What to Expect in Your First Trauma Counseling Session (Virtual & In Person)

From What’s Discussed to Professional Advice If You’re Feeling Nervous About Trauma Counseling

After experiencing a traumatic incident, you may have mixed emotions about starting trauma counseling—one of the main benefits we offer here at American Trauma Insurance.

While some may be eager to begin the healing process, others may feel hesitant. You might wonder what to expect, what you’ll be asked, or whether you have to share everything right away.

To demystify the process, we spoke with Caitlynn Allen-Kehoe, LMHC-D, Clinical Team Leader at Allied Wellness Collective, about what those first few minutes and sessions are really like.

What to Expect in Your First Trauma Counseling Session

Initial Moments

“Every counselor takes their own approach to introducing themselves and going over some 'housekeeping' expectations. For instance, I will introduce myself, tell them how glad I am they came to the session, and then go over a few brief housekeeping items—such as note-taking, how the first couple of sessions will go with history gathering, the late cancel/no-show policy, and confidentiality limits.

I will then ask if they have any questions about what I talked about or any therapy-related questions.

I know it may seem odd to address some of those items in the beginning, but it's important. Sometimes it sparks questions and/or helps them feel a little more at ease because they already have a sense of who I am.”

Discussing Your Trauma

What Happens in the First Session?

“Prior to the first session (or after the first session), a client may be asked to fill out a structured assessment. These are helpful tools for clinicians to gain additional self-reported information and understand the severity and intensity of the client's symptoms.

In the first session, clients are asked to further elaborate on what brings them into therapy. Most of the time, if a person is willing to engage in therapy, they want to start processing through their trauma. The clients' symptoms, intensity, duration, and frequency of said symptoms will be discussed. Questions about suicidal ideation and homicidal ideation will also be asked.

There is also a history gathering that happens in the first session; how much depends on how far the client wants to dive into their reasons for coming into therapy. History gathering includes, but is not limited to, mental health history, family history, substance use history, and social support.

Goals may be discussed in the first session if the client is ready for that. Some clients are not ready to create goals in the first session, and that's okay. The goal after the first session may just be to come to the next session and continue discussing their experiences, possibly writing down thoughts and memories in between sessions. Usually, by the end of the third session, goals are created.”

Taking Your Time

What If You’re Not Ready to Share?

“If someone isn't ready to go into detail about their trauma, that is okay. What does need to be discussed is what symptoms they are experiencing, such as struggling with sleeping, appetite issues, physical symptoms, etc. Most clinicians will not push if a client isn't ready to go into detail about their trauma, especially in the first session.”

Homework and Coping Tools

Do Counselors Assign Homework?

“Homework depends on where that client is at. Some clients want homework and thrive with more structure to a session, while others can't handle the thought of structured homework because just attending a session took so much out of them.

Usually, clients will come away from a first session with some kind of actionable item. What that is, though, really depends on where the client is at mentally and emotionally and what they want out of the first session.”

Overcoming Anxiety

Advice for Nervous Clients

“For clients who are nervous to start, please know that therapy is all about you. If you don't want to talk about something, you don't have to. If you want a consultation prior to the first session to learn if you even vibe with the therapist, request it. You are in control. If you don't like how the first session is going, you don't have to complete the session.

Every therapist is different, with different approaches, personalities, and styles. The first one you come across may not be the one for you, and that's okay. Therapy is like dating—you may have to meet with a couple of different therapists before finding the right one.

Please note that a therapist should NEVER date a client, and if a client feels or experiences any kind of advances that feel uncomfortable… run and report them. Just like in any profession, there are some therapists in the profession for the wrong reasons. Most, though, just want to help and be the support that so many people desperately need and are searching for.”

Moving Forward After the First Session

What to Do If You Feel Overwhelmed

“If a client leaves a session feeling unsure or overwhelmed, it's so important to reflect on why. Is it because you just shared some of the most horrible things that have happened to you with a stranger? Totally understandable. It's important to try to regulate that nervous system—go for a walk, listen to music, practice deep breathing exercises, engage in any kind of movement, journal thoughts and feelings, or call a loved one. If nothing is working, it's okay to request a sooner session with the therapist.

Is the client feeling unsure or overwhelmed because they didn't feel understood, listened to, or vibed with the therapist? Then, maybe give the therapist another session or two. After that session, make a determination if you want to keep working with that therapist. If not, that's okay! You can request a referral to a different therapist.”

Conclusion: Embracing the Journey of Healing

Whether you’re a current ATI customer looking for trauma-informed support, a broker helping connect individuals with the right resources, or a provider seeking to join a network that prioritizes quality care both in-person and virtually—ATI’s trusted network makes it possible.

Starting therapy can feel daunting, but remember, it’s a journey we take together. We’re here to support you every step of the way. Let’s focus on healing without the burden of financial stress.