What to Expect During Your First CBT or ERP Session

Starting therapy for the first time can feel both exciting and a bit nerve-wracking. If you’re considering Cognitive Behavioral Therapy (CBT) or Exposure and Response Prevention (ERP), you’re already taking a great step toward improving your mental health. But what will that first session actually be like? What should you do to prepare? And how does the process work?

We’re here to walk you through what to expect during your first CBT or ERP session, demystifying the process so you can feel confident and ready to begin. From preparation to goal setting to understanding the techniques behind ERP, we’ll cover everything you need to know about starting therapy.

What Are CBT and ERP?

Before we get into the details of your first session, it’s important to understand what CBT and ERP are and why they’re highly effective, evidence-based approaches.

Cognitive Behavioral Therapy (CBT):

CBT focuses on the connection between thoughts, feelings, and behaviors. Often used to treat anxiety, depression, and other mental health conditions, CBT helps you identify unhelpful thinking patterns and develop healthier coping strategies.

Exposure and Response Prevention (ERP):

ERP is a specific type of CBT, designed especially for individuals with anxiety disorders like Obsessive-Compulsive Disorder (OCD). The goal is to expose you to anxiety-provoking situations in a safe, controlled way, while helping you resist the urge to engage in compulsive behaviors. Over time, this reduces anxiety and strengthens your ability to tolerate uncertainty.

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Preparing for Your First Session

The first session is all about laying the groundwork for your therapy experience. To make the most of it, a little preparation goes a long way.

1. Complete Pre-Session Paperwork

Before your first appointment, you’ll receive paperwork to fill out online. This includes HIPAA-secure forms containing questions about your medical history, current challenges, and any goals you’d like to achieve through therapy. Take your time answering these questions honestly, as they provide a helpful foundation for your therapist to understand your needs.

2. Reflect on Your Goals

Take a moment to think about what you want to achieve through therapy. Are you hoping to manage your OCD symptoms, reduce panic attacks, or improve your self-esteem? While it’s okay to be uncertain about your goals, having a general idea helps the therapist guide the session effectively.

3. Choose a Comfortable Setting (for virtual sessions)

If you’re meeting your therapist virtually, set up in a quiet space where you feel comfortable and won’t be interrupted. A cup of tea, a notebook, and a stable internet connection can help set a positive tone. If you’ve scheduled in-person sessions in our office, make yourself a cup of tea or coffee, grab a snack, and make yourself at home at our waiting room until your therapist greets you.

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What Happens During the Session

Wondering what those 50 minutes will look like? Here’s a step-by-step breakdown of what typically happens during a first CBT or ERP session:

1. Introduction and Relationship Building

Your therapist will start by introducing themselves and explaining their approach to therapy. This is a time to ask questions, express any concerns, and get to know each other. Building trust and rapport is key to effective therapy.

2. Gathering Background Information

Your therapist will review the information you provided in your paperwork and ask follow-up questions. They’ll explore your mental health history, current symptoms, and what brings you to therapy. If the therapy is for your child, the first session is often with parents only to understand their perspective before meeting with the child.

3. Discussing the Therapy Process

The therapist will outline what your sessions may look like, discuss the therapy model (CBT or ERP), and explain how they’ll work with you to address your challenges. They’ll also go over standard policies like confidentiality and session structure.

4. Identifying Treatment Goals

Together, you and your therapist will set initial goals tailored to your specific needs. Clear, measurable goals give therapy direction and help track progress over time.

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Understanding Exposure Therapy for ERP

If you’re seeking ERP specifically, your therapist will take time to explain how exposure works and why it’s effective. Here’s a quick breakdown:

What Is Exposure?

Exposure involves gradually facing situations or thoughts that trigger anxiety. For example, someone with OCD who fears contamination may practice touching doorknobs without washing their hands afterward. The goal is to reduce the fear response over time.

How Does It Help?

ERP helps “rewire” how your brain responds to fear. By resisting compulsive responses during exposure, you teach your brain that the feared situation isn’t as dangerous as it seems. Over time, this leads to reduced anxiety and increased resilience.

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Common Questions About Starting CBT or ERP

It’s natural to have questions before starting therapy. Here are some of the most common concerns we hear:

“What if I don’t know what to talk about?”

That’s completely fine. Your therapist will guide the session with targeted questions to help you explore your thoughts and feelings.

“Do I have to do exposure therapy in my first session?”

No! Your first session is more about understanding your needs and creating a treatment plan. Exposure therapy only begins when you and your therapist feel ready, likely around session 4-6, if appropriate. There is a considerable amount of assessment, and cognitive work that comes before ERP.

“Will therapy be uncomfortable?”

Therapy can feel challenging at times, but it’s a safe space where your therapist will tailor sessions to your comfort level while still helping you grow.

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Take the First Step Toward Better Mental Health

Your first CBT or ERP session is the start of a collaborative, healing process. It may feel daunting initially, but with the right therapist and a clear plan in place, it can also be empowering and life-changing. Whether you’re struggling with anxiety, OCD, or simply looking to improve your mental wellbeing, therapy can help you achieve meaningful growth.

At GroundWork CBT, we specialize in evidence-based approaches like CBT and ERP to help individuals and families overcome challenges and thrive. We offer both in-person sessions in Orlando, and teletherapy to fit your lifestyle. Take the first step today by scheduling your appointment with one of our experienced therapists. Together, we’ll build a plan that transforms challenges into strengths. Request An Appointment Now!