What to Expect in Your First Eating Disorder Therapy Session

Starting therapy for an eating disorder is a brave step. If you feel unsure about what happens in the first session, you’re not alone. The aim isn’t to judge or interrogate you; it’s to understand your experience, reduce immediate stress, and begin building a plan that feels safe and possible. Below is a clear, practical guide to what usually happens — straightforward, calm, and easy to take in.

Why the First Session Matters

Relationship building: The therapeutic relationship is the foundation for all progress. Your first session focuses on trust - getting to know your therapist, their approach, and how you work best.

Clarity and safety: You’ll walk away with a better sense of what therapy can address, how boundaries and confidentiality work, and what next steps could look like.

Baseline understanding: Your therapist will gather relevant history and context to understand your patterns, stressors, and goals without rushing or pressuring you to share.

How the Session Begins

Introductions and housekeeping. Expect a warm welcome, a quick review of informed consent, confidentiality, limits to confidentiality (e.g., risk of harm or legal requirements), and how communication works between sessions.

Your priorities first. Most therapists start by asking what brought you in, what feels most urgent, and what you hope will be different in a few weeks or months.

You set the pace. You won’t be pushed to share more than you’re ready to. If something feels too raw, say so — that’s part of the process.

What Your Therapist Will Ask About (and Why)

Current behaviours and patterns. Restriction, bingeing, purging, compulsive exercise, body-image distress — these questions help identify triggers, routines and risks.

Physical health. Sleep, energy, dizziness, fainting, and periods are discussed to determine whether a medical check-in is needed. Your therapist may suggest contacting a GP or other clinician if there are physical concerns.

History and context. When symptoms began, past supports, significant life events, family dynamics, trauma history (if relevant and safe to discuss), perfectionism, anxiety, or depression.

Daily life impact. School or work, relationships, social situations, and how symptoms affect functioning and quality of life.

Motivation and ambivalence. It’s normal to feel conflicted. Therapists often use motivational interviewing to explore readiness, values, and what matters most to you right now.

You can answer as little or as much as feels safe — the aim is mutual understanding, not ticking boxes.

What Eating Disorder Therapy Does - and Does Not - Do

What therapy focuses on. Therapy works on the thoughts, emotions and relationships that keep behaviours in place: coping strategies, body image, stress, perfectionism and communication patterns.

What it doesn’t replace. Therapy is not a substitute for medical or nutritional care. Therapists do not prescribe meal plans; when helpful, they collaborate with registered dietitians and medical professionals, with your consent, as part of a broader care team.

Tailored care. There is no one-size-fits-all path. Some people benefit from structured programmes; others need slower pacing and stabilisation before moving into more active work.

Approaches Your Therapist May Use

Motivational interviewing: To reduce shame, explore ambivalence, and strengthen your own reasons for change.

CBT or DBT-informed strategies: To identify thinking patterns, reduce all-or-nothing rules, build distress tolerance, and replace harmful coping with safer skills.

Trauma-informed care: If trauma or chronic stress are relevant, the pace stays safe and anchored.

Family work or caregiver support: Where home dynamics matter, especially for younger clients.

Self-compassion and values work: To counter perfectionism and rigid standards with kinder, more sustainable ways of relating to yourself.

Your therapist will explain their approach in plain language and check if it aligns with how you want to work.

Safety, Confidentiality, and Boundaries

Confidentiality: Your conversations are private with clear exceptions (risk of harm to yourself or others, abuse/neglect concerns involving minors or vulnerable persons, or legal requirements). Your therapist will outline these early, so there are no surprises.

Risk and stabilisation: If there are immediate risks (e.g., fainting, self-harm thoughts), your therapist will focus first on safety planning and appropriate referrals. This is about care and stabilization, not punishment or loss of autonomy.

Consent for collaboration: If you choose to involve a physician, dietitian, school, or caregiver, your therapist will obtain your written consent and limit information sharing to what’s necessary.

What You’ll Leave With After the First Session

A clearer picture of goals: Short-term (e.g., reduce urges, improve sleep, manage anxiety spikes) and longer-term (e.g., rebuild trust with your body, reduce rigid rules).

Initial tools: One or two practical strategies tailored to your patterns - such as a distress tolerance plan, coping alternatives for high-risk times, or a body image trigger map.

A follow-up plan: Frequency of sessions, options for caregiver involvement (if applicable), and discussion of whether you’d benefit from additional supports.

You’ll also have the option to pause, reflect, and decide if the fit feels right - therapy works best when you feel respected and understood.

If You’re a Parent or Caregiver

You can be part of the solution: With the client’s consent (and in line with age and legal considerations), family therapy can help reduce conflict, align support strategies, and create a calmer home routine.

Practical support: You can learn how to respond to distress without escalating shame, how to set compassionate boundaries, and how to collaborate with therapy goals without trying to “control” recovery.

Your needs matter too: Therapy can provide space to manage your own stress, grief, and fears - so you can support your loved one more consistently.

What You Don’t Have to Do in the First Session

You don’t have to have a perfect story: Timelines are often messy. It’s okay to say “I don’t know” or “I’m not ready to talk about that.”

You don’t need to commit to long-term therapy on the spot: You can take time to decide, ask about options, and consider your comfort with the plan.

You don’t have to fix everything at once: Small, manageable steps build momentum. The first session prioritizes understanding and relief, not a complete overhaul.

How to Prepare (Only if it Helps)

If preparation reduces anxiety, try these gentle steps. If not, just come as you are.

Jot down key points: Times of day symptoms feel strongest, triggers you’ve noticed, goals that matter most (e.g., less mental space taken up by food rules or body checking).

Identify supports: Who helps you feel safer? What has helped even a little? What makes things worse?

Choose boundaries: Decide on topics you want to approach slowly and let your therapist know upfront.

If you are looking for help with disordered eating, feel free to explore our page on eating disorder therapy, contact us, or book your free consultation to see how our eating disorder therapist can help.