Reflections Mental Health Services

By Alphonso Gaita, LCSW · Reflections Mental Health Services · Telehealth across New York State

Most people are nervous before their first therapy session. That’s normal. Telehealth adds a second layer: now you’re nervous about the conversation and about the technology. Will the link work? What if my dog barks? Do I sit at my desk or on the couch?

I’ve done thousands of telehealth sessions. Here’s exactly what to expect for your first telehealth therapy session — from the paperwork beforehand to the moment you log off — so you can focus on what actually matters: showing up and being honest.

Before the session: paperwork and prep

After you book, you’ll receive 2-3 emails. Don’t ignore them. Open them when you’re not multitasking and read carefully:

• Intake forms — usually a 5-10 minute online form covering basics. Most practices use a HIPAA-compliant portal (we use MyTheraNest).
• Informed consent — explains confidentiality, mandatory reporting exceptions, fees, and the cancellation policy. Read it. Ask if anything’s unclear.
• Telehealth link — sent shortly before the session. Click to test it earlier in the day so you’re not troubleshooting at 9:59am.
• Insurance info — if you’re using insurance, fill in your member ID and group number on the intake form.

Setting up your space

You don’t need a fancy setup. You need privacy and decent internet. Quick checklist:

• A door you can close. Not negotiable. Bedroom, office, parked car — whatever offers actual privacy.
• Wired or strong Wi-Fi. Bandwidth issues kill rapport.
• Headphones if anyone else is home. Helps with audio quality and your privacy.
• Water nearby. Therapy is verbally tiring.
• Tissues. Just in case.
• Phone on Do Not Disturb. Notifications during therapy are jarring.

What you wear doesn’t matter. Comfortable. Clothed. That’s it.

The first 5 minutes

You’ll click the link, your therapist will join, and the first thing they’ll do is some version of: “Welcome — can you hear me okay? Is this a good time and place to talk?” They’re checking tech AND privacy. Answer honestly. If your kid is about to wake up, say so. We can adjust.

Then they’ll briefly review the consent forms, confirm the structure (sessions are usually 45-50 minutes), and confirm the cancellation policy. After that, the actual work begins.

The middle of the session: what they’ll ask

Most first sessions follow a loose structure called an intake or biopsychosocial assessment. The therapist is gathering information — not diagnosing or solving anything yet. Expect questions like:

• “What brought you in today?” — open-ended; share as much or as little as feels right
• “What’s been going on lately that made you decide to reach out?”
• “How long has this been going on?”
• “What does a hard day look like? What does a good day look like?”
• “Have you been in therapy before? What worked, what didn’t?”
• “Tell me a little about your family / relationships / work situation.”
• “Any safety concerns I should know about — current thoughts of harming yourself or others?”
• “What would success look like for you in our work together?”

You don’t have to have polished answers. “I don’t know yet” is a completely valid answer to most of these. Therapy is the place where you figure it out, not where you arrive having already done so.

Things people commonly worry about (and don’t need to)

• “What if I cry?” — Then you cry. Therapists are not surprised by tears.
• “What if I have nothing to say?” — That itself is something to talk about.
• “What if my issue is too small?” — There’s no minimum bar of suffering. Wanting to feel better is enough reason.
• “What if my issue is too big?” — A trained therapist has heard versions of it before.
• “What if we don’t click?” — Then we talk about it, and either adjust or refer you to a better fit. No hurt feelings.
• “What if I’m a difficult client?” — Almost no one is. People worry about this who never need to.

The last 5 minutes

Your therapist will start to wrap up about 5 minutes before the end. They’ll usually summarize what you talked about, name a theme or two they’re noticing, and ask how this felt. They’ll suggest a frequency (most people start weekly), book the next session, and confirm any follow-up.

If you have logistical questions, save them for these last few minutes — that’s the right time.

After the session: it’s normal to feel a lot

Most people feel some combination of relieved, exposed, tired, hopeful, slightly hungover after a first session. That’s all normal. You just spent 50 minutes being honest with a stranger about hard things. Drink water, take a walk, give yourself an easy afternoon if you can.

After 2-3 sessions you should start to feel something — at minimum, less alone with the thing that brought you in. If you don’t, that’s worth raising with your therapist. Honest communication in the therapy relationship is part of the work.

References

• Connolly, S. L., et al. (2022). Rapid increase in telemental health within the Department of Veterans Affairs. JAMA Psychiatry, 79(2), 105–107.
• Hilty, D. M., et al. (2013). The effectiveness of telemental health: A 2013 review. Telemedicine and e-Health, 19(6), 444–454.
• American Psychological Association. (2024). Telepsychology Best Practices.