What actually happens in a first counselling session

The most common reason people put off booking is not cost and not stigma. It is not knowing what the hour will be like — and a vague fear that they will be asked to open the worst thing in their life to a stranger within ten minutes. That is not how a first session works.

The first ten minutes are administrative, on purpose

We start with the boring part: confidentiality and its limits, how notes are kept, fees, and cancellations. It is deliberately first. Knowing exactly who can and cannot see what you say changes how much you are willing to say, so it would be backwards to leave it to the end.

Confidentiality has limits, and I would rather you heard them from me at the start than discovered them later. They are narrow, they are legal rather than discretionary, and I will tell you what they are before you decide what to bring.

Then I mostly listen

The bulk of a first session is you describing what brought you, in whatever order it comes out. It does not need to be chronological and it does not need to be the full story. People often start with the most recent thing rather than the biggest thing, and that is a perfectly good place to begin.

I will ask questions, but they are orienting questions rather than an interrogation — how long this has been going on, what you have already tried, what a bad day looks like, what a better one would look like. If a question lands somewhere you are not ready to go, you can say so and we move on. "I do not want to talk about that yet" is a complete answer and it does not need a reason.

What we do at the end

The last ten minutes are for working out whether this is useful and what happens next. Sometimes that means a plan. Often it just means agreeing what to look at next time. It can also mean deciding that a different kind of support fits better — a physician, a group programme, a specialist service — and if that is the case I will say so.

You are also assessing me. Fit between a counsellor and a client is the part of this work that is most consistently associated with it going well, and it is not rude to conclude after one session that the fit is not there.

What you do not need to bring

• —A diagnosis. Most people arrive without one, and working out what is going on is part of the work rather than a prerequisite for it.
• —A tidy explanation. If you could already explain it neatly you would probably not need the appointment.
• —A referral, for privately paid sessions. One is needed for some funded streams, and those are set out on the fees page.
• —A decision about how long you are committing for. That is not settled in the first session.

If you would rather ask something before booking anything, that is genuinely fine and it costs nothing. Most people who eventually book have asked a question first.