Starting therapy can feel like a big step. It is normal to feel nervous, unsure, or even a little scared. You might wonder what to say, what the therapist will think, or how your Medicaid or other insurance will work.
This guide walks you through what usually happens before, during, and after your first therapy session. The goal is to help you feel a little more ready, not perfect.
If you are still trying to find someone, you can read How to find a Medicaid therapist near you for step-by-step help.
Before your first visit
After you sign up and choose a therapist, you will usually get some basic details:
- The date and time of your first session
- How long the session will last (often 45–60 minutes)
- How to join if it is online, or where to go if it is in person
If your visit is online, you will likely get a video link. At the time of your session, you click the link, and your therapist will meet you there.
You may also get a few forms to fill out. These can include:
- Basic information: your name, address, contact information, and emergency contact
- Consent forms: pages that say you agree to get care and understand the risks and benefits
- Privacy forms: how your information is protected and when it can be shared
You do not have to understand every legal word. It is okay to ask questions. Your therapist or the office staff can explain things in simple language.
How your therapist will start the session
At the start of your first session, your therapist will usually greet you and try to help you feel more at ease.
If you are doing online therapy, they may ask:
- Can you see and hear me clearly?
- Can I see and hear you?
- Are you in a private place where you feel safe to talk?
Next, they will talk about privacy in plain words. It might sound like:
"Most of what you share here is private. I do not talk about it with others without your permission. There are a few times I may have to share for safety, like if you are in danger or a child is being hurt. If that ever comes up, I will explain what is happening."
You can ask questions at any time. For example:
- "Who can see my notes?"
- "What happens if I do not want something shared?"
Your therapist's job is to help you understand what is going on.
Questions your therapist may ask
After the welcome and privacy talk, your therapist will want to learn more about you. They often start with a simple question, like:
"What brought you here today?"
You do not need to tell your whole life story. You can share just a few main things that feel important right now. For example:
- "I have been feeling very down and tired for a few months."
- "My anxiety is getting in the way of work and sleep."
- "Our child is having big outbursts, and we do not know what to do."
Your therapist may ask:
- How long things have felt this way
- If you have ever been in therapy before
- If you take any medicines now
- A bit about your family, work, school, or daily life
They may also ask gentle questions about safety, like if you ever have thoughts of hurting yourself or others. These questions are not to judge you. They are used to keep you safe and to help choose the right kind of support.
You are allowed to share at your own pace. If something feels too hard to talk about, you can say, "I am not ready to share that today." A good therapist will respect that.
Talking about Medicaid and insurance
At some point, money and insurance will come up. This might be handled by your therapist, by a front desk person, or by a billing team that works in the background.
They may check:
- That your Medicaid, Medicare, or other plan is active
- That your therapist is "in-network" with your plan
- If there is a copay or any visit limits
You may hear words like:
- Copay: a set amount you pay at each visit, like $0, $5, or $20
- Coinsurance: a percent of the cost that you pay
- Deductible: a set amount you must pay before the plan covers the full share
If these words are confusing, that is normal. You can ask for them to be explained in simple terms. You can also read more in our post called Using Medicaid and insurance for therapy, which breaks these ideas down in a clear way.
If you are worried about cost, you may find ideas in Getting started with therapy on a budget. It shares simple ways to manage money while still getting help.
How you can prepare for your first session
A little preparation can make your first therapy session feel less scary. You can:
- Write a few notes about what you want help with
- List any questions you have about therapy or your plan
- Think about what you hope might feel different in your life in a few months
If your visit is online:
- Try to find a private, quiet spot
- Use headphones if that makes you feel safer and more comfortable
- Test your internet, camera, and sound if you can
It is okay if you feel nervous, talk fast, or cry. Many people do in a first session. Your therapist expects this.
What happens during the session
Most first sessions have a similar rhythm:
- A welcome and check-in
- A short talk about privacy and how therapy works
- Questions about what brought you in and how long it has been going on
- Questions about your history, like past care, medicines, or big life events
- A quick safety check
Some therapists also use simple forms or rating scales to understand how you feel. For example, they may ask you to rate your mood or anxiety. This can help track progress over time.
You do not have to say everything perfectly. It is okay to pause and think. It is also okay to say, "I am not sure how to say this," and try your best.
After the session: next steps and goals
Near the end of the visit, your therapist may repeat back what they heard and suggest some first goals. It might sound like:
"It sounds like your sleep and stress at work are the biggest problems right now. I think we can start by building some coping tools and looking at your daily routine."
They may suggest:
- Meeting every week or every other week
- Trying a small exercise between sessions, like a journal or breathing practice
- Talking with your doctor if medicine might help
You get to decide if you want to book another visit. You can say, "Yes, this feels like a good fit," or "I want to think about it." Both are okay.
How to know if the therapist is a good fit
The first session is also a time for you to notice how you feel with this therapist. You can ask yourself:
- Do I feel heard?
- Do I feel judged, or do I feel understood?
- Does the therapist explain things clearly?
- Do I feel at least a little bit safer or more hopeful by the end?
Therapy does not "fix" everything in one session. But you should feel like the therapist is on your side and has a plan.
If you have had a few sessions and still feel stuck, you can read How to tell if therapy is working for simple signs of progress and questions you can bring up.
How Lavni fits into your first session
Lavni is a Medicaid-first online therapy platform. We focus on helping people use their Medicaid, Medicare, or commercial insurance to see licensed therapists.
With Lavni:
- You tell us what state you are in and what you want help with.
- We show you therapists who take your plan and are licensed in your state.
- Most visits happen online by secure video, so you can meet from home or another private place.
We help you understand your coverage and work in the background on billing, so you can focus on your sessions.
You do not have to do this alone
Your first therapy session can feel big. But you do not have to walk into it blind.
You can:
- Prepare a few notes
- Ask questions about privacy and cost
- Take breaks if you feel overwhelmed
- Decide, over time, if this therapist feels right for you
You deserve care that fits your life, your plan, and your story. Taking this first step is a brave move toward feeling more supported in your daily life.