What Happens in a Child’s First Therapy Session?

By Heather Steele, MS, CPC, LCAS, LCMHC-QS

Owner & Lead Therapist at Morrisville Counseling & Consulting, PLLC

If you’re considering therapy for your child, the very first question most parents ask me is simple and heartfelt:

“What will actually happen in that first session?”

For many parents, this step comes after weeks—or months—of worry.

You may have noticed changes in your child’s mood, behavior, or anxiety levels. You might feel unsure whether therapy is truly needed, or nervous about how your child will react.

At Morrisville Counseling & Consulting, I work with families across Morrisville, Raleigh, Durham, Cary, and Apex, and I want you to know this: the first therapy session is not about pushing your child to talk, labeling them, or “fixing” anything.

It’s about safety, connection, and understanding.

Let’s walk through what you and your child can expect.

Before the First Session: Preparing Your Child (and Yourself)

Before your child ever meets their therapist, parents often wonder how much to explain.

In most cases, simple and honest language works best. You don’t need to provide long explanations or frame therapy as something scary or serious.

You might say:

• “We’re meeting with someone whose job is to help kids talk about big feelings.”

• “This is a place where you can play, talk, and feel supported.”

• “You don’t have to talk if you don’t want to.”

Children take their cues from you.

When parents approach therapy calmly and confidently, children are more likely to feel safe doing the same.

The Goal of the First Session: Building Safety, Not Solving Everything

The most important thing to know is this:

The first session is not about treatment yet.

It’s about:

• helping your child feel comfortable

• building trust with the therapist

• understanding what your child is experiencing

• learning about your family and your concerns

For many children, therapy starts not with words—but with play, creativity, and gentle interaction.

According to the American Academy of Child & Adolescent Psychiatry (AACAP), early child therapy sessions focus on helping children feel comfortable, understood, and safe, while the therapist learns about the child’s emotional world and daily functioning.

What the First Session Often Looks Like for Children

A Warm, Low-Pressure Introduction

Your child’s therapist will start by helping your child feel at ease. This may include:

• showing them the room

• explaining that there are no right or wrong answers

• letting them explore toys, games, or art materials

There is no expectation that your child will open up right away. Many children need time to observe, warm up, and feel safe.

Play Is Communication

Especially for younger children, play is how emotions are expressed.

During the first session, your child may:

• draw pictures

• play with toys or games

• move around the room

• talk a little—or not much at all

Therapists trained in child counseling understand that behavior, play themes, and emotional tone often communicate more than words.

According to research published by the Association for Play Therapy (APT) and the National Institutes of Health (NIH), approximately 71% of children referred to play therapy show positive change.

Getting to Know Your Child as a Whole Person

Rather than focusing immediately on “what’s wrong,” the therapist is learning:

• what your child enjoys

• how they relate to adults

• how they manage transitions

• how they express emotions

This helps therapy feel less like an evaluation and more like a relationship.

What Happens With Parents During the First Session

Parent involvement is an important part of child therapy, especially at the beginning.

Parent Check-In or Intake Conversation

You may spend part (or all) of the first session speaking with the therapist about:

• your child’s history

• current concerns

• changes you’ve noticed

• family dynamics

• school or social stressors

This information helps the therapist understand your child in context—not in isolation.

What About Privacy and Confidentiality?

Many parents wonder: “Will I know what my child talks about?”

In child therapy, the goal is to balance:

• your child’s sense of safety and privacy

• your role as a parent and caregiver

Therapists typically share:

• themes and progress

• concerns related to safety

• ways you can support your child at home

But children are not required to repeat everything they say in session.

That privacy is what helps trust grow.

What If My Child Doesn’t Talk at All?

This is incredibly common—and not a problem.

Some children:

• stay quiet

• play silently

• test boundaries

• avoid eye contact

This doesn’t mean therapy isn’t working. It means your child is assessing safety.

Trust develops over time, and therapists are trained to respect your child’s pace.

A Fictionalized Example

“Ella,” a 7-year-old from Cary, came to her first session feeling anxious and withdrawn. Her parents worried she wouldn’t engage.

During her first session, Ella barely spoke—but she drew pictures quietly and played with figurines. Her therapist noticed themes of control and safety emerging through play.

Over the next few sessions, as trust built, Ella began sharing more openly. Therapy didn’t rush her—it met her where she was.

After the First Session: What Parents Can Expect

After the first session, parents often ask:

• “Did it help?”

• “Is it working yet?”

The first session is about foundation, not outcomes.

Your therapist may:

• share initial observations

• suggest a general treatment plan

• recommend frequency of sessions

• discuss goals moving forward

You may also receive guidance on how to support your child between sessions.

What Therapy Is (and Isn’t) for Children

Therapy is not:

• punishment

• discipline

• a sign of failure

• something only “serious” kids need

Therapy is:

• support

• skill-building

• emotional safety

• a place to process big feelings

Many children who attend therapy are thoughtful, sensitive, and trying their best in a world that feels overwhelming.

Child Therapy in the Triangle

At Morrisville Counseling & Consulting, we provide child and teen therapy for families across Morrisville, Raleigh, Durham, Cary, and Apex. Our therapists are trained in developmentally appropriate, trauma-informed approaches that respect your child’s emotional world.

We work collaboratively with parents while protecting the trust children need to heal.

Taking the First Step

If you’re considering therapy for your child, it’s okay to have questions, worries, or mixed feelings.

A free 15-minute consultation can help you talk through concerns, learn what to expect, and decide whether therapy feels like the right next step for your family.

You don’t need to wait until things feel unmanageable. Support early can make a lasting difference. Want to know even more? Check out our article: Why Kids Lie: A Child Therapist’s Guide for Parents