First Therapy Session Anxiety: A Guide For Starters

Medically reviewed by Julie Dodson, MA, LCSW
Updated January 22nd, 2025 by BetterHelp Editorial Team

Therapy can make a significant difference in many life challenges, including relationship concerns and mental health conditions. However, some people who have never been to therapy might not know what to expect from the therapeutic process. Attending therapy for the first time can make people feel nervous, which is a normal and valid reaction. Below, explore first therapy session anxiety symptoms and what to expect during your first session.  

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Are you anxious about therapy?

Do I need to prepare before starting therapy?

Typically, clients don’t have to prepare for their first therapy session. If you prefer, you can write down topics you’d like to discuss beforehand. As part of the intake process, you may be asked about any medications you take and the doses. Write down your medical history to have the information ready. 

What to expect during your first therapy session

During the first therapy session, therapists typically explain their approach to therapy. They may explain that you are always in control of what you’d like to discuss and that you can pause at any time. The rest of the first session often involves you and the therapist getting to know each other. The therapist may ask about the concerns that brought you to therapy and whether you have any experience with mental health support. This session typically doesn’t involve conversations about deep trauma, but feel free to discuss any concerns and ask questions. 

What if I cry during the first session with my therapist?

While each person is unique, the first appointment often doesn’t get into deep traumatic memories. However, if you have an urge to cry, crying is a valid emotional response and has proven beneficial for mental wellness. Therapists are typically used to seeing people cry as they discuss challenging emotions. If you see a therapist in person, they may have tissues nearby, as crying tends to be a natural response during therapy. If you see a therapist online, it’s still okay to cry and express your emotions. 

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Feel free to ask your mental health professional questions

Although you may be asked several questions during your first session, you can also ask the therapist questions. You might ask about treatment goals, frequency of appointments, and any other topic that comes to mind. If you think you might forget your questions, write them down before your first appointment. You may also try to remind yourself that therapists are typically used to being asked about their credentials and therapy practice, so don’t be afraid to clarify any doubts. 

What can you do about first therapy session anxiety?

Many people feel anxious during their first therapy session. They may be afraid that they won’t know what to say or that they will shock their therapist. In these cases, remind yourself that most therapists have seen hundreds of patients with diverse challenges. Although the exact details of the challenges one faces may be unique, the themes may be similar across different people. 

To ease any nervousness you experience, you might consider looking up your therapist’s credentials and areas of experience. Some therapists may also publish information about papers they have written or conferences they have attended. This information may help ease your nerves and assure you that you are seeing a qualified, licensed professional. In addition, if you have a friend who has seen a therapist, you might ask them what their first therapy session was like. By learning about their therapy experience, you might feel more comfortable going into your first session. 

What to do after the first session and subsequent therapy sessions

After the first session, consider writing down your first impressions. Given that the first session often doesn’t involve lengthy discussions about deep concerns, you might not have much insight or advice to write down. However, you may at least have enough information to decide if you’d like to continue with the therapist. If you don’t want to continue, know that it is totally normal to change therapists. Most therapists are used to having clients who decide to work with another licensed mental health professional. 

If you decide to continue with your therapist, taking notes after each session may be helpful. Subsequent sessions may offer more insight into what you’re experiencing. If your therapist offers coping strategies, consider writing these down to reinforce them. 

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Are you anxious about therapy?

Online therapy for your first session

If you’re nervous about meeting with a therapist in person, you might consider trying your first therapy session online through a platform like BetterHelp. With online therapy, you may feel more at ease, as you can connect with the therapist from home or anywhere you have an internet connection. You can communicate with the therapist via video chat or by phone or live chat if you aren’t uncomfortable with being on camera. In recent years, many researchers have studied online therapy and found it to be effective for several mental health conditions. One systemic review and meta-analysis published in 2020 concluded that online therapy was as effective as in-person therapy for depression symptoms.

Takeaway

Many people experience nervousness before their first therapy session. However, the first session tends to be about you and the therapist getting to know each other. You can feel free to discuss anything you want, with no obligation to reveal any topic you don’t want to discuss. Finally, you might consider online therapy if you aren’t comfortable with an office setting for your first time in therapy. Online therapy allows you to communicate with your therapist from home or anywhere you feel comfortable.

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