20 Activities for a First Therapy Session

A first therapy session has several jobs to do at once. The therapist is beginning an assessment, the client is deciding whether the space feels safe, and both people are working out what would make therapy useful. A thoughtful activity can make that process feel more human and less like an interview.

The activities below are not a checklist that must be completed in one appointment. Choose one or two that suit the client’s age, communication style, presenting concerns and level of comfort. Assessment, consent, safeguarding and risk procedures should still follow your professional and organisational requirements.

1. The “What Would Make Today Useful?” Question

Begin with one practical question: “What would make leaving today feel worthwhile?” The answer may be a plan, a clearer understanding, a chance to tell the story or simply feeling less alone. This gives the client influence from the first few minutes and helps the therapist prioritise what matters now.

2. A Gentle Session Road Map

Briefly draw or describe the possible shape of the session: introductions, what has brought the client in, hopes for therapy and next steps. Invite the client to change the order or add a topic. Predictability can reduce uncertainty without making the conversation rigid.

3. The Three Things to Know About Me

Ask the client to share three things they would like you to understand about them. These do not need to be problems; interests, identities, relationships, strengths and preferences are all welcome. The activity helps the therapist meet the person before focusing on symptoms.

4. Comfort and Safety Preferences

Explore what helps the client feel comfortable when talking: having time to think, seeing questions written down, using humour, taking breaks or not maintaining eye contact. Record any reasonable preferences and explain what can be accommodated.

5. Hopes, Worries and Questions

Divide a page into three sections labelled Hopes, Worries and Questions. The client can write, draw or talk through each section. This often surfaces concerns about judgement, confidentiality, homework or not knowing what to say.

6. My Life in Five Headlines

Invite the client to describe five “headlines” from their life as though they were introducing the important chapters of a story. They decide which chapters to include and how much detail to share. Follow their lead rather than asking for a complete history immediately.

7. The Support Team Map

Place the client in the centre of a page and map important people, communities, services and places around them. Use different distances to show closeness or availability. The map can reveal both existing support and areas of isolation.

8. A Typical Day Snapshot

Walk through an ordinary weekday from waking to bedtime. Notice routines, demands, energy changes, relationships and moments when the problem becomes easier or harder. This provides useful context while keeping questions concrete.

9. The Strengths Spotting Conversation

Ask how the client has managed to get through difficult periods so far. Listen for persistence, humour, insight, creativity, care for others or willingness to seek support. Reflect strengths specifically instead of offering generic reassurance.

10. The “More of, Less of” List

Create two columns: More of and Less of. The client might want more calm, connection or confidence and less avoidance, conflict or worry. Translate broad wishes into observable changes together.

11. The Preferred-Future Postcard

Ask the client to imagine sending a short postcard from a point in the future when things are somewhat better. What would the message say? Keep the improvement realistic rather than perfect. The postcard can reveal meaningful outcomes in the client’s own language.

12. Problem Impact Circles

Draw circles for areas such as sleep, school or work, relationships, health, routines and enjoyment. The client rates or colours how much the current concern affects each area. This creates an accessible overview and helps identify where change would matter most.

13. Exceptions Detective

Ask about a recent time when the problem was absent, smaller or easier to manage. Explore what was different without implying the client should already know how to fix everything. Exceptions can reveal supports, conditions and skills that therapy can build upon.

14. The Coping Toolkit Inventory

List what the client currently does when distressed, including strategies that help briefly but create problems later. Approach every response with curiosity: what does it do for them, when does it work and what does it cost? This avoids labelling coping as simply “good” or “bad.”

15. Values Quick Sort

Offer a short set of values—such as family, learning, creativity, stability, kindness, freedom and achievement—and ask the client to choose five that feel important. Discuss where life currently aligns with those values and where it feels pulled away.

16. A One-to-Ten Scaling Question

Ask the client to rate a relevant area from 0 to 10, defining both ends clearly. Follow with: “What keeps it from being one point lower?” and “What might move it half a point?” This elicits resources and small next steps.

17. Therapy Preference Menu

Present choices about how therapy might work: talking, visual activities, worksheets, behavioural practice, games, between-session experiments or a mixture. Explain that preferences can change. Choice supports collaboration and can prevent assumptions about what engagement should look like.

18. Create a Shared Goal Draft

Turn one concern into an initial goal that is meaningful, specific enough to notice and open to revision. For example, “stop anxiety” might become “attend one social activity and stay for 30 minutes.” Check that the goal belongs to the client.

19. Name One Small Experiment

Agree on an optional, manageable action before the next appointment. It could be noticing a pattern, trying one coping skill or recording when the problem is less intense. Frame it as information-gathering, not a test of motivation.

20. End-of-Session Check-Out

Finish with three prompts: “What felt useful?” “Was anything uncomfortable or unclear?” and “What should we do differently next time?” Respond non-defensively. The way feedback is received can strengthen trust more than a perfectly planned session.

Choosing the Right First-Session Activity

The best first-session activity is the one that helps this particular client feel understood while giving the therapist clinically useful information. Some clients will welcome structure; others will need space to tell their story. Some will talk easily; others may engage more through rating scales, drawing or choice-based prompts. A collaborative beginning communicates an important message: therapy is something done with the client, not to them.