You booked your child’s first therapy session. Somewhere between booking it and now, you started second-guessing it.
Maybe you are wondering whether the problem is really big enough to justify this. Maybe you are worried your child will feel singled out, or that a stranger will form a view about your parenting before you have finished explaining.
Here is the first thing worth knowing, because it settles a surprising amount of that worry. At our Ottawa practice, the first appointment is with you. Your child comes in later.
Jump to:
Who comes to the first appointment?
The first session is with the parents or caregivers.
There is a practical reason for that. You need to be able to say difficult things and ask blunt questions without an audience, and that is hard to do with a nine year old sitting beside you. It also means your child’s first experience of the therapy room is not listening to adults discuss what is wrong with them.
How the sequence usually runs:
- Session 1. Parents or caregivers. History, concerns, and what you want to be different.
- Session 2, and sometimes a third. Your child comes in. The focus is building a relationship, helping them feel comfortable in the space, and identifying their strengths.
- After that. Skills work on the specific difficulties, with parents often brought into part of a session so the same approach continues at home.
You can read the full description of this process on our children and parents page.
One consequence worth planning around: you do not need to prepare your child for anything before your own appointment. That conversation comes later, and you will have a much better sense of what to say once you have had it.
What to do before you arrive
Before your first therapy session, preparation is mostly paperwork and memory.
Bring the documents. Previous reports and evaluations, school communications, an IEP or 504 plan if your child has one, and anything you have from other providers. Our FAQs note that intake and policy paperwork gets reviewed at the start of the first session, so leave a few minutes for it.
Write down what you might forget. Most parents arrive with the recent incidents fresh and the early history hazy. A few notes on when you first noticed something, and what you have already tried, beat trying to recall it on the spot.
The things we most often wish parents had brought are the written ones. Report cards, any email a teacher sent about a concern, previous testing. Parents leave these at home on the assumption we only want their account. We want both, and the paperwork often shows a pattern across years that nobody had lined up before.
Think about what you want. What would need to be different in six months for this to have been worth doing? A rough answer is fine, but it is the question that shapes everything else.
### Telling your child, before their own session
Tell them where they are going, in plain language, before you leave the house. Surprise arrivals tend to go badly in our experience, because a child who works out mid-journey that this is about them will often spend the session defending themselves.
Something simple usually works: “We’re going to meet someone whose job is helping kids with worries. You’ll talk, and there are usually some games.” With younger children we generally find “talking” lands more easily than “therapy.”
If your child asks why they have to go, naming a difficulty works better than naming a fault. “Mornings have been really hard lately and I want us to get some help with that” is heard very differently from “because of how you’ve been behaving.”
If the question comes up in the room, we will usually take it ourselves, so you are not answering under pressure. Something close to: “Your parents told me mornings have been hard. My job is to figure out what would make them easier. You’re not in trouble, and nothing is wrong with you.” Then we move on. No speech about it.
What we would avoid: promising your child they will not have to talk about anything they do not want to, and rehearsing what they should say. Children often arrive with a prepared answer, and it takes a while to get past it.
What the first therapy session actually looks like
It is a conversation, and it is mostly you talking. We will tell you how long to allow when you book.
The session covers paperwork briefly, then moves into history. You will not be asked to perform or to have organized your thoughts in advance.
For many parents this is the first time they have told the whole story to someone whose job is to listen to it. That can be harder than expected, and it is a normal response, not a problem.
You will also get to ask questions. How this works, what happens next, how long it might take. Ask about cost and logistics too, since those are easier settled at the start than discovered later. Our fees range from $120 to $295 per hour depending on the scope of the work, and you get the specific figure in writing before your first appointment.
What we will ask you
The ground covered is fairly standard for a child mental health evaluation. The American Academy of Child and Adolescent Psychiatry describes a comprehensive evaluation as typically covering presenting concerns, health history, family history, development, school and friendships, and interviews with both parents and child (AACAP). That description is written about psychiatric evaluation, and the areas covered are much the same in a psychological one.
