Most parents feel some combination of relief and uncertainty the first time they schedule therapy for their child. Relief because you finally took the step. Uncertainty because you do not know what is actually going to happen once your child sits down with a therapist.

That uncertainty is completely normal. The more clearly you understand what the first appointment looks like, the easier it becomes to prepare your child and walk into it with realistic expectations.

Here is what the first therapy appointment typically involves, whether it happens in person or through adolescent counseling online.

Before the First Session: What Intake Looks Like

Most providers will ask you to complete an intake process before the first session. This usually involves a short questionnaire about your child's mental health history, current concerns, sleep, school performance, and any significant life events. Some providers send this by email in advance; others complete it during a brief pre-session call.

For telehealth appointments, you will also receive a link to the secure video platform ahead of time. No special software is usually required. A smartphone, tablet, or laptop with a camera and a stable internet connection is enough.

At Mount Behavioral Health, the intake process is kept simple so that families are not overwhelmed before they have even started. You can expect a brief outreach from our team to confirm the appointment, gather basic information, and answer any questions you have before the first session begins.

What Happens During the First Therapy Session

The first session is primarily about the therapist getting to know your child. It is not a deep diagnostic interview or a structured lesson. The therapist will ask open questions designed to understand what your child is experiencing, what they enjoy, what feels hard, and what they are hoping therapy might help with.

For most children and adolescents, the first session feels more like a conversation than an appointment. A good therapist will not rush toward a diagnosis or a formal treatment plan on day one. Building trust comes first, and that takes time.

Research on child and adolescent therapy consistently shows that the therapeutic relationship is one of the strongest predictors of treatment success. A first session that focuses on connection rather than assessment tends to produce better long-term outcomes.

For Younger Children: What Sessions Look Like at Ages 9 to 12

For children on the younger end of the age range, therapy sessions often look different from traditional talk therapy. Therapists who specialize in working with ages 9 to 12 may use structured activities, drawing, storytelling, or play-based approaches to help children express what they are experiencing.

Parents of younger children are often more involved in the first session. The therapist may spend time speaking with the parent first, then transition to working directly with the child, or alternate between the two depending on the child's comfort level.

At Mount Behavioral Health, we serve children and adolescents ages 9 to 21. You can learn more about our approach to telehealth therapy for children and teens on our website.

How to Talk to Your Child About Therapy Before the Appointment

What you say to your child before the first appointment matters. Children who feel coerced or uninformed about therapy tend to be more resistant. Children who understand what therapy is and why they are going tend to engage more openly.

For younger children, simple and honest language works best. Something like: "We are going to talk to someone who helps kids with their feelings. It is kind of like going to a doctor, but for your mind and emotions." For older teens, being direct and collaborative tends to work better: "I noticed you have been having a hard time lately, and I thought it might help to have someone to talk to who is not me."

Avoid framing therapy as a punishment or consequence for behavior. Do not promise that it will definitely fix the problem after one session. Let your child know they can tell the therapist anything without it getting back to friends or school. Acknowledge that the first session might feel awkward, and that is completely normal.

What to Do If Your Child Is Reluctant

Reluctance before a first therapy appointment is common, especially among teenagers who feel singled out or who worry about what their friends might think. Some amount of resistance is not a signal that therapy is wrong for your child. It is often just nervousness about something new.

If your child is resistant, avoid forcing the issue or framing therapy as non-negotiable in an adversarial way. Instead, give them some control over the process. Let them choose the time of the appointment if possible. Reassure them that they can tell the therapist what they are comfortable with and that the first session is just a conversation.

Telehealth can help here. For many teens, the option to join a session from their bedroom rather than a waiting room reduces the stigma and lowers the initial barrier. They are already on their phone or laptop. The setting is familiar.

What Comes After the First Session

At the end of the first session, the therapist will usually share initial observations and discuss next steps. This might include a recommended frequency of sessions (typically weekly to start), any initial goals, and how progress will be tracked over time.

Parents of younger children will often receive a brief summary at the end of the session. For older adolescents, communication with parents is guided by consent — the therapist balances the teen's right to privacy with appropriate parental involvement.

It is worth knowing that the first session rarely tells the full story. A single appointment gives the therapist a starting point, not a complete picture. The real work typically begins in sessions two and three once trust has been established.

Frequently Asked Questions

Should I stay for my child's first therapy session?

For children ages 9 to 12, parent involvement in the first session is common and often helpful. For older adolescents, the therapist may recommend starting one-on-one to allow the teen to speak openly. Follow the therapist's guidance, and let your child share their preference if they have one.

How long is a typical first therapy session?

Most first sessions run 45 to 60 minutes. The first appointment sometimes runs slightly longer due to intake discussion and goal-setting. Subsequent sessions are typically 45 to 50 minutes.

What if my child does not like the therapist after the first session?

Fit matters in therapy. If your child does not feel comfortable after the first or second session, it is worth discussing with the provider whether a different therapist might be a better match. A reluctance to return is worth exploring before assuming therapy itself is not the right approach.

Do I need a referral from a pediatrician to start therapy?

In most cases, no referral is required to begin therapy at Mount Behavioral Health. You can contact us directly, complete a brief intake, and be seen within days.

Will insurance cover my child's first therapy appointment?

Most major insurance plans, including Medicaid and Child Health Plus, cover telehealth mental health services in New York. Telehealth parity laws require that virtual sessions be covered at the same rate as in-person care. Contact us to confirm your specific coverage before the first appointment.

Ready to Book Your Child's First Appointment?

Taking the step toward therapy is one of the most important things a parent can do for a struggling child. The first session is not a test. It is a conversation, and it is the beginning of a process that can make a real difference.

Mount Behavioral Health offers licensed telehealth therapy for children and adolescents ages 9 to 21 across all five boroughs of New York City. We accept most major insurance plans including Medicaid, and new patients can typically be seen within days.

Call us at (718) 400-0545 or visit mountbh.org to schedule your child's first appointment.

‍