Based on what you’ve shared, your therapist might:

• Offer their initial understanding of your situation
• Suggest a preliminary diagnosis if applicable (though this often takes several sessions to determine with certainty)
• Discuss treatment options or approaches that might help
• Propose goals for therapy
• Explain what therapy might look like going forward

This is a conversation, not a lecture. You can ask questions, express concerns, or disagree with their assessment.

Planning Next Steps (5-10 minutes)

Before the session ends, you’ll typically discuss:

• Whether you’d like to continue working together
• How frequently to meet (weekly is common for active issues, biweekly or monthly for maintenance)
• What to focus on in upcoming sessions
• Any homework or things to think about before next time
• Scheduling your next appointment

Payment and Logistics

At the end of the session, you’ll typically settle payment. Your therapist should provide you with an invoice for medical aid claims if applicable.

Common First Session Experiences

You Might Cry

Many people cry in their first therapy session, and that’s completely okay. Therapists expect this and are comfortable with emotions. They’ll have tissues available and will give you space to feel what you’re feeling.

Crying doesn’t mean you’re weak—it often means you’re finally in a safe space to express feelings you’ve been holding in.

You Might Feel Worse Before You Feel Better

Talking about difficult things can bring up painful emotions. It’s common to leave your first session feeling emotionally drained or even more upset than when you arrived. This is often a sign that you’re starting to address things you’ve been avoiding.

The discomfort typically eases as you continue therapy and develop coping strategies.

You Might Not Click Immediately

The therapeutic relationship is important, and it’s okay if you don’t immediately feel a strong connection. Give it 2-3 sessions to see if the relationship develops. However, if after several sessions you still feel uncomfortable or unheard, it’s okay to find a different therapist.

You Might Feel Relief

Some people leave their first session feeling lighter, hopeful, or relieved. Just having voiced their struggles and feeling heard can be powerfully validating.

You Might Feel Skeptical

It’s normal to wonder whether therapy will really help or whether the therapist truly understands your situation. These doubts often decrease as therapy progresses and you experience changes.

You Might Not Say Everything

You don’t have to share everything in your first session. Building trust takes time. It’s completely okay to start with what feels safe and gradually share more as you become more comfortable.

What Your Therapist Is Not

It’s helpful to understand what therapy isn’t:

Not advice-giving: Therapists generally don’t tell you what to do. They help you explore options, understand yourself better, and make your own decisions.

Not friendship: The therapeutic relationship is professional and confidential, with boundaries that protect you and the effectiveness of treatment.

Not judgment: Good therapists create a non-judgmental space where you can explore thoughts and feelings without shame.

Not a quick fix: Therapy is a process that takes time. Meaningful change typically doesn’t happen after one session.

Not one-sided: You’ll need to actively participate—doing homework, practicing new skills, and honestly engaging with the process.

Questions You Can (and Should) Ask

Don’t hesitate to ask your therapist questions. Here are some good ones:

About their approach:

• “What therapy approach do you use, and how does it work?”
• “What will our sessions typically look like?”
• “How will we know if therapy is working?”

About logistics:

• “What happens if I need to cancel an appointment?”
• “Can I contact you between sessions if I’m struggling?”
• “How long do you anticipate therapy taking?”

About them:

• “What’s your experience with [your specific issue]?”
• “Have you worked with clients from [your background/culture]?”
• “What’s your training and qualifications?”

About the process:

• “What can I do between sessions to support my progress?”
• “How will we track progress?”
• “What should I do if I disagree with something you suggest?”

Red Flags: When to Find a Different Therapist

While most therapists are ethical and professional, here are signs you should find someone else:

• They breach confidentiality (except in legally required situations)
• They judge, shame, or criticize you
• They impose their values, beliefs, or life choices on you
• They seem distracted, frequently check their phone, or don’t give you full attention
• They make inappropriate comments about your appearance, relationships, or personal life
• They suggest romantic or sexual involvement (this is never acceptable)
• They guarantee results or make unrealistic promises
• They discourage you from seeking medical care when needed
• They insist on a specific course of action without exploring your preferences
• You consistently feel worse after sessions without progress over time
• They’re late frequently, cancel often, or seem disorganized
• They push you to discuss things you’re not ready to discuss

Trust your instincts. If something feels wrong, it probably is.

