Help! I’m scared to talk to a therapist.

Tips to Calm Pre-Therapy Anxiety

Rachel M. Menge, LCSW, PMH-C

Have you been considering therapy but felt scared to make your first appointment?

This is completely normal. Many people experience discomfort, anxiety, or even fear prior to making a scheduling an appointment. This is in part because therapy feels very vulnerable. Exposing our inner worlds, our thoughts, feelings, and struggles can cause us to feel like we may be judged, shamed, or exposed. It takes a lot of courage to open yourself up to a person who is, by all regards, a stranger.

However, those who do push through this discomfort and find a good therapeutic fit (a therapist they trust and connect with) generally report that therapy becomes a welcoming, supportive space they look forward to and feel comforted by. In fact, research shows that the amount of connection a person feels towards their therapist (the therapeutic alliance) is at least as important to positive treatment outcomes as the type of therapy!

After more than 10 years of working with clients of all kinds, here the top fears I hear and my top tips for calming pre-therapy anxiety.

“I don’t know what to expect.”

Every therapist functions a bit differently, but, just like going to the dentist or doctor, there are some general practices that are universal across all therapy practices.

Prior to starting, you will find a therapist you are interested in working with via your insurance panel or a directory like Psychology Today. Many therapists are fully booked now, so don’t be discouraged if it takes a few tries.

Once you have found a therapist to work with, your therapist will likely ask you to complete some intake paperwork and forms about your current mental health. Some of these items are required by law and some are to help the therapist determine what you are seeking help with. Answer them as throughly as you can and feel comfortable with. If you don’t feel comfortable sharing something, just write that.

After this, your therapist will schedule you for your first session. Sometimes this is called an assessment, intake, or evaluation session. It usually lasts 60-90 mins. During this time, your therapist will review the paperwork you completed, take a clinical history, and discuss your desires for therapy (goals).

Most therapy offices look similar to a living room or small office with comfortable chairs. If your therapist is in private practice, their office might be in a shared space like suite or other building. There is usually a waiting room, sometimes shared, that you will be asked to wait in until your session starts.

Many therapists now offer telehealth sessions. You can typically ask to do telehealth if you’re not comfortable coming in person. The research is now showing that telehealth is just as effective as in person. You’ll want to make sure you have a private space and a strong internet connection.

Following your first session (or two), you and your therapist will decide on some treatment goals and discuss your treatment plan. This might include type of therapy style the therapist will be using, recommendations for additional treatments (like a medication referral, support group, or couple’s counseling). You will also decide on how often you’ll meet and might select a “standing appointment” (a regular day and time that’s your session spot). Generally speaking, most clients start with weekly sessions for about 12 weeks or so, though the length of treatment can vary greatly.

One thing to keep in mind is that, just because you have intake does not mean you are obligated to continue or schedule more sessions. I always tell my clients that the first session or two are getting-to-know you sessions. Sometimes, I might not be the right fit for a client and that’s okay! If your therapist isn’t feeling like the right fit, it’s okay to say so. Therapists are comfortable managing this feedback (we are trained to!) and many will provide you a few referrals if you tell them what you’re looking for that you aren’t finding in them.

“I’m afraid my therapist will judge me or think I’m “crazy.”

This is a common one. Until recently, going to therapy or having a “diagnosis” was heavily stigmatized. Although this is changing, many of us have internalized the idea that seeking mental health treatment or having mental health issues is a sign of moral weakness, failure, or shame.

Here’s a secret though: many therapists are in therapy themselves, as it is a recommended aspect of our training and practice.

Most therapists deeply believe in the healing power of theraputic relationship, understand that all people struggle from time to time, and believe mental health is health. We are here to help, not judge, and we so believed that therapy could help people that way that we decided to make it our careers. In fact, most therapists, including me, are incredibly impressed by their clients’ abilities to preserver through adversity, struggle, and trauma.

Your therapist has also probably heard a lot, and the things you share, as shameful or extreme as they may seem to you, are likely not the first time your therapist has heard something similar. It’s hard to shock us.

Therapists truly are here to listen and help, without judgement.

“I am worried that I will have to talk about things that make me uncomfortable or make changes I am not ready to make.”

You are never required to share anything you don’t feel comfortable sharing. Therapists are trained in nonverbal communication, and if they notice you hesitating, they might change the topic or ask you what is making you hesitate. Even if they do not, it is perfectly normal and acceptable to say “I am not ready to talk about that.”

You are also never required to make changes you aren’t ready to make. Again, therapists are trained to avoid offering advice, giving directives, or otherwise exerting influence over a client’s life. I tell my clients to think of me as simply a guide. I can use my knowledge and experience to give a summary of what I think might be happening and some potential solutions. It is completely up to the client to decide if they want to try those solutions.

As you develop a relationship with your therapist, you may feel more comfortable revisiting uncomfortable thoughts, memories, or feelings with your therapist. This is normal too. It’s quite common for a client to disclose something they didn’t initially mention later on in therapy. As therapists, we don’t feel that you lied to us or feel upset by this. Most of us understand that this is normal, and we usually feel honored that you have decided to trust with something you hold so close.

“I won’t know what to talk about.”

This is such a common concern, but a big question, so stay tuned for a future blog post on this topic!