What Happens in Your First Online Therapy Session?
What happens in your first online therapy session? Recorded openings usually explained that meeting. Later tasks can wait until the next one.
What the Opening Is For
What happens in your first online therapy session, in one study of recorded online CBT, is usually an explanation of the tasks for that meeting, and most of those explanations stopped at the meeting itself. What to expect in your first online therapy session is a chance to hear which tasks belong to this meeting, and which ones can wait until the next one. If that explanation does not arrive, ask for both, then read how a personal CBT program is arranged, whether that kind of care has evidence, and what it costs.
In the opening moments of those first sessions, Ekberg and colleagues write that "At this point, most therapists either produced a description outlining the tasks of the first and subsequent sessions (n = 36) or the first session only (n = 108). On other occasions (n = 32), no attempt was made to manage clients' expectations by outlining what would happen in therapy." The parentheses are counts of openings, and together they are the 176 openings in the analysis. They are not a headcount of therapists. The openings with no outline came from 2 of the 15 therapists. A direct question with no outline beforehand often drew a non-answer, and the same part of the paper says that result does not always happen.
| What the opening covered | Where it sits in this set | What stays outside the count |
|---|---|---|
| This meeting and later ones | One of the three groups | A rule that every first meeting must preview later ones |
| This meeting, stopping there | The largest of the three groups | A headcount of therapists |
| No outline of what would happen | Openings from 2 of the 15 therapists | An automatic failure to answer |
What Can Wait Until the Next Session
What can wait until the next session, in this trial, includes a goal for the work, when the opening says the questions in front of you are there to assess the situation. What happens in the first therapy session, here, sat inside an assessment phase that occupied the first and second sessions. A first CBT session whose opening described this meeting and the ones after it could name those questions as the immediate task and leave goal setting for the next time. That is one way a person learns the first meeting can be arranged differently from what follows. The counts above record whether the tasks were described. The authors call the early phase assessment, and in this trial that phase occupied the first and second sessions. The larger group of openings is the group whose explanation stopped at the meeting in front of them.
Ekberg and colleagues note that "clients may struggle to engage with the therapeutic process in the absence of appropriate expectation management by therapists." The conclusion keeps the same strength: when someone is told what the work involves, they may more readily engage from the start. Whether a longer course has trial support is the subject of does online therapy work.
Who Those Openings Belong To
The openings belong to one trial, and the boundaries travel with the count. People often call this kind of opening an online therapy intake. In this study the authors' assessment phase ran across the first and second sessions.
The referral rule is the sentence "Clients were referred to the trial by their GP if they were between 18 and 75 years old, had been diagnosed with a new episode of depression within the preceding 4 weeks and had not been treated for depression in the previous 3 months." Entry also required a Beck Depression Inventory score of at least 14 and an ICD-10 diagnosis of depression. People were left out for a history of alcohol or substance misuse, bipolar disorder, a psychotic disorder, psychotherapy already under way, or being unable to communicate proficiently in English. The sessions were typed in real time on psychologyonline.co.uk. Each person could have up to ten sessions, and each session was one hour. Fifteen therapists took part, and average attendance was seven sessions. The trial had 183 pairs. Seven had no record of how the first session opened, which is why the analysis uses 176. This is a UK general-practice trial of typed CBT for a new episode of depression. It is a different arrangement from the company linked on this site, and it is not a description of every online session in the United States.
What to Ask When Nobody Says
What to say in the first therapy session can be a question about the format, asked before the story. The box on the screen can stay empty for a minute. The first line can be the question, and the story can follow once you know what this meeting is for. Ask what this meeting is for, and what can wait until the next one. The transcripts include people who asked how a session begins, and whether the therapist would ask the questions or they were meant to talk. Those questions mark an unclear format. They are not lines you need to type. You can stop at the question. The rest of a breakup, a panic, or a bad week can wait for a later meeting. A chart does not sit the hour with you. If the worry arrived as an astrology question, astrology and anxiety is where that line is drawn.
If This Hour Is the Wrong Door
If you are thinking about suicide, or about not being here, call or text 988 in the United States, or use your local emergency number. Stay on that call. An intake form is the wrong door for that hour.
Which Plans Include a Live Hour
A live hour, on a plan that includes one, is still that opening. Whether the distress has changed is a later question. The review of the program this site links to lists the Basic plan as self-guided use of the CBT program plus messaging, and no live session. The same review lists a couples plan. The step described here is support for you as one person, and a hope of getting a relationship back is a different aim. After signup, the review says you are matched with a licensed therapist and can switch if the match is poor. The week on that program is worksheets, with messages a therapist answers on weekdays. Prices stay on how much online therapy costs. If the question you are actually asking is how heavy the distress is, that sorting is on is CBT right for you. The program page is online therapy. Open it after you have read the evidence page and the cost page.
Frequently Asked Questions
Do I have to explain everything in the first session?
No. Asking what this meeting is for, and what can wait until the next one, is a complete way to begin.
What is the first meeting actually doing?
The opening in the study above was often an account of the tasks for that meeting. The early phase the authors call assessment occupied the first and second sessions, so a goal for later could be named as waiting. A live video hour belongs to the plans that list one. On the program this site links to, the review's Basic plan is self-guided use of the program plus messaging. The study's own sessions were typed, and each one was an hour, which is a different arrangement from that menu. Evidence and price live on the pages linked above. The program page is the place to look once you have read them.
Is every first session a video call?
No. The study used typed sessions. On the linked program, a live session is on the plans that list one, and the review's Basic plan is self-guided use plus messaging.
What if I do not know what to say?
Ask what this meeting covers and what can wait. Some people in the study asked how to start because the format had not been explained. You can ask that before you offer the story.
When the Laptop Is Still Open
The laptop can stay open. Write one line beside it: what this meeting is for, and what can wait until the next one. Then read whether online therapy works and what it costs before you open the program.
This page summarizes published research in general terms. It is not a diagnosis, a treatment plan, or psychological advice.