Individual Video Counseling: What to Expect in Your First Session

By Nicole Wilkerson, LMHCA · Washington Licensed Mental Health Counselor Associate

Considering individual video counseling can bring up questions that go beyond getting the camera to work. You might wonder what you are supposed to say, whether you will feel comfortable opening up, or what a counselor actually does during the conversation.

You can come to a first session with a specific concern or a less defined sense that you want support. Counseling gives you time to explore what is happening and decide, with your clinician, where to begin. This guide explains what that process can look like as you consider individual counseling with me.

A laptop, blank notebook, pen, and headphones on a wooden table in soft natural light.

Key takeaways

Individual video counseling is a scheduled, one-to-one appointment with a counselor through a telehealth platform.
The first session usually centers on understanding your concerns, explaining the process, and discussing a starting focus.
You can bring questions, notes, uncertainty, and feedback about what feels helpful.
Your needs, privacy, access to technology, and the clinician’s assessment help determine whether video sessions are appropriate.

What is individual video counseling?

Individual video counseling is a scheduled appointment in which you and a counselor meet one-to-one through a telehealth platform. You can see and hear each other in real time while discussing your concerns, working toward agreed goals, and reviewing what is helping.

The National Institute of Mental Health’s guide to virtual mental health support explains that therapy and other mental health services can be offered remotely, depending on the provider and your care needs. A video appointment is one format for receiving that care.

The details matter: ask how long the appointment lasts, which platform the practice uses, and how contact works between sessions. Booking video counseling does not automatically include ongoing messaging or support outside appointment times.

If you are still deciding who to work with, my guide to finding an online therapist in Washington State covers credentials, fit, and questions to ask before booking.

What happens in your first video counseling session?

An initial appointment often includes more background questions than later sessions. Your counselor is learning about your circumstances, the support you need, and whether their services are appropriate. The exact order and pace vary by clinician and practice.

You get oriented to the process

Your counselor should explain what to expect, confidentiality and its limits, and the consent process. For video care, this may also include confirming your location, checking that you can speak privately, and agreeing on what to do if the connection drops.

This is a good time to ask about anything you did not understand in the paperwork. You can also mention practical needs, such as difficulty hearing through the device or concerns about interruptions.

You talk about what brought you in

Your counselor may ask what has been difficult lately, when you first noticed the concern, and how it affects your daily life. They may also ask about relevant health information, relationships, previous counseling, or other support.

You do not need a polished explanation. “I keep worrying even when nothing is happening,” or “I am having a harder time with this change than I expected,” can open a useful conversation. If a question is difficult to answer, you can say that or ask why it is being asked.

You discuss where to begin

You and your counselor can identify an initial focus and talk about next steps. Sometimes that focus becomes clearer over several conversations. You can ask what the counselor recommends, how the work connects to your goals, and when you will review it together.

In my work, I make room for your questions and perspective as we consider that starting point. You can learn more about my approach as a Washington LMHCA before reaching out.

What can you talk about in individual counseling?

Your starting point might be a recurring problem, a recent event, or a feeling you have struggled to name. Topics can include:

Worry and stress: feeling on edge, replaying conversations, or finding it hard to switch off.
Low mood or feeling disconnected: changes in motivation, interest, or how you experience everyday life.
Relationships: repeated disagreements, difficulty expressing needs, or uncertainty about boundaries.
Life transitions: changes in work, family, responsibilities, relationships, or your sense of identity.
Emotions and reactions: wanting to understand why certain situations affect you so strongly.

These experiences can overlap. A conversation that begins with work stress might also touch on expectations you place on yourself or what happens when you need to ask for help. Your counselor can help assess what is relevant and whether another type of support is needed.

You can also bring something ordinary but persistent: an interaction you cannot stop thinking about, a decision you keep postponing, or a moment when you reacted differently than you wanted to.

How do ongoing sessions and counseling goals work?

After the first appointment, sessions may involve checking in on what has happened, exploring a particular situation, noticing patterns, and considering different ways to respond. The work depends on your needs and the clinician’s training and approach.