Cultural Considerations in South African Therapy

Integrating Traditional and Western Approaches

Some South Africans successfully integrate therapy with traditional healing practices. A good therapist should respect your cultural beliefs and be open to working alongside traditional healers if that’s important to you.

Language and Expression

If English isn’t your first language but your therapist only speaks English, don’t hesitate to ask them to explain things differently if you don’t understand. Good therapists will work to ensure clear communication.

Addressing Historical and Social Context

Issues like apartheid’s lasting impacts, ongoing inequality, racism, economic stress, and violence are real factors affecting mental health in South Africa. These aren’t just “individual” problems, and a good therapist should recognize social and historical contexts.

Family and Community

In many South African cultures, family and community are central. Your therapist should understand that individual wellbeing often can’t be separated from family and community wellbeing.

After Your First Session

Reflection

Take some time after your first session to reflect:

• How did you feel during and after the session?
• Did you feel heard and understood?
• Do you think you could work with this therapist?
• Were your questions answered?
• Do you feel hopeful about the process?

Following Through

If you felt positive about the experience:

• Schedule your next appointment before leaving, or do so within a day or two
• Complete any homework or reflections your therapist suggested
• Start noticing patterns or issues you want to discuss in future sessions

Giving It Time

Don’t judge the entire therapy process based solely on your first session. It typically takes several sessions to:

• Build trust and rapport
• Fully understand your situation
• Develop a treatment plan
• Start seeing changes

Give therapy at least 4-6 sessions before deciding whether it’s working for you (unless there are serious red flags).

Being Patient With Yourself

Change takes time. Be patient and compassionate with yourself as you engage in this process.

Special Circumstances

First Session with a Psychiatrist

If you’re seeing a psychiatrist (who can prescribe medication), the first session will likely focus more on:

• Detailed symptom assessment
• Medical and psychiatric history
• Medication history and current medications
• Discussion of whether medication might be helpful
• Explanation of medication options, benefits, and side effects

Psychiatrists typically spend less time on in-depth talk therapy and more time on assessment and medication management, though some do provide therapy as well.

First Session for Couples or Family Therapy

If you’re attending therapy with your partner or family:

• The therapist will want to hear from everyone
• They’ll ask about relationship dynamics and shared concerns
• They’ll establish ground rules for respectful communication
• They may see individuals separately at some point
• The focus is on relationship patterns, not blaming individuals

First Session for Children or Adolescents

If you’re bringing your child to therapy:

• The therapist will likely speak with you first, then with your child (or vice versa)
• They’ll explain confidentiality limits to both you and your child
• Younger children might use play or art to communicate
• Teenagers typically need some confidential space from parents
• The therapist will balance your right to information with your child’s need for privacy

Making the Most of Therapy Going Forward

Be Honest

Therapy only works if you’re honest. Share what you’re actually thinking and feeling, even if it’s difficult or embarrassing.

Be Active

Therapy isn’t something done to you—it’s something you actively participate in. Complete homework, practice skills between sessions, and reflect on what you’re learning.

Communicate About the Process

If something isn’t working in therapy—you don’t understand the approach, you’re feeling stuck, or something your therapist said bothered you—speak up. These conversations can strengthen the therapeutic relationship.

Be Patient

Meaningful change takes time. Some weeks you’ll feel like you’re making progress; other weeks might feel harder. This is normal. Trust the process.

Practice Self-Care

Continue taking care of yourself outside of therapy—sleep, nutrition, exercise, social connection. Therapy is most effective when combined with overall self-care.

Final Thoughts: You’ve Already Taken the Hardest Step

Deciding to seek therapy and following through with that first appointment is often the hardest part of the process. By reading this guide and preparing for your first session, you’re already demonstrating courage and commitment to your wellbeing.

Remember that therapy is a collaborative process. You and your therapist are working together toward your goals. You’re not expected to have everything figured out or to be perfectly articulate about your feelings. You’re simply expected to show up, be honest, and engage with the process to the best of your ability.

Your mental health matters. Seeking help is a sign of strength, not weakness. You deserve support, understanding, and effective treatment.

Take a deep breath. You can do this. And whatever you’re facing, you don’t have to face it alone anymore.

If you need help finding a therapist in South Africa, contact:

• SADAG (South African Depression and Anxiety Group): 0800 567 567
• They can provide referrals to qualified therapists in your area and information about affordable options

For emergency mental health support, call the crisis lines listed on our Contact page.