If you’ve never done therapy before — or never done it online — it’s normal to feel uncertain about what you’re walking into. Most people who schedule a first session carry some version of the same questions: Will I have to talk about everything right away? What if I don’t know what to say? Is telehealth actually as effective as in-person therapy?
Here’s what you can realistically expect.
Before the Session: Setup Takes Five Minutes
Online therapy requires nothing more than a private space, a device with a camera and microphone, and a stable internet connection. You’ll receive a secure link before your appointment — no app downloads required. Most people join from home, which has an unexpected advantage: you’re already in a comfortable, familiar environment.
If privacy is a concern (thin walls, roommates, family members nearby), headphones and a white noise app running outside the door go a long way.
The First Session Is About Listening — Mostly Mine
The first session is not about solving anything. It’s a conversation, and its main purpose is for me to understand you: what’s been going on, how long it’s been going on, what you’ve tried, and what you’re hoping will be different.
You don’t need to arrive with a prepared speech or a list of symptoms. You don’t have to share anything you’re not ready to share. I’ll ask questions, and we’ll go from there.
By the end of the first session, you should have a clearer sense of whether this feels like a good fit — and so will I.
What We Won’t Do in Session One
We won’t dive into your deepest trauma on day one. We won’t assign homework before we’ve built a working relationship. And I won’t offer a diagnosis at the end of 50 minutes as if that settles anything.
Good therapy is built on trust, and trust takes time. The first session is the beginning of that process, not the whole thing.
Is Online Therapy as Effective as In-Person?
This is the question most people don’t ask out loud but want answered. The short answer: yes, for most conditions and most people.
Research on telehealth therapy consistently shows outcomes comparable to in-person treatment for anxiety, depression, trauma, and adjustment difficulties. What matters most is not the medium — it’s the quality of the therapeutic relationship and the approach being used. Those travel just fine over a screen.
What Happens After the First Session
If we decide to move forward, we’ll schedule regular appointments (typically weekly at the start) and begin setting concrete goals. What do you want to be different in three months? Six months? One year? What would you need to feel, think, or do differently to get there?
The approach I use — drawing on Mindfulness-Based Cognitive Therapy, Emotionally Focused Therapy, and somatic techniques — is collaborative. You’re not a passive recipient of treatment. You’re doing the work, and I’m there to make that work as efficient and sustainable as possible.
Paying For Therapy
Payment in full is accepted by credit or debit card at the time of service. While I don’t participate in any insurance panels, you will receive a receipt (often called a “superbill”) which you can submit to your insurance for reimbursement. To help you access any out of network benefits you may have, I have partnered with Thrizer (Thrizer.com), a payment application that handles this process automatically for you so you can pay only what you truly owe for our sessions. It is entirely up to you whether to use Thrizer or submit your superbill to your insurance company yourself.
One Last Thing
A lot of people wait longer than they should before reaching out. They want to be “bad enough” to justify therapy, or they worry they’re taking a spot from someone who needs it more.
There’s no threshold you have to clear. If something is getting in the way of the life you want, that’s enough.
Dr. Ray Bepko is a licensed psychologist in New York and Florida offering telehealth therapy for anxiety, depression, trauma, and life transitions. Schedule a free 15-minute consultation at raybepkophd.com.