Your first therapy session: how it goes
What happens at the first meeting, what I ask about and what you have every right to stay silent about. Fifty-five minutes, one to one, with no forms and no medical file.
If you are reading this, you have most likely already decided — and now you are afraid of the unknown. Not of the help itself, but of what you will have to say out loud and what comes next. Here it is in order, without generalities: what happens at a first meeting, what I ask about, and what you have every right to stay silent about.
A word on terms first. I am a doctor and a psychotherapist, and I also do psychological counselling. For someone with an ordinary request the first meeting is the same either way — the difference is not in how the conversation goes, but in what stands behind the specialist. There is a separate section on that below.
What happens at the first meeting
A conversation. Fifty-five minutes, one to one, with no witnesses and no rush.
There will be no tests, questionnaires or forms at the door. No medical file where something gets written down. No requirement to fit the main thing into the time available — as far as we get is as far as we get, the rest is for the next meeting. You speak as much as you are ready to; I ask questions where I need to understand more precisely.
What you leave with
By the end you have two answers: what is happening to you and what we are going to do about it. The decision to continue is yours — made at home, calmly, not in the consulting room.
Step by step
How a first consultation goes
Getting acquainted
The first five minutes are there so you stop sitting on the edge of your chair. I briefly say how we work, how long the meeting runs and that everything said stays here. No opening ritual and no «tell me about yourself» from the doorway — we start when you are ready to start.
You describe what is happening
The main part of the meeting. In your own words, in any order — from the end, from the middle, from whatever came to mind first. Nobody expects a coherent account from you: putting it together into a picture is my job, not yours. If all that comes out is «I feel bad and I do not know why», that is enough to start.
I ask questions
Not an interrogation and not history-taking from a form. The questions come out of what you have said: when it started, what it coincided with, what is happening in the body, what you have already tried. Each question serves one purpose — to understand the mechanism, not to fill in a box.
You ask questions
A required part, not politeness at the end. Ask about the method, about the training, about how long it will take and what it will cost later. A person has the right to understand who they have come to. What exactly to ask — the list is below.
We agree what comes next
I say plainly whether this is my case, which method I suggest and roughly how many meetings it will take. If it is not my case, I will not take it on and will name who to go to. Whether to continue you decide at home: nothing to sign, and a first meeting creates no obligation.
What I will ask about
There are not many questions, and almost all of them are about now, not about childhood. Here they are, so you come without a sense of the unknown.
When did it start and what did it coincide with?
There is almost always a starting point, even if you never connected it with the state.
How are sleep and appetite?
The body reacts earlier and more honestly than words. Sleep shows how heavy the state is.
What have you already tried?
So as not to offer what has already failed you, and to see where exactly it broke down.
Is there anyone close who knows?
Having support changes the pace of the work. Not having it is part of the picture too.
Have you been examined? What are you taking?
A doctor’s question rather than a psychologist’s: the thyroid, blood pressure and medication prescribed elsewhere can all produce symptoms that look like anxiety and apathy.
What do you want to be different?
The hardest question of the meeting. If there is no answer, that becomes the first task of the work.
About the requests people bring most often — conditions I work with.
What you may stay silent about
Anything you are not ready to talk about today.
The main fear before a first meeting sounds roughly like this: «I will have to turn myself inside out in front of a stranger». You will not. «I do not want to talk about that yet» is a complete answer that needs no explanation and does not spoil the work. I will not insist, will not come at it from another angle, and will not return to the subject until you do.
You may stay silent about childhood, about family, about relatives’ diagnoses, about what happened ten years ago, about money, about sex, about the war. You may leave out names and say «someone». You may say: «that is the main thing, but not today» — and we will work around it until it becomes possible.
The only thing not worth staying silent about is thoughts of not living. Not because I will do something behind your back, but because it determines what kind of help you actually need.
Checking the specialist
What to ask to tell whether this specialist is right for you
Asking is only awkward for the first thirty seconds. A sound specialist answers calmly — and that, in truth, is the main test. Six questions and what the answer means.
What is your training?
The answer should be concrete: the university, the years, the specialisation. A vague «I have done a lot of courses» is a bad sign.
