What Actually Happens in a Child's First Therapy Session

Most children arrive at a first session expecting something closer to a medical examination — that they will be asked what is wrong with them and given a verdict. What they find is a room with cushions, some pens, a box of odd objects, and an adult who is in no hurry.

The first ten minutes

I do not start with the problem. I start with the room: where the toilet is, how long we have, what happens if they want to stop. Then I explain confidentiality in language they can hold — that what they say stays in the room, unless I am worried someone is being hurt, and that if I ever needed to tell someone, I would tell them first.

What the session actually looks like

1. 01
   Under about nine

   Mostly play, drawing, sand, figures. The therapist is watching themes, not asking for narrative.

2. 02
   Nine to twelve

   Games with talking alongside. Side-by-side activity lowers the pressure of eye contact.

3. 03
   Teenagers

   Usually conversation, often starting with something unrelated — music, school, a series they are watching. That is not small talk; it is alliance building.

4. 04
   The parent portion

   Often the first twenty minutes with parent and child together, then time alone with the young person. Arrangements vary and should be explained in advance.

What the therapist is assessing

• Safety — always first, always checked.
• Sleep, appetite, school attendance, friendships.
• How the difficulty started and what has changed since.
• What the child thinks is going on, which is often different from what the parents think.
• Strengths, interests and the parts of life that are still working.

Preparing your child without building it up

Afterwards

Expect very little. Children often come out lighter and say nothing, or come out flat because the session touched something. Both are normal. Resist the debrief. The most useful sentence is: 'Same time next week' — followed by an ordinary evening.