What a first appointment involves

The first meeting is usually not therapy. It is an assessment: a structured conversation whose purpose is to work out what is going on and whether this service, and this person, is the right fit. Knowing that in advance takes some of the strangeness out of it.

What normally happens

Practicalities first. How long sessions are, how often, how many, what happens if you cancel, how to contact them between sessions and whether that is expected at all. In private practice this is set out in a working agreement, sometimes called a therapeutic contract.

Confidentiality, and its limits. This should be explained clearly and unprompted, in plain language. Therapy is confidential, but not absolutely: practitioners are required to break confidentiality where there is a serious risk of harm to you or to someone else, and in some circumstances involving children or vulnerable adults, or where the law requires it. A practitioner who cannot explain their limits is telling you something.

History. What brought you, when it started, what has happened before, what has and has not helped, physical health and medication, and your circumstances — work, home, who is around you.

Risk questions. You will very likely be asked directly whether you have had thoughts of suicide or of harming yourself or others, and whether you feel safe where you live. These questions are asked of everyone. They are not an accusation, they are not a trap, and an honest answer gets you better help than a careful one.

Goals. What you want to be different. It is entirely acceptable not to know yet.

In NHS services the assessment may be by telephone or video and may be conducted by a different person from the one who goes on to treat you. That is normal.

What you are entitled to ask

You are assessing them as much as they are assessing you. Reasonable questions:

• Which register are you on, and under what name? (See checking a practitioner.)
• What kind of therapy do you practise, and what does it involve week to week?
• Have you worked with this sort of difficulty before?
• Do you have clinical supervision?
• How will we know whether this is working, and what happens if it is not?
• How does the work end?

None of these is rude, and a practitioner who bristles at them has answered the important question.

Afterwards

You are allowed to decide it is not right and to try someone else. Fit matters, it is not measurable in advance, and changing after one or two sessions is unremarkable — say so plainly rather than disappearing, if you can.

Equally, an assessment can conclude that a different service is more appropriate. Being redirected is not a rejection; it usually means the problem is better served elsewhere.

What should not happen

Some things are outside the ethical frameworks all the main registers publish: pressure to commit to a long course before you have decided, a sexual or romantic approach, contact that drifts into friendship or business, dismissal of your questions about training or registration, or discouragement from talking to your GP. If any of these occur, the complaints routes on the checking a practitioner page are where to take it.