The most honest answer is: mostly, we talk. But knowing what to expect can take a lot of the pressure off, especially if this is your first time.
Before your first session, you'll usually complete some intake paperwork — background information, current concerns, medications, and consent forms that cover confidentiality and fees. This helps your counselor arrive prepared and saves time in the session itself.
In the first meeting, your counselor will typically ask what brought you in, what you're hoping to work on, and a bit about your history and current life — family, work, relationships, sleep, and anything you feel matters.
You don't have to arrive with the 'right words' or a clear diagnosis. 'I'm not sure exactly, but something feels off' is a fine place to start. Part of the counselor's job is to help you name what's going on.
Expect it to feel a little awkward. You're telling a new person real things about your life; nervousness is normal. Most people feel a little more comfortable by the second or third session, once the space starts feeling more familiar.
This is also your chance to interview your counselor. How do they work? What experience do they have with concerns like yours? What does progress usually look like? Fit matters — you're allowed to ask.
You never have to share more than feels safe. Pace is part of the work. If something is too big to bring up in session one, that's completely fine. You'll get there when your body says it's ready.