The National Institute of Mental Health’s overview of psychotherapy describes approaches that can include examining thoughts and emotions, developing coping or communication skills, and exploring troubling experiences. It also recommends discussing treatment goals and how progress will be assessed.

Goals can start with a broad wish, such as wanting to feel less overwhelmed. Together, you can discuss what that would look like in daily life. Here are a few examples of topics and goals you might discuss with a counselor.

What you bring to a session	What you might explore	A possible goal
“I replay conversations after work.”	The worry behind the replaying and how it affects your evening.	Notice the pattern earlier and choose a way to respond.
“I say yes, then feel resentful.”	What makes it hard to express your needs or take time to decide.	Practice a response that gives you room to make a choice.
“My life changed, and I don’t feel like myself.”	Changes in identity, relationships, responsibilities, or expectations.	Identify the support and adjustments that matter to you now.

You can revisit a goal when your circumstances change or when something is not helping. Feedback such as “I need more time to talk this through,” or “I would like something practical to try,” gives your counselor information about your experience.

My counseling services page describes the concerns we can begin exploring together.

What if opening up on video feels awkward?

A screen may feel unfamiliar at first. You might notice yourself watching your own image, wondering where to look, or worrying about a pause in the conversation. You can name those concerns instead of trying to hide them.

It is okay to use notes, ask for a moment to gather your thoughts, or say that you are unsure how to explain something. If you become emotional, you can ask to pause. Your counselor can talk with you about what would make the conversation easier to continue.

Comfort and trust are worth discussing as the work develops. If the format continues to make it hard to participate, ask about adjustments or whether in-person appointments would be a better fit.

How can you prepare for a private video session?

Choose a setting where you can speak without being overheard and set aside the appointment time. HHS’s telehealth preparation guide recommends testing your technology, checking visit instructions, and writing down questions. Do not join a session while driving or running errands.

Before the appointment:

Test the camera, microphone, internet connection, and appointment link.
Consider who could hear your side of the conversation; headphones do not make your voice private.
Keep the practice’s contact details nearby in case you lose the connection.
Ask about accommodations or platform help you may need.
Bring a few notes about what has felt difficult or what you want to ask.

HHS also offers guidance on protecting your privacy during telehealth, including using a private device and avoiding public Wi-Fi. If you cannot find a private setting, discuss that with the practice before the appointment. Ask which communication channel to use for personal health information.

Frequently asked questions about individual video counseling

How long are sessions, and how often would we meet?

Confirm the appointment length with the practice before scheduling. How often you meet should be discussed with your clinician based on your needs, the care plan, and availability. There is no single schedule or number of appointments that suits everyone.

Does insurance cover individual video counseling?

Coverage and costs vary by plan, clinician, and practice. Ask the intake team about your specific benefits, fees, and cancellation policy. If you want to work with me, the practice teams listed on my Get Started page can help you check those details.

Can teens attend individual video counseling?

I work with teens age 13 and older, as well as adults. The practice can explain consent, paperwork, and appointment options. Ask how privacy and caregiver involvement will be discussed and how the clinician assesses whether video care suits your teen.

Where can I be during a video appointment with you?

For video appointments with me, you need to be physically in Washington State during the session. Tell the practice before scheduling if you expect to be traveling outside Washington.

Do I need to know exactly what I want to talk about?

No. You can begin with what has been happening or what led you to make the appointment. Your counselor can ask questions to help you find a focus. You are also welcome to bring a specific topic or ask about the purpose of the conversation.

Starting individual video counseling with Nicole

I offer counseling for teens 13+ and adults navigating anxiety, stress, relationship concerns, and life changes. As a Washington Licensed Mental Health Counselor Associate, I practice with clinical supervision and take a warm, collaborative approach.

To ask about video appointments, visit my appointment options page and contact Counseling Services for Wellbeing’s intake team. Request Nicole Wilkerson, LMHCA, and ask about current availability, appointment arrangements, insurance, and fees.

If you have a general question about working together first, you can contact me here. A brief question is enough to begin; please save personal health details for your practice’s intake process.