The power of the first session: on being seen for the first time
Showing up for the first therapy session is a powerful demonstration of personal resilience. It requires individuals to overcome the initial feelings of fear and uncertainty, while bearing the emotional pain that motivated them to take this first courageous step. Beneath the surface, the real question is often: Will I be heard…will this actually help? Whether it’s private practice, outpatient clinics, or detention centers, every new client shares a common experience – the need to be seen. The next two stories are a reminder that healing doesn’t begin with insight or intervention – it begins with presence.
The vulnerability of beginning
George* was sitting in the waiting room when I first met him. He appeared tense and uncertain. Back in my office, the signs of nervousness became even clearer. The slight tremble in his voice, his closed-off posture, and flushed skin. I asked him a question I ask all my clients; "Is this your first time in therapy?" It's a simple way to gauge how familiar someone is with the process – but more importantly, it’s a way to begin building empathy, by remembering how vulnerable it can feel to be here for the first time. George gave me a small shrug. “Yeah, I’ve never done this before. I was going to cancel, but my PCP said I should try it out.” There was a hesitance in his voice and a guardedness in the way he held himself, as if he wasn’t sure if this had been a good decision. I acknowledged how daunting it can feel to start therapy and open up to a complete stranger. I reassured him that there was no pressure to say anything he wasn’t ready to share, and gently asked if he felt comfortable telling me what brought him in.
In an almost impatient tone, he immediately began listing off his problems as if he were stating facts that should be obvious to anyone listening. Beneath the surface, I could sense the exhaustion of carrying these struggles alone, without solutions, without expecting anyone to truly hear him. I stayed quiet, listening attentively. This was his session, and I was simply there to navigate it with him. Suddenly, he caught himself mid-sentence. “I’m sorry – I’ve been talking so much.” I smiled, and said, “There is no need to apologize, this space is for you.” He paused, and for the first time since we met, his shoulders dropped slightly. He let out a small sigh, like he was letting go of just a little bit of the weight he'd been carrying. After a moment, I offered a gentle reflection, acknowledging the heaviness he had been holding for so long. He started to cry quietly. And then he said it: “This is the first time I feel seen.”
George left the session feeling noticeably lighter, with a sense of emotional relief that hadn't been there when he first walked in. He didn’t just offload the stress — he allowed himself to take up space, to be seen, heard, and validated in a way he might not have experienced before. As George left that day, I was reminded how powerful it can be just to be heard. Therapy often begins, not with answers, but with the simple, brave act of speaking and being met with understanding.
George’s words stayed with me, not because they were rare, but because they were so deeply human — and so often hidden. I’ve heard versions of that same longing in places where trust was much harder to come by.
Meeting resistance with presence
Imagine being in a place where the walls are bare, the routines rigid, and individuality is stripped away. A place where society’s biases are heavy, where young people are judged, stereotyped, and stigmatized long before anyone stops to hear their story. A place where vulnerability is seen as a weakness. And yet, even within these walls, versions of the same words echo through the therapy rooms: "This is the first time I feel heard."
It’s something I witnessed often during my time working with adolescents in juvenile detention centers. In many therapy settings, it’s not uncommon for teenagers to meet adults with a degree of skepticism — the classic "What would you know about my life?" energy. But in juvenile detention, that gap is even wider. These adolescents don’t just see me as another adult. They see me as part of a system that has judged and punished them. Court-mandated therapy carries its own heavy weight: the assumption that they're broken, wrong, or in need of fixing. By the time they walk into the first session, many are already in defense mode — guarded, frustrated, and unsure why they should trust me at all.
I recognize that I will never fully understand the challenges these adolescents have faced in their lives. But I do understand what it feels like to be seen as a human being.
I know what it means to have someone care for you not because they have to, but because they truly want to — to feel that your presence matters to someone else and that you are worthy of kindness. That small but powerful knowing becomes the bridge. It’s how I begin to meet them, not as juveniles or offenders, but as people who deserve to be seen.
Because of that, my focus was to offer something different in the first session: choice, and the chance to be treated with genuine respect — something that started by first building safety without pressuring them to open up.
I didn’t pretend they weren’t required to be there. They knew it, and I acknowledged it. But part of offering them choice meant helping them figure out how they wanted to use the 50 minutes they were required to spend with me each week. Early sessions weren’t focused on uncovering past traumas or diagnosing symptoms. Instead, it was a space where adolescents could share their interests, their passions, or even their silence.
For some adolescents, that first session became an opening to begin feeling comfortable sharing pieces of their story. For others, it was slower, more cautious. Regardless of the pace, the first session offered them the chance to be seen without judgment or expectations. And when someone begins to see themselves as worthy of care and respect, they start to realize they deserve better – better treatment, better opportunities, better futures – and with that realization, they become more willing to work toward it.
The power of presence in every first session
In every setting, and with every person, the first session isn’t about using the right intervention or saying the perfect thing. They may not leave the session with answers or revelations, but they should leave knowing they are not invisible. The power of the first session lies in presence: holding space with empathy and acceptance, allowing someone to feel seen and offering hope that healing is possible.
And presence requires more than intention – it requires space. That's where Upheal helps. By automatically generating intake notes, assessments, and documentation, Upheal allows therapists to stay fully engaged with their clients in the room, without the constant pull of note-taking. Every bit of energy can go toward what matters most: seeing, hearing, and holding space for healing to begin.
