In plain words

Confidentiality in therapy means that by law your therapist must keep what you say private. The main exception is when your therapist believes there is a serious and immediate risk of harm to you or someone else. In that situation they may be required to act. Everything else stays between you and your provider.

Therapy can feel unfamiliar, especially if talking to a counselor was not common where you grew up. Knowing what usually happens takes away a lot of the worry. Here is what a first therapy session is really like.

At a glance
  • The first session is mostly the therapist getting to know you, and you set the goals together at your own pace.
  • What you say is confidential, with only narrow exceptions when there is a serious, immediate risk of harm.
  • Most people need several sessions to feel a difference, and it is okay to change providers if the fit is not right.
  • You can use a free, qualified interpreter for every session, and therapy works well through one.

The first session

The first session is mostly the therapist getting to know you. A session usually lasts about 45 to 50 minutes. When you arrive, you may fill out a few forms about your health and what brings you in; you can ask for these in your language and for an interpreter to go through them with you. Then the therapist will ask about your history, what brought you in, and what you hope to change. They may ask about your sleep, your mood, your family, your work, and whether you have had counseling before.

You do not have to share everything at once, and you can go at your own pace. If a question feels too hard, you can say, “I am not ready to talk about that yet,” and that is a normal, accepted answer. If you feel like crying, that is welcome here; therapists expect strong feelings and are trained to sit with them. If you do not know what to say, you can say that too, and the therapist will help you begin. You and the therapist set the goals together, so nothing is decided without you.

NIMH's "Psychotherapies" page, which explains what talk therapy is and the main approaches. Captured June 30, 2026.

It is confidential

Your conversations are private

A therapist may have to act only when there is a serious, immediate risk of harm to you or someone else. Your immigration status is not one of these exceptions, and simply having thoughts of suicide does not, by itself, mean the therapist calls the police.

What you say in therapy is private. The therapist will explain the limits at the very start, and the limits are narrow. In general, a therapist may have to act only when there is a serious and immediate risk of harm: if you are about to seriously hurt yourself or someone else, or if a child, an elderly person, or a person with a disability is being abused or neglected (APA Services). These duties come from state law and are meant to keep people safe.

It helps to know what these limits are not. Simply having thoughts of suicide does not, by itself, mean the therapist calls the police or sends you to the hospital; in that situation a therapist usually talks with you, checks how much danger you are in, and helps you make a safety plan (APA Services). Your immigration status is not one of these exceptions, and a therapist is not there to report you. Apart from the narrow safety situations, your conversations stay between you and your provider. You can use a qualified interpreter for every session, and the relationship still works well through an interpreter. A trained interpreter is bound to keep what you say private too.

The kinds of therapy

There are several approaches that research has shown to work. A common one is cognitive behavioral therapy (CBT), which helps you notice and change troubling thoughts and behaviors. CBT is usually short and practical: many people meet weekly and finish a course in about 12 to 20 weeks, though some feel better in fewer sessions and some need more (Cleveland Clinic). Other well-studied approaches include therapy focused on trauma, and talk therapy that works on relationships and difficult feelings. These evidence-based therapies can reduce symptoms of depression, anxiety, and other conditions, and many people also use therapy for the effects of trauma or everyday stress (NIMH). Your therapist will explain the approach they suggest and why it fits your goals. It is fair to ask, “How does this kind of therapy work, and how will we know it is helping?”

How long it takes

Most people need several sessions before they feel a difference. You and the therapist will set goals and review your progress as you go. Medicine, from a psychiatrist or your primary care provider, can be combined with talk therapy. If that comes up, ask about the benefits, the possible side effects, and how long it takes to start working.

It is okay to change providers

The fit between you and your therapist matters. A large review of hundreds of studies found that a strong, trusting working relationship between you and your therapist is one of the most consistent things linked to getting better, across many kinds of therapy (Flückiger et al., 2018). If the first provider does not feel right, you can ask for someone else. Looking for a better match is a normal part of finding care, not a failure on your part.

Therapy and everyday care

Taking care of yourself supports your treatment: steady sleep, some movement, staying connected with people, and a daily routine all help. These things support therapy, but they do not replace it (NIMH, MedlinePlus). Think of them as working alongside the care you get from your provider.

You can ask the chatbot to help you prepare for a session or draft questions in your language, and you always have the right to a free, qualified interpreter for every visit.

What to bring and what to ask

Coming with a few notes makes the first session easier. Nothing formal is needed, but these help:

What to bring
  • A few words about what has been bothering you and when it started.
  • The medicines you take, including ones for physical health; bring the bottles or a photo of the labels.
  • A note about any past counseling or hospital care, if you have had any.
  • Your insurance or Medicaid card, if you have one.

It is also fair to ask the therapist questions. You can say:

You can ask the therapist

"Have you worked with people from my community or country before?"

"How does therapy with an interpreter work here?"

"What kind of therapy do you think would help me, and how long might it take?"

"What will this cost, and do you take my insurance or offer a sliding scale?"

How to find a therapist, including in your language

If you do not have a provider yet, these free tools can help you start:

  • Community health centers offer counseling on a sliding scale and are used to arranging interpreters. Find one near you at findahealthcenter.hrsa.gov. They serve you no matter your ability to pay or your immigration status.
  • findtreatment.gov is a free federal search tool for mental health and substance use care.
  • Medicaid covers mental health care in every state. If you have Medicaid, your plan can give you a list of counselors and arrange an interpreter; call the member number on your card.
  • Dial 211 to reach low-cost counseling and other help in your area, offered in many languages.

When you call, you can say, “I speak [your language]. I need a therapist, and I need an interpreter at no cost to me.” Asking for an interpreter is your right, and it does not cost you anything. See Your right to a free, qualified interpreter.

Therapy by phone or video, and in your language

You do not always have to travel to an office. Many providers now offer therapy by video or phone. Research shows this works: in careful studies, therapy delivered by video was as effective as meeting in person for problems like depression and anxiety (Singla et al., 2025). Video or phone can make care easier if you have no transportation, work long hours, or care for children at home. For a long, emotional, or complex visit, you can still ask to meet in person.

Therapy through a qualified interpreter also works well, and it can even help you open up. One review of studies found that when a professional interpreter is used, people share more about hard experiences and symptoms than with an untrained helper or no interpreter at all (Bauer & Alegría, 2010). The words you use in a mental health visit carry meaning, so a trained interpreter who keeps your exact meaning protects your care.

Common worries, answered

  • Do I have to take medicine? No. Talk therapy on its own helps many people. Medicine is a choice you make together with a clinician, and you can start with therapy alone and decide later.
  • What if I cannot afford it? Community health centers set the fee by what you can pay, Medicaid covers mental health care, and you can call 211 for low-cost options near you. Cost should not be the reason you go without care.
  • Will my family be told? No. What you say is private, with only the narrow safety exceptions above. Your provider will not share your visits with family, an employer, or immigration authorities without your permission.
  • Will they understand my background? You can ask for a provider who has worked with people from your community, and you can change providers if the fit is not right. That is a normal part of finding good care.

Sources

LINC is a research prototype, not a medical or legal service. Translation can be wrong; you have the right to a free, qualified interpreter. For anything high-stakes, do it with a community health worker or someone you trust. In a crisis, call or text 988, or 911 for immediate danger.