What actually happens in a therapy session?

Starting therapy can feel like a big step, especially when you're not sure what to expect. Will I have to talk about my childhood? Will I lie on a chaise longue and be analysed? What if I cry?

In this post, I'll walk you through what actually happens in a therapy session - especially if your therapist works with EMDR or cognitive behavioural therapies (like me).

First things first, we work together

Every session is shaped around your needs. You bring your expertise in your experiences and your life. The therapist brings the knowledge and experience of therapeutic processes. We put those things together and find a way forward.

If you feel able to, you can help set the pace of therapy, so we don't go too fast or too slow for your needs and goals. You can ask questions, pause, and sit in silence if you need to. There's no pressure to share anything before you're ready, and you don't need to share absolutely everything about yourself for therapy to be successful.

What happens in a first session?

The first session is often more of a gentle getting-to-know-you conversation. It usually includes:

• An overview of how therapy works and what to expect

• Some questions about what’s brought you here

• A chance to talk about what you’d like help with, even if you’re not quite sure yet

• Time to ask questions about the therapeutic approach used

The main aim of the first session is to answer the question: do we think we can work together? So, there's no pressure to get into anything in-depth straight away.

What about ongoing sessions?

After that first session, we begin to explore things in a bit more detail and depth, but always at a pace that feels manageable.

Below are a few details to give you an idea of what a typical session might entail if your therapist works with CBT, ACT or EMDR as a primary approach. Although, as I mentioned in this post, many therapists integrate ideas from different approaches - it all depends on what you're working on and what feels right for you.

CBT (Cognitive Behavioural Therapy)

CBT focuses on the connection between your thoughts, emotions, and behaviours. Sessions could include:

• Identifying unhelpful patterns in our thoughts

• Learning to work with them in different ways

• Making plans to try out healthier routines, or to experiment with different ways of being

• Developing practical strategies to cope with anxiety, low mood or stress

• Revisiting difficult events to try and make sense of them

• Sometimes mapping things out on paper (or on-screen if we're online)

It’s structured, goal-oriented, and great for people who want practical tools to change how they feel and respond to life’s challenges.

ACT (Acceptance and Commitment Therapy)

ACT helps you stop struggling with difficult thoughts and feelings, and focus instead on living a life that aligns with your values.

In an ACT-based session, we might explore:

• How to notice and unhook from painful thoughts

• Building psychological flexibility (how you respond to inner experiences)

• Mindfulness techniques

• Clarifying what truly matters to you, and how to move toward it, even with discomfort present

It’s about making room for what’s hard, while still making meaningful choices.

EMDR (Eye Movement Desensitisation and Reprocessing)

EMDR is especially helpful in the context of traumatic or very distressing memories that feel stuck or unresolved.

An EMDR session may involve:

• Talking very briefly about a memory, image, or body sensation

• Using bilateral stimulation (usually eye movements or tapping) to help your brain process what’s been “frozen”

• Reducing the intensity of old experiences, so they feel more manageable in the present

This only happens when you feel safe and ready. You’re always in control of the pace.

Will I just talk the whole time?

Yes and no. Whilst most therapies do rely on a dialogue between therapist and client, we're talking with a purpose. We're trying to understand or problem-solve something, and we're doing that in a way that aligns with your values and goals. That's very different to having a general chat about the week, or an offload.

As well as a therapeutic conversation, sessions may often include:

• Guided reflection or mindfulness exercises

• Practicing skills together

• Drawing connections between past and present

• Exploring what happens in your body as well as your thoughts

• Reviewing patterns and how they show up in daily life

Each session is different, depending on where you are and what’s coming up.

What if I get emotional?

This is often a sign that something meaningful is happening. Tears, silence, laughter, frustrations - all emotions are welcome. You don't need to hold things together for your therapist; it's a place to take the mask off. If that sounds terrifying to you, I understand. Some people are really comfortable with emotional displays, others less so. Again, we go at your pace.

Will I be told what to do?

A therapist's role is to support, guide, and help develop different perspectives. Therapists are not there to force or fix anything, nor give advice on the 'best' course of action in a particular situation. Particularly when we're overwhelmed, we'd often love someone to come and tell us what to do for the best, but this is not within a therapist's gift. They can help you explore different options, test out ideas, and help you rebuild if things don't go to plan. Anything you choose to act upon is exactly that - your choice.

Ready to explore therapy?

If you’re curious about what therapy could offer you, I’d be happy to answer any questions you may have. You can get in touch via the contact form at the bottom of the page. I offer a calm, confidential space to begin - no pressure, no sales tactics, no chaise longue (sadly).