Navigating Anxiety About Therapy: From First Session to Farewell
Anxiety in therapy is normal—but manageable. Learn how to tackle the jitters and ease into sessions. Tips, tools, and resources inside.
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Starting therapy? Returning to it? Ending it? One thing’s for sure—anxiety can tag along for all of it.
It can be exciting and filled with hope. It can be completely nerve-wracking and overwhelming. It’s quite common to experience the swirl of emotions, anything from apprehension to curiosity back to fear of being judged and longing to connect.
And I tell you that as a person in and out of therapy for years. It’s nothing to judge.
Choosing to do the therapeutic work means looking in the figurative mirror. It means facing vulnerabilities, fears and anxieties. It means being brave and facing yourself, your limiting beliefs and the barriers to your health and happiness.
YIKES!
Drop the pearls, baby! Here’s the truth about that anxious voice in your head telling you it’s terrifying: it’s not permanent, and it doesn’t have to stop you.
Whether you’re nervous about your first session, reconnecting with therapy after time away, or wrapping up an incredible therapeutic adventure, this guide is for YOU.
Facing Anxiety Before Your First Therapy Session
Ah, the first session. It’s exciting! And nerve-wracking. Like a blind date, though with less swiping and more self-disclosure on that first meeting. It’s perfectly normal to feel nervous about starting therapy.
The therapy space invites your deepest shame and fears, so naturally, it’s normal to get nervous about what could be said, felt and explored.
Some folks enter therapy for the first time and struggle with what to talk about and how forthcoming to be. Others are trying out a new therapist and experience anxiety when facing old issues with a new person. A total stranger, actually. Yeah, anxiety is quite appropriate.
Why We Get Anxious Pre-Therapy
Clients feel apprehensive prior to their first session for a number of reasons:
You don’t know what to expect (and your brain hates the unknown).
Talking about yourself feels uncomfortable (like the spotlight is on you!)
You’re worried the therapist might not “get” you or like you (we all want to be accepted).
These jitters, while annoying, are weirdly universal. The good news? They usually fade as the relationship with your therapist grows. A strong therapeutic alliance (a fancy term for trust and connection) is like the secret sauce that makes therapy work.
Time spent together naturally makes room for connection, education, safety and healthy challenges. All of this builds rapport and strengthens courage. Time really does heal, and in this case, it softens the nerves.
How to Calm Your Nerves
So now that we’ve validated it, how can you feel less anxious before the first session?
Have a Game Plan: Think ahead of time about why you’re seeking therapy. Consider how you want to be challenged and supported. Consider what you want out of this experience. Starting with structure can make the unknown feel less daunting.
You’re the expert on YOU and you’re in charge. Don’t expect the person in the other chair to know why you’re here and what you need.
Ask Questions: No question is stupid and neither are you. Ask for clarity, for information and for understanding. Curious about the therapist’s style? Wondering how long sessions last? Ask!
Therapy is about YOU, and asking questions can help break the ice. It builds rapport, lends clarity and invites connection. Therapy, too, is about connection.
Be Honest from the Start: Therapy works best when you keep it real. Share your fears, hesitations, or even confusion about the process.
Be the version of you that you want to be, PLEASE, and not the version of you that you THINK your new/old therapist wants to meet.
Nervous about sharing your “why” for seeking therapy? Here’s how journaling can help you get clear on your emotions before an appointment. Check out 5 Ways Journaling Can Help Improve Your Anxiety.
Returning to Therapy (aka Therapy Reunion Jitters)
Been to therapy before and took a break? Coming back can feel a little like showing up to a party after ghosting your friends. You might be bracing yourself for questions or judgment, especially if you’re starting with a new therapist.
Research demonstrates that initial anxieties often subside once a therapeutic alliance is formed, as trust and rapport develop between client and therapist (Horvath & Luborsky, 1993).
And if this connection is already present because you’ve made it so, trust that those initial butterflies will settle in the body once you start catching up. Returning to a former therapist can be both anxiety provoking and comforting because you’re returning to a safe place and a safe support system.
Why Therapy Reunions Can Be Tricky
For seasoned clients, returning to therapy yet to a new support kicks up anxiety for sure:
You don’t want to rehash your entire life story (again).
You’re nervous you’ll have to explain why you stopped going (and be judged for it.)
Accountability feels daunting. Facing your therapist, of all people, is the ultimate in facing your shit.
It’s quite common and easy to validate. Clients ghost therapists, drop from therapy, and even graduate ALL THE TIME. Me too, girlfriend! It’s human.