Expect questions across these areas.
The presenting concern. When it started, what makes it better or worse, what you have tried, and what a bad day actually looks like.
Developmental history. Pregnancy and birth, early milestones, speech, sleep, eating, early medical issues.
School. Performance, any support in place, the teacher’s view, and whether home and school are seeing the same child. That last one matters more than parents expect. A child who is fine at school and falling apart at home, or the reverse, is telling us something specific.
Family. Who lives at home, recent changes, and any family history of mental health or learning difficulties. We are not inspecting your parenting. The National Institute of Mental Health notes that some mental disorders run in families, while being clear that a family history “doesn’t necessarily mean you will develop that disorder” (NIMH). We ask because it often gives us context early.
Sleep, screens, food and exercise. Unglamorous, and more relevant than they sound.
You will not remember every date, and approximate is fine. If something is hard to say out loud, you can put it in writing and send it ahead of the appointment instead of raising it in the room.
When your child comes in
Your child’s own first session is usually the second appointment, and its job is to make the room feel safe, not to fix anything.
That stage is about building a relationship, helping your child feel comfortable, and identifying their strengths before any skills work starts. Children who feel safe in the room tend to engage more readily with the harder work when it comes.
With a child who is nervous or silent, the approach that generally works is to stop asking questions. We put something on the table to do, draw or build or play, and talk sideways over the top of it, not face to face. We say what is going to happen, that they will not be made to talk about anything that day, and that they can ask us anything. Then we let them set the pace. Most children start talking once it is clear nothing is being extracted from them.
It is also where the question parents most want answered, and are least likely to ask out loud, comes up: do you stay?
That depends on your child’s age and on what we are working on, and it is agreed with you rather than decided over your head. Younger children usually have their parents closely involved, often in the room for some or all of a session. Older children and teenagers generally need more private time for the work to function.
What matters more than the seating is that the ground rules get set explicitly at the start, with everyone in the room. That conversation covers what will be shared with you, what your child can keep private, and where the limits sit.
For younger children, parents are closely involved and generally have access to what is going on. For adolescents, Illinois law gives the young person a real say. That is worth knowing before you assume otherwise.
A minor aged 12 or over can consent to outpatient counseling in their own right. That right has a limit. Without a parent’s consent, counseling for a minor under 17 is initially capped at eight 90-minute sessions. The statute sets out how services continue past that point.
Within that framework, 405 ILCS 5/3-550 says a parent is generally not informed without the young person’s written consent. The exception is where the provider believes disclosure is necessary. If we reach that point, your child is told before you are, and they can choose to stop.
Records work on a similar principle. Under the Mental Health and Developmental Disabilities Confidentiality Act, a parent of a 12 to 17 year old can usually inspect their records. That access applies if either of two things is true: the young person is informed and does not object, or the therapist finds no compelling reason to deny it.
Separately, parents may request and receive their child’s current condition, diagnosis, treatment needs, services provided and any medication.
Where safety is genuinely at risk, we act. As licensed psychologists we are mandated reporters under Illinois law. If we have reasonable cause to believe a child may have been abused or neglected, we must report that concern to the Department of Children and Family Services.
That threshold is what triggers a report. Talking about a parent does not, by itself.
Two more points worth stating plainly. Where counseling relates to alleged abuse or neglect by a parent or guardian, 405 ILCS 5/3-550 treats seeking that person’s consent as presumed detrimental to the child. And if a report is made, state law does not require us to tell the parent. DCFS guidance is explicit that this is a matter of professional judgment, and that a child’s safety should always weigh in the decision.
None of this is meant to shut you out. It is the framework we work inside, and we will walk you through exactly how it applies to your child at the start.
If a child is in danger right now
If you or a child you know is in immediate danger, call 911.
To report suspected child abuse or neglect in Illinois, call the DCFS Child Abuse Hotline on 1-800-25-ABUSE (1-800-252-2873). You do not have to be certain, and you do not have to be a professional to call.
