The hardest part about therapy is starting it. But once a person gets over that hurdle, the logical next question is, what is it going to look like? How will it feel? How does it operate? Will it be strange communicating with a (virtual) stranger on the other side of the screen?
While online therapy is more common than ever, not everyone is privy to what happens in advance. Often, the first few sessions are exploratory and a signal that something may be coming up makes the next portion less intimidating.
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Getting Ready (The Tech Stuff No One Tells You)
Long before the first session happens, there is often a lot of paperwork in advance. For example, many therapists will send intake forms electronically to acquire medical history, symptom presentations, reasons for therapy and insurance inquiries. These forms can be fairly lengthy; relatively personal from the get-go (are you currently in therapy with someone else, have you been previously?), it’s easy to rush through them just to get them done. However, responses that boast some time and effort allow therapists to note red flags and general history from the onset.
The tech stuff is better than expected. Most therapists use HIPAA compliant video platforms which translate to layman terms as safeguarded connections for privacy. Some places have a patient portal that is accessible in-house; others, third-party services, distribute links via e-mail/text. Either way, it’s best to test the link prior to showtime to avoid added stress. Ideally, checking the camera for quality, microphone reception and volume sensitivity and internet speed allow for focus on therapy, not troubleshooting, once the session begins.
A quiet spot lends more credence than expected. It’s tough to have therapy while sitting in one’s car in a parking space; it’s equally challenging to conduct therapy with a roommate trying to shower while one tries to talk in the next room. There needs to be a space where someone feels comfortable talking without the fear of being overheard. Where that’s situated, bedroom, home office, closet (if that’s the only place with reliable privacy), it doesn’t matter, but it must be free of distraction.
What First Sessions Look Like
First sessions, whether online or in-person therapy, for example, will be the same, getting to know one another. The therapist will likely introduce how they work, their style and respective rules (i.e., confidentiality) while simultaneously operating with an understanding of what’s been going on as recently as now that someone sought therapy after they sought out this connection.
The first session will feel like an interview, and it is. The therapist is collecting intel and gauging a communication style. But it’s also an opportunity for the prospective client to gauge if this therapist might be viable; not all therapists work well with certain clients, and that’s okay.
Some people come into their first session wanting to word vomit everything they’ve been holding onto; others choose to take their time exposing themselves and their truths. Both are valid responses. There is no wrong way to have a first session of therapy. The therapist has likely witnessed every reaction under the sun surrounding this vulnerable disposition so no judgment should be passed.
The Insurance Question (Because It Matters)
Insurance coverage for online therapy usually ranges the same as in-person sessions (generally speaking), however, it’s best to check during the setup process beforehand. There are some therapists who accept certain insurances; some are out-of-network; some do not accept insurance at all, and that either means paying out-of-pocket on-site or submitting bills post-therapy for reimbursement elsewhere.
For people who need insurance to cover sessions, it’s recommended to find online therapy that takes insurance first before getting too far into sessions. Money adds up quickly and no one wants to go three sessions in only to find that out-of-pocket coverage is astronomical. Insurance practices are usually clear about policy and rates on the FAQ page of their websites; if not, they’re always welcome questions before booking.
How Connections Are Made
Most connecting factors of online therapy become established based on whether patients can feel rapport with virtual strangers from a screen or not. The answer? Yes, but it feels different.
At first, it’s strange because there may be a slight delay on video calls, awkward at-home eye-contact when someone should be looking at the camera but truly can’t see them from their perspective, or just the oddness of being vulnerable while someone else is being vulnerable thousands of miles away from each other in each other’s homes. But by the second or third session, it fits together; the technology is no longer at the forefront, it’s the conversation.
Therapists who do online work often know how to cultivate presences through a screen; they respond appropriately enough to body language (to an extent), ask follow-up questions about noted thoughts and more help create a therapeutic atmosphere even if virtually. It’s not as good as being together in an office, but it’s close enough that effective therapy can still occur.
What Happens in Sessions Two, Three, and Beyond
After the first session, the following appointments start to develop a rhythm. The therapist might dive deeper into specific issues, start introducing coping strategies, or work on identifying patterns that keep coming up. The pace varies depending on what’s being worked on and what approach the therapist uses.
Some therapists assign homework between sessions. This might be journaling, practicing certain techniques, or paying attention to specific thoughts or behaviors. Other therapists don’t do homework at all and keep everything within the session time. There’s no universal standard here, it depends on the therapist’s style and what makes sense for the situation.
These early sessions are also when it becomes clearer whether the therapist is a good match. Do they seem to understand what’s being said? Do their questions and observations feel relevant? Does the session leave someone feeling heard, or does it feel like they’re just going through motions? These are all things that become apparent after a few meetings.
When Online Therapy Might Not Be the Right Fit
Online therapy works well for a lot of people, but it’s not perfect for everyone or every situation. Some people find it harder to open up when they’re at home, especially if the home environment is part of what’s causing stress. Others miss the physical separation that comes with going to an office for therapy, where there’s a clear boundary between therapy space and everyday life.
For certain mental health situations, in-person care might be more appropriate. Crisis situations, severe symptoms that need closer monitoring, or conditions that benefit from more intensive support often require more than what online sessions can provide. A good therapist will recognize when that’s the case and help coordinate a higher level of care if needed.
Technical issues can also be a barrier. If the internet connection is unreliable, if there’s no private space to have sessions, or if the video format just doesn’t work for someone, it makes sense to consider in-person options instead.
The Adjustment Period Is Normal
Starting therapy is an adjustment regardless of the format. The first few sessions are about building trust, figuring out communication styles, and establishing what the work together is going to look like. Online therapy adds a small layer of technical adjustment on top of that, but most people find it becomes second nature pretty quickly.
The important thing is giving it a fair shot. One session might not be enough to know if a therapist or the online format is going to work. Three or four sessions usually give a much better sense of whether it’s heading in a helpful direction. If it’s not working after that, it’s completely reasonable to try a different therapist or a different approach.
Therapy, whether online or in person, is about finding support that actually helps. The format matters less than finding someone who understands the situation and can provide useful guidance. The first few sessions are just the beginning of that process.