The First Session: What to actually say to a psychiatrist when you don’t know where to start.

Staring at a psychiatrist across a Zoom screen or a coffee table can feel like being an actor who walked onstage and realized they forgot the script. You know you’re there because things aren’t “fine,” but suddenly, the English language feels very small.

If you’re worried about the silence, don’t be. Here is exactly how to navigate that first hour when you have no idea where to start.

1. Admit the Awkwardness

The most effective way to break the ice is to simply name the feeling. Your psychiatrist isn’t judging your performance; they’re observing your process.

Try saying: * “I actually have no idea how to start this.”

“I’m feeling really nervous/awkward right now.”
“I know I need to be here, but my mind is blank.”

2. Focus on the “Current Symptom”

If you can’t summarize your entire life story, just talk about the last 48 hours. What was the physical sensation or thought that finally pushed you to book the appointment?

Try saying: * “I haven’t been sleeping well for a week because my brain won’t shut off.”

“I find myself getting angry at small things lately, like the dishes.”
“I feel a constant ‘weight’ in my chest, and I want to figure out why.”

3. The “Table of Contents” Approach

Think of your first session as a trailer for a movie, not the whole film. You don’t have to solve anything today; you’re just giving them the highlights.

Try saying: * “There are three things on my mind: my job, my relationship with my mom, and my general anxiety.”

“I don’t want to dive deep yet, but I want to eventually talk about [X].”

4. Let Them Lead

If the pressure to speak is too much, it is perfectly okay to hand the reins over to the professional. They are trained to ask the right questions to get the gears turning.

Try saying: * “I’m struggling to find the words. Can you ask me some questions to help me get started?”

“What do you usually need to know about a new client first?”

Key Takeaway

Your psychiatrist doesn’t need a polished monologue. They need you. Whether you come in with a 10-page list or just a heavy heart and a lot of shrugs, you’re doing it right. The “work” is simply showing up.