If you are a young person reading this and you are not safe at home, you are allowed to tell someone. A teacher, a school counselor, a doctor or any other adult you trust can help you make that call.
Being asked to step out is not a judgment about you. Children often speak more openly without a parent present. There are various reasons for that, and one we see frequently is simple protectiveness: a child who knows a subject upsets you may avoid it while you are sitting there.
If you want to stay, say so at the start, not afterwards. It is a reasonable request, and it is better discussed than assumed.
A quiet child still gives us a great deal to work with. How they use the room, what they play with, what they draw, how they respond to an unfamiliar adult. For younger children in particular, the play is how the assessment happens, not a warm-up before it.
What your child might say afterwards
Possibly nothing. Prepare for that, because it worries parents more than it should.
In our experience a shrug, or “fine,” is among the most common answers to “how was it?” It is not a reliable sign the session went badly. Most children have no language for the process, and some are protecting the privacy of something that felt good precisely because it was theirs.
A few things tend to help.
Ask one low-stakes question, not five. “Did you like her?” beats “what did you talk about?” You are asking about fit, which is what matters early.
Give them the car ride off. Some children need a long stretch of quiet after concentrating hard.
A harder evening is possible. Occasionally a session stirs things up and there is more emotion at home that night. Tell us if it happens. It is useful information, not a complaint. Some children are noticeably lighter instead. In our experience either reaction, or neither, sits well within the ordinary range.
How long until we see a change?
Honest answer: usually longer than you want, and the research gives a partial picture, not a promise.
One useful reference point comes from treatment for depression specifically, so read it as indicative, not as a rule covering every child and every difficulty. In a meta-analysis of 40 randomized trials covering 3,779 children and adolescents treated for depression, 39% of those receiving psychological treatment met the response threshold at around two months, against 24% in control conditions. Clinically significant improvement came out at 54% of treated young people against 32% of controls (Cuijpers et al., European Child and Adolescent Psychiatry, 2023). Most of those figures were estimated from aggregate trial data rather than reported directly by the trials themselves, which is worth knowing before leaning on the exact numbers.
Three things are worth drawing out of that carefully.
What therapy was compared against changed the result. Measured against waiting lists, 42% of treated young people responded versus 20% of controls. Measured against usual care, it was 37% versus 28%. The relative effect differed significantly by control type (p = 0.02), so the headline figure is an average across quite different situations, not one clean answer.
Two months is when researchers measured, not when change starts. The study did not track when improvement began. Some families notice something much earlier.
Falling short of the threshold is not the same as nothing happening. Response meant roughly a 50% reduction in symptoms, which is a demanding bar. A child can be meaningfully better and still not reach it.
What we tell parents is this. The first sessions go on relationship, not results. The earliest changes are small and domestic, a shorter argument or an easier bedtime, well before the presenting problem shifts. And expect us to review progress with you openly as the work goes on, rather than leaving you to wonder. If it is not working, that is a reason to change the approach, not a reason to quietly give up on it.
On leaving early. In a small qualitative study, researchers interviewed seven parents who had left one specific treatment, Parent-Child Interaction Therapy, at a single fee-for-service clinic. Their reasons varied. Some felt they had made enough progress and were finished. Others raised the pace and structure of the treatment, disagreement with particular procedures, whether it suited their child, clinician factors, and cost and time commitments that had not been clear enough at the outset (Ufford et al., International Journal of Environmental Research and Public Health, 2022).
Seven parents and one treatment model does not describe child therapy generally. Treat it as a prompt about what to raise, and not as a pattern, and the prompt is this: if something is not working, say so out loud instead of quietly disengaging. Cost, pace, fit and doubt are all legitimate to raise, and raising them early is what lets us do something about them.
Frequently Asked Questions
Who comes to the first therapy session?
At our practice the first therapy session is with parents or caregivers. Your child is met at the second appointment, and sometimes a third, where the focus is building a relationship and helping them feel comfortable before any skills work begins.