Which method do you work in, and why that one?
It is a good sign if they explain in plain language. If all you get is terminology, it will stay unclear later too.
Roughly how long will this take?
Nobody can give an exact figure, and a promise of «three sessions» is a reason to be wary. But a range and some landmarks you should be given.
What happens if we are not a good fit?
The right answer is «tell me and we will discuss it, and I will recommend a colleague if I can». Taking offence at the question speaks for itself.
What does it cost, and what about payment later?
The price should be named before you book, not after the meeting. Packages and discounted bundles are not what therapy is.
Do you work with my situation?
«I work with everything» is a worrying answer. Every specialist has limits, and a conscientious one will name them.
How to prepare
You do not. There is no need to prepare specially, and that is not a figure of speech: turning up «in good shape» for a psychotherapist is as odd as tidying yourself up before seeing a doctor with a fever.
But three things do help — and all of them are about comfort, not about doing it right.
And one anti-preparation: do not rehearse your account. A memorised text gets in the way — you end up watching yourself not to lose the thread instead of speaking.
An hour before and an hour after
Do not squeeze the meeting between two errands. After the conversation you need time to come back to yourself — a walk home at least.
One sentence on why you are coming
Not a properly formulated request, just: «I do not sleep», «I cannot keep going», «second year in a fog». That is enough to start with the substance.
Test results, if you have them
Not required, but useful: if you have been round the doctors and everything is «clean», I will look — it saves us both time.
Format
Online or in person: what to choose for a first meeting
Both formats work; the only question is where it will be easier for you to speak. Choose not «what is more effective» but «where I will definitely not be interrupted».
In person — if this is you
Online — if this is you
The format can change as we go: start online and move to in-person meetings, or the other way round. More about in-person appointments on separate pages: psychotherapist in Kharkiv and psychotherapist in Lozova.
How a first meeting with a doctor differs from one with a psychologist
From the outside, in no way. The same conversation, the same fifty-five minutes, the same room. The difference is in what the specialist hears behind your words.
Behind the same story a doctor sees one more layer: the thyroid, blood pressure, side effects of medication prescribed by someone else, the difference between a panic attack and a heart rhythm disturbance. Sometimes behind «anxiety» there is a test result nobody has looked at for two years.
This does not make the conversation medical — it just lowers the chance that we spend six months working on something that is treated differently.
Reassurance
What will not happen at the first meeting
What happens after the first meeting
Most often, relief. For the first time in a long while you said out loud what you had been carrying, and the world did not collapse.
But the opposite happens too: the day or two after the meeting can be harder than before it. Almost nobody warns about this, and they should — this is exactly where people abandon therapy, deciding it has made things worse.
The explanation is simple: we touched something that had lain untouched for years. A muscle aches the day after a first workout in the same way. This is not the state getting worse, it is a reaction to it finally moving. It usually passes within a few days.
Price and booking
What it costs and how to book
55 minutes, in person or online — the price is the same. Follow-up meetings are agreed individually and discussed at the first one.
Appointments are with me — psychotherapist Roman Budaev: in person in Kharkiv and the region, online across Ukraine and abroad.
Frequently asked questions
How do I start the conversation?
With whatever sentence comes first — there is no correct opening. «I do not know where to start» works too: we will start there.
What if I freeze and cannot speak?
Then I will do the talking and you answer «yes» and «no» until it gets easier. This happens often, and leading the meeting is my job, not yours.
Do I have to talk about my childhood?
No. Many requests are resolved by working with what is happening now. We turn to the past only if it turns out the cause lies there.
What if after the first meeting I decide it is not for me?
Say so plainly — I will not take offence. A first consultation creates no obligation, and I will suggest a colleague if I can.
Will anyone find out that I came?
No. Not your employer, not your relatives, not a clinic. In private practice there is no file and no register.
How many meetings will it take?
It depends on the request. I will give you a landmark at the first meeting, once I see the whole picture — and it will be a range, not an exact number.
The material on this page is for information only and does not replace an in-person consultation. If you need help urgently — crisis help and helpline numbers.
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