Spoiler alert: your therapist doesn’t care why you took a breather. Real talk, they do NOT care. They care that you’re back and ready to keep working.
Easing Back Into the Groove
How to combat anxiety when “back” in therapy:
Break the Ice: Feeling awkward? Say so! Calling out the elephant in the room can help you feel more at ease and make space for an honest, fresh start.
Make a joke, set new intentions, take up the space to own the decision to leave and also, the decision to return.
Be Open to Feedback: This is hard and also, is part of the process. Face the music and do it with a face you recognize who has proven to be safe and caring.
Do it with someone whose arms are open when you decide to return. That acceptance “back” is part of healing.
Celebrate Showing Up: Coming back to therapy is an act of courage. Refuse to shame yourself for “falling off”—doing the work when you’re ready is what matters.
And your therapist knows this, too. You’re back, baby! Is that not what counts?
If you’re feeling stuck and unsure how to start again, I’m here to help. Learn more about my online therapy for women.
Ending Therapy (and the Anxiety That Comes With It)
Graduating therapy sounds like a dream, right?
Some of us know what it’s like to have a healthy goodbye with our support systems. This could mean that you’re feeling strong and healthy, and you choose to end sessions because for now, you don’t need the weekly check-ins.
This could also mean that you’ve reached your goals and feel prepared to move forward on your own with a full tool box (for your coping tools).
Sounds amazing, yeah?
Turns out, it can leave you feeling shaky. Suddenly, the safety net you’ve relied on is gone, and cue the what-ifs. It’s like leaving a job you love—with no guarantee you’ll find the same kind of connection elsewhere.
Common Worries About Ending Therapy
The fear of walking the road alone without your “sidekick.”
Missing the weekly dose of validation and support.
The uncertainty of life without therapy as a grounding ritual.
Don’t stress, Sassy gal. To be scared at the beginning of something is normal, yes? So is being scared at the end! End signifies change, and most of us fear it, despite it being a constant.
How to Tackle “Goodbye Anxiety”
Process Feelings of Loss: If ending therapy feels like a breakup, that’s okay. Talk about it with your therapist so they can help you “close the chapter” in a healthy way.
Build a Tool Kit Together: Feeling prepared eases anxiety. Work with your therapist to create a plan or set of strategies to use after sessions end.
Celebrate Your Progress: You’ve shown up for yourself in big ways. Acknowledge your growth and honor how far you’ve come.
For more ways to foster inner strength and resilience as you transition out of therapy, check out 8 Ways Vision Boards Can Help Ease Your Anxiety.
Anxiety in Therapy is Normal
Feeling nervous before or during therapy is not only common—it’s backed by psychological research as a natural response to vulnerability and the unknown. Studies show that anxiety around therapy often stems from a fear of judgment, uncertainty about the process, or past negative experiences with disclosure.
The therapeutic setting encourages deep self-reflection, which can trigger the brain’s threat response, activating the amygdala—the part responsible for processing fear (Phelps & LeDoux, 2005).
Simply put, if you feel nervous, it’s because your brain is doing what it’s wired to do when faced with something new.
The good news? It gets easier with time as your brain learns what therapy is, and these jitters are often a sign that you’re stepping outside your comfort zone—an essential part of growth and why you’re coming to therapy in the first place.
Final Thoughts
Is therapy nerve-wracking? At times, yes. But it’s also bold, brilliant, and deeply rewarding. Whether you’re prepping for your first session, reconnecting with a therapist, or navigating life post-therapy, know this: feeling anxious about therapy simply means you're showing up and doing the work.
Scary. AND brilliant.
Anxiety provoking. AND brave.
There are several therapies for anxiety, and if you spend any time with me, you know we can talk about it, envision it, practice it and achieve it.
Some of the popular ways in which you can address anxiety in therapy are here:
CBT and Mindfulness based CBT
Exposure Therapy
EMDR (Eye Movement Desensitization and Reprocessing)
Acceptance and Commitment Therapy
Ignoring the psychotherapy jargon, what these therapies include are explanations for anxiety and fear, techniques for emotion regulation and practices for new perspective.
Humans don’t make changes unless they are uncomfortable. These therapies work to explore the discomfort from various angles and offer relief in unique ways.
If anxiety has been keeping you stuck, it’s time to take the first (or next!) step. Learn more about customized support for anxiety through online anxiety therapy for women.
Be well, Sassy reader. Till next time.
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