How to Start a Therapy Session as a Therapist – A Step-by-Step Approach

Starting a therapy session can feel like walking into uncharted territory—especially for new therapists or those developing their own professional style. Whether you're in the early stages of your counselling career, or you're an established professional looking to enhance client engagement, knowing how to begin a session can shape the entire therapeutic relationship. The opening moments set the tone, build trust, and create a safe space for open dialogue.

This guide delves into a step-by-step approach to starting a therapy session as a therapist. It's practical, human-centred, and applicable across various forms of therapy including CBT, integrative, and psychodynamic practices. Read on to explore best practices, tips, and techniques that will help you start each session feeling confident, grounded, and ready to connect with your clients.

1. Prepare Yourself Mentally and Physically Before the Session

Before even entering the session room—virtual or physical—it’s essential to take a moment to ground yourself. As a therapist, your presence can significantly affect the emotional security your clients feel. Clients notice more than your words—they observe your body language, energy, tone, and attention. Start by checking in with yourself. Are you anxious, distracted, or feeling low? Recognising and regulating your own state helps ensure you are fully present.

Take a minute to slow your breathing, sip some water, and clear your mind of external concerns. Consider reviewing any session notes and thinking about any issues the client may want to revisit or build upon. If you're conducting teletherapy, make sure your environment is quiet, private, and free of unnecessary distractions. A clutter-free desk or room significantly impacts your ability to stay focused.

Another practical point: ensure that your space is welcoming and neutral. Whether you are working from a professional office or remotely, small details like lighting, warmth of tones, and eye-level seating arrangements make clients feel at ease. These subtle preparations speak volumes about your professionalism and care.

2. Begin with a Warm, Friendly Greeting

Therapy is deeply personal; first impressions truly count. Starting with a warm, genuine greeting can ease tension and make clients feel valued. Use your client’s name when appropriate, and don’t underestimate the power of a smile or a kind tone. This immediately builds rapport and lets the client know they’re entering a safe, supportive space.

For returning clients, a welcoming line such as “It’s nice to see you again” or “How have you been since we last spoke?” helps establish continuity while opening the door for reflection. For new clients, a line like, “Welcome, I’m glad you’re here,” can validate their commitment to seeking help.

If the session is online, acknowledge and empathise with any initial technical awkwardness. Even commenting on the weather or asking how their day has been can humanise the space before diving into deeper matters. Remember, these few minutes are not wasted—establishing emotional safety is a cornerstone of effective therapy.

3. Reiterate Confidentiality and Boundaries (Especially in First Sessions)

Creating trust is the foundation of therapy, especially when meeting a client for the first time. Take a moment to reaffirm the confidentiality of your sessions, clearly stating what is and isn’t shared outside your professional scope. This helps your client relax and communicate openly, especially around sensitive topics.

Explain any exceptions to confidentiality clearly and calmly—such as situations involving harm to self or others. Equally important are boundaries regarding timekeeping and cancellation policies. Making clients aware of structures can help them feel secure and respect the therapeutic frame.

In online sessions, express the measures you’ve taken to maintain the privacy of the virtual environment. Clients today are increasingly aware of digital privacy, and addressing it shows responsibility and foresight on your part.

4. Use an Open-Ended Question to Invite Conversation

Once pleasantries and boundaries are established, transition into collaborative dialogue. Open-ended questions are your best tools—they spark introspection and empower clients to take leadership in exploring their thoughts.

Consider this: instead of saying “So, what happened this week?” try “How have you been feeling since our last conversation?” or “What would be helpful for us to focus on today?” These questions are expansive and allow the client to steer the narrative in a direction that feels meaningful to them.

For new clients, prompts like “What brought you here today?” or “Tell me a little about what’s been going on for you recently” strike a balance between clarity and flexibility. Your body language should also show interest—leaning in, maintaining soft eye contact, and staying attuned to their tone and expressions.

If a client is resistant or quiet, validate that too. You might say, “I notice this feels hard to talk about right now, and that’s okay—we can take our time.” Honouring their process creates space for real, authentic progress later on.

5. Set Shared Goals or Session Intentions

Setting a shared agenda enhances clarity and mutual understanding. Clients often arrive with conflicting emotions or scattered thoughts. Helping them focus on key areas they’d like support with during the session provides both structure and momentum.

Say something like, “Is there anything specific you’d like us to work on today, or would it help if we explored what’s been on your mind lately?” If a client feels unsure, suggest revisiting previous topics or reviewing goals you’ve been working on together.

Goal setting doesn’t always have to be large-scale. Even a simple, session-specific goal—like practising grounding techniques or exploring a recent emotional episode—can give direction. It shows you value their autonomy while guiding them with care and intention.

6. Create a Smooth Flow into Deeper Exploration

Once the groundwork is laid, transition comfortably into exploring the core of the session. Watch for verbal and non-verbal cues indicating readiness. Some clients might jump right in with emotional content, while others may need gentle support to move past surface-level updates.

Summarise or reflect periodically: “It sounds like you felt really overwhelmed when that happened—can you tell me more about that moment?” These reflections reassure the client that they are being deeply listened to, while also guiding the discussion toward emotional processing, patterns of thought, and behavioural insights.

Avoid rushing this part—therapy gains its power from patience and presence. Stay curious rather than directive. If you sense resistance or ambiguity, normalise it. “Many people feel unsure of where to start, that’s completely okay—let’s explore what feels most accessible right now.”

7. Be Flexible but Maintain Focus

Therapy is a dynamic space—sessions may not always go as planned. Personal stories may bring up unexpected emotions, and clients may backtrack or diverge from an agreed agenda. Your job is to steer gently but intentionally, ensuring the space remains productive and grounded in their needs.

Check in at intervals. “Is this direction still feeling useful to you today?” or “Would you like to explore this further, or shift towards something else for now?” These collaborative points of contact help clients feel empowered and respected.

At the same time, trust your instincts. If avoidance patterns are emerging, you might say, “I noticed we steered away from that topic quite quickly—shall we return to it when you feel ready?” This balance of flexibility and focus defines the art of therapeutic navigation.

8. Conclude the Opening Constructively

Setting up the session constructively gives you and your client a solid starting platform. Make a mental note of the client’s key themes, emotional tone, and comfort level. Use these cues to guide your pacing and interventions further into the session.

As the session unfolds, maintain awareness of time so that you can also craft a thoughtful closure later on. Effective session openings make it easier to reach meaningful conclusions—with clients feeling seen, heard, and supported.

By mastering the art of the therapeutic opening, you not only enhance the quality of each session but deepen the trust and growth possible within the client-therapist relationship. These earnest first minutes can hold profound power—offering a doorway to healing, one conversation at a time.

Conclusion

Knowing how to start a therapy session as a therapist is more than a checklist—it’s an evolving skill, rooted in presence, empathy, and structure. From preparing your mindset to building rapport with warm greetings and setting intentions, each step creates a therapeutic space centred on trust and collaboration.

Depending on your practice and the type of therapy provided, these principles can be tailored to meet you and your clients where they are. When done mindfully, the session opening can be the most powerful few minutes of the entire process—setting the emotional and relational framework for healing and insight to emerge.

Take these ideas, personalise them, and let your own authenticity shape the conversation. At the heart of every great session is a therapist who’s prepared, present, and profoundly human.