What should I tell my child before their first appointment?
Tell them where they are going, in plain language, before you leave. Name the difficulty, not a fault. Something like “we’re meeting someone who helps kids with worries” tends to work better than clinical terms, and surprise arrivals generally go worse.
What if my child refuses to talk?
That is common and workable. Much of an early session is observational rather than verbal, so how a child uses the room, what they choose to play with and what they draw all give us something to work with. Silence does not waste the appointment.
Will I be in the room when my child is seen?
It depends on your child’s age and what we are working on. Younger children usually have parents closely involved. Teenagers generally need more private time, and Illinois law gives minors aged 12 and over real say over their own counseling information. Ground rules are set explicitly at the start.
How many sessions before we see improvement?
Research on psychological treatment for depression in children and adolescents measured outcomes at around two months, where 39% met a response threshold against 24% in control conditions. That is depression-specific, and it marks when researchers measured rather than when change begins.
Booking, and what comes next
If you have already booked, the preparation is small. Bring your paperwork, and know the conversation with your child can wait until after your own first therapy session.
If you have not booked and are still weighing it up, that hesitation is worth taking seriously. The free 15-minute consultation exists for exactly this. It is a short conversation about whether this is the right step, not a commitment to a course of therapy.
You can read more about our work with children and parents, or about Dr. Melissa Terry and Dr. Vinita Menon. If what you are really wondering is whether your child needs an assessment rather than therapy, our page on psychological testing for children explains that process.
When you are ready, you can book an appointment.
This article is general information about how therapy works at our Ottawa, Illinois practice. It is not a diagnosis, and it cannot predict how any individual child will respond. The summary of Illinois law here is general information, not legal advice, and how it applies depends on your situation.
References
Retrieved 20 August 2026. Each claim was confirmed against the source below. Some legal publishers block automated requests, so a link may return an error to a script while serving normally in a browser.
- Cuijpers, P., Karyotaki, E., Ciharova, M., Miguel, C., Noma, H., Stikkelbroek, Y., Weisz, J. R., & Furukawa, T. A. The effects of psychological treatments of depression in children and adolescents on response, reliable change, and deterioration: a systematic review and meta-analysis. European Child & Adolescent Psychiatry, 32(1), 177-192, 2023. Published online 6 October 2021. 40 RCTs, 3,779 participants. doi.org
- Ufford, A., Wigod, T., Shen, J., Miller, A., & McGinn, L. A Qualitative Analysis of Attrition in Parent-Child Interaction Therapy. International Journal of Environmental Research and Public Health, 19(21), 14341, 2022. Seven parent interviews at a single clinic. doi.org
- American Academy of Child and Adolescent Psychiatry. Comprehensive Psychiatric Evaluation. www.aacap.org
- National Institute of Mental Health. Looking at My Genes: What Can They Tell Me About My Mental Health? www.nimh.nih.gov
- Illinois Compiled Statutes, 405 ILCS 5/3-550, Mental Health and Developmental Disabilities Code. Minor consent, the eight-session limit, and the presumption regarding a parent alleged to have abused or neglected the child. codes.findlaw.com
- Illinois Compiled Statutes, 325 ILCS 5/4, Abused and Neglected Child Reporting Act. Licensed psychologists are named mandated reporters, on reasonable cause to believe. codes.findlaw.com
- Illinois Compiled Statutes, 740 ILCS 110/4, Mental Health and Developmental Disabilities Confidentiality Act. Parental access to a 12 to 17 year old’s records, as amended 1 January 2024. codes.findlaw.com
- National Center for Youth Law. Minor Consent and Confidentiality Compendium, Illinois. 2024. youthlaw.org
- Illinois Department of Children and Family Services. Manual for Mandated Reporters. “State law does not require that the mandated reporter notify parents of the report.” dcfs.illinois.gov
- Illinois Department of Children and Family Services. Reporting Child Abuse and Neglect. Child Abuse Hotline 1-800-25ABUSE (252-2873). dcfs.illinois.gov
