What to Expect at Your First Counseling Appointment
If you've never been to counseling before — or it's been a long time — it's normal to have questions about what the process actually looks like. This page walks you through everything step by step, from your first phone call to walking out after your first session.
There are no surprises here. The more you know going in, the easier it is to focus on what actually matters once you're there.
Step by Step: From Your First Call to Your First Session
You call or reach out
The first thing most people ask when they call is whether their insurance is accepted and whether we're taking new clients. From there, our intake team will walk you through your coverage, your estimated co-pay, and your options for providers. If you're unsure what type of service you need — counseling, medication management, or psychological testing — that's fine. We'll help you figure out the right starting point based on what you're dealing with and what your insurance covers.
You're matched with a provider
We take into account your insurance, your availability, your reason for seeking services, and any preferences you have — including whether you'd prefer a male or female counselor. We'll typically recommend the provider we think is the best fit and offer a couple of alternatives in case the timing doesn't work. You're welcome to look over the profiles on our website, and if you want to talk through your options while you're on the phone, we can do that too.
You complete your intake paperwork
After scheduling, you'll receive access to our patient portal where you can fill out your intake paperwork online ahead of time. The form collects basic information: name, date of birth, contact details, insurance information, and your reason for seeking services. It's straightforward and has been designed to be quick. If you aren't able to complete it online beforehand, plan to arrive about 15 minutes early to fill it out in person at the office.
You arrive and check in
When you come in, the front desk will ask for your photo ID and insurance card so we can make copies. Your co-pay will be collected at this point. Then your counselor will come down to meet you and bring you up for your session. For telehealth appointments, you'll join through the patient portal — your counselor will provide instructions. If you're new to Zoom or aren't sure how it works, don't hesitate to call ahead and we'll walk you through it.
Your first session
The first session is an introduction. Your counselor's focus is on getting to know you — who you are, what brought you in, and what you're hoping to get out of the process. This is normal and intentional. Most counselors will let you know upfront that the first two to three sessions are about building rapport and understanding your situation before the deeper work begins. You won't be expected to unpack everything on day one.
Ongoing sessions
All sessions are typically 60 minutes. Starting from the third or fourth session, your counselor will begin working more directly on what you came in for. How many sessions you'll need depends entirely on your situation — there's no fixed number, and most insurance plans don't limit how many times you can be seen. Your counselor will check in with you regularly about how the process is going and adjust as needed.
A note on expectations: Some people come in hoping the first session will resolve something. It usually won't — and that's not a bad sign. The relationship you build with your counselor over the first few sessions is what makes the real work possible. Give it time before deciding whether it's working.
Understanding Your Costs and Insurance
Insurance is the thing that trips people up most often before their first appointment. Here's a plain-language breakdown of how it typically works:
| Situation | What to expect |
|---|---|
| You have a copay plan | You pay a fixed amount per session — typically $50 or under — regardless of how many times you've been seen that year. |
| You have a high-deductible plan | You pay the full session rate (often $100+) until you've met your deductible for the year. After that, your insurance kicks in and your cost drops — sometimes to zero. |
| No insurance or insurance we don't accept | Self-pay rates apply. If those are out of reach, ask about our sliding scale fee program or intern sessions ($55 flat rate). |
| You have HSA or FSA funds | Yes, those can be used for counseling sessions. |
We're in-network with Aetna, Anthem, United, Cigna, Centra, TRICARE, Medicare, and Medicaid, among others. The best way to know what you'll pay is to call your insurance provider and ask what your mental health benefits look like — or call us and we can try to help you sort through it.
One thing worth knowing: We can call your insurance on your behalf in some cases, but we always recommend you make that call yourself too. It acts as a double-check — if we miss something, you'll catch it. Knowing your deductible status and whether you have a copay or coinsurance before your first appointment will save you from any surprises at check-in.
Understanding Your Provider Options
When you look through our provider profiles or get a recommendation from our intake team, you'll notice different credential levels. Here's what they mean:
A licensed counselor has completed their undergraduate and graduate degrees and all required supervised hours, and holds an independent license to practice. A resident has completed their degree and is working toward independent licensure under the supervision of a licensed provider — they are licensed, but not yet independently. Most clients won't notice a practical difference in session quality. A clinical intern is still completing their degree and gaining supervised experience. Interns are seen at a flat rate of $55 and do not bill insurance.
If you're unsure which type of provider is right for your situation, our intake team can help you think through it based on what you're dealing with and what your insurance covers.
Frequently Asked Questions
What happens during a first therapy appointment?
The first session is primarily an introduction. Your counselor gets to know you, learns what brought you in, and begins building rapport. It's not typically a deep dive into treatment yet — most counselors will tell you upfront that the first two to three sessions are about getting to know each other before working on specific issues.
What should I bring to my first appointment?
Bring a photo ID and your insurance card. Your co-pay will be collected at check-in. If you didn't complete the intake paperwork online through the patient portal beforehand, arrive about 15 minutes early to fill it out in person.
What should I talk about in my first therapy session?
You don't need to prepare a script. Your counselor will guide the conversation — they're trained to ask the questions that help them understand your situation. The main thing is showing up. If there's something specific you're nervous about or want to make sure gets addressed, it's fine to mention that at the start of the session.
How does a first appointment with a therapist go?
You check in at the front desk, hand over your ID and insurance card, and pay your co-pay. Your counselor comes to meet you and brings you to the session room. The hour is spent getting acquainted — your background, what brought you in, and what you're hoping to work on. You leave with a scheduled follow-up appointment.
What is the cancellation policy?
For counseling, your first missed intake appointment is forgiven. After that, a $65 fee applies for no-shows or cancellations without 24-hour notice. For psychological services, a 3-day notice is required because of the scheduling complexity and active wait list for those appointments.
What if I'm not sure whether I need counseling, medication management, or something else?
That's a common question and one our intake team handles often. If you want to start with the most cost-effective option, we'll usually point you toward a counselor first and let them make a recommendation from there. If you'd rather get a more comprehensive picture upfront, a psychological evaluation with Dr. Sibcy or Dr. Hilton can set up a full treatment plan tailored to your situation. Either path works — it often comes down to what you're comfortable with and what your budget looks like.
Can a family member call to schedule an appointment for me?
In Virginia, anyone 14 and older can consent to their own mental health services — which means we need to speak directly with the person seeking services, not a parent, guardian, or family member. For children under 14, we work with a parent or legal guardian to schedule. If you're trying to get a family member into counseling and aren't sure how to approach it, give us a call and we'll help you think through it.
What if I try one session and decide it's not for me?
That happens, and it's okay. Sometimes people aren't ready yet — and recognizing that is actually useful information. If the reason is practical (insurance, cost, scheduling), let us know and we'll do what we can to find a workable option. If it's about the fit with a particular counselor, we can help match you with someone different. You're not locked into anything.
If you have questions we haven't answered here, the best thing to do is call or text us directly. Our intake team is there specifically to walk new clients through this process — it's most of what they do, and no question is too basic.
Light Counseling sees clients in person at our offices in Lynchburg, Richmond, Glen Allen, Midlothian, Colonial Heights, and Christiansburg, Virginia. We also offer telehealth appointments across most states. You can also visit our full FAQ page or learn more about billing and insurance.