By Twyla Adkins, PMP

For most people – and rightfully so – it takes a while to get used to the idea of sitting in front of a stranger and sharing your most vulnerable thoughts. It’s different from trauma dumping over drinks with your bestie, or dropping a storytime online (I mean, your therapist has your government name and your insurance information.) 

You’ve asked for help, but the closer your therapy session gets, the more nervous you feel (and lowkey start thinking about ghosting). “The therapy process is deeply vulnerable, and that can feel scary, understandably!” said Dr. Traci Williams, Psychologist and owner of Layered Feels, who I asked about how to deal with being nervous before your therapy session.

Nervous before therapy? Start here to calm your pre-session nerves

Feeling like your heart is trying to dip up outta your chest? Totally normal. “Being nervous about opening up with someone you barely know while you find the courage to experience your hard-to-face emotions is normal and can be a sign you’re about to do something brave!” explained Dr. Williams. 

There’s a lot of questions and concerns around therapy sessions. What am I supposed to say? What if the therapist starts to give me *bombastic side eye* the minute I start talking? What if I start crying in therapy?

Don’t worry about what to say. If it helps, before your session, write down some things you’d like to discuss, or start with what prompted you to schedule your appointment. Go at your own pace and start where you feel comfortable. It’s your time to say what’s been on your mind. Your therapist will be there to help guide the conversation along, if that’s what’s needed at that time.

Dr. Williams recommends sharing your concerns with your therapist. “It’s okay to say, ‘I’m nervous about starting therapy.’ Remember, you don’t have to be perfect, and there’s no “right way” to show up in your sessions. Your therapist is expecting and welcoming of your imperfections.” 

I was afraid of opening up in therapy. Growing up as an Afro-Caribbean person, mental health was often seen as an unnecessary way to have people in your business, a sign of weakness, and went against the idea that “God was enough”. What if I said something too personal? What if others found out?

Having the courage to start therapy shows a willingness to change. But be kind to yourself if the idea of things changing makes you nervous. Change is scary for anyone, regardless of whether it’s for the better or worse; your brain will try to maintain the status quo. Your therapist will be there to help, at your pace, and address the things you want to work on.

Remember a therapist isn’t there to judge you; they’re trained to give you a safe space to discuss and work through things. Also, most therapists are in their line of work because they genuinely care. You don’t have to force the conversation or the connection – when you’re ready to get the most out of therapy, and you have a therapist that’s a good fit for you, it’ll happen. “Most people who have fears before therapy become comfortable with time, so give yourself some grace,” said Dr. Williams.

If you’re worried about confidentiality, thankfully, because of HIPAA laws, therapists are legally unable to share your identifiable health information, so what you say in session stays there. Laws vary by state, but your therapist only discloses what you share if there’s an imminent risk of you hurting yourself or others, suspicion of child, elder, or dependent adult abuse, or if they were compelled by a judge in the court of law. 

What to expect if it’s your first therapy session

While each therapy practice can differ, generally, your new therapist will spend the first session  getting to know you. “They will spend time explaining their practice policies and ensuring you know what to expect,” Dr. Williams explained. “They’re likely to ask why you want to begin therapy and what you hope to address. If time allows, they’ll ask about your history to begin to learn more about you.” 

When you haven’t been to therapy in forever

If it’s been a while since your last therapy appointment, they won’t hold it against you. “Your therapist understands that life happens and is not going to judge you for spending time away from therapy. It can be a good starting point to share how you feel about returning to sessions with your therapist. They’re likely going to want an overview on how you’ve been doing during your time away.” 

I’ve absolutely ghosted my therapist before. And when I’ve gotten back on her calendar, I was anxious about how I was going to catch her up on everything that’s happened. Do I make a very cutesy, very mindful, very demure PowerPoint? “You don’t need to worry about picking up where you left off; you can start this part of your healing journey from where you currently are,” said Dr. Williams.

Showing up nervous still counts as showing up

It’s not unusual to be nervous when doing something that feels vulnerable AF. If you’re feeling overwhelmed before therapy, resist the urge to ghost your therapist and cancel your session. Feel free to let your therapist know that you’re nervous (now you have at least one thing to talk about, you’re doing great, sweetie!)

If you can, avoid rushing to your appointment and complete any paperwork ahead of time to alleviate the anxiety around the new experience. I subscribe to the idea of romanticizing your therapy sessions and having something to look forward to either before or afterwards. Think of it as a mental health date to put you first. 

Remember that if your therapy session doesn’t go as planned, it doesn’t necessarily mean that therapy isn’t for you. Sometimes a particular style of therapy – or you and a therapist – aren’t a match. Finding the right one for you can take time, but it’s worth it. Be nervous and show up ready to do the work anyway, and know that you can take the session at your own pace.

This interview has been edited for length and brevity.

Dr. Traci Williams is owner of Layered Feels, a board-certified clinical psychologist, and certified financial therapist™. She is regularly featured in major media outlets, including The New York Times, Parents, and Forbes. She has over a decade of experience assessing and treating all age groups. She is a proud Trinidadian who calls Atlanta her second home.
Twyla Adkins, PMP, is a wellness writer, multiple sclerosis advocate, and business strategist who writes about the lived realities of chronic illness, neurodivergence. Her work—featured by outlets like NBC News—blends lived experience with strategic insight, uses words to connect us, make sense of what hurts, and remind us we’re not alone.  When she’s not writing, you can find her sneaking a book into her bag, making obscure movie references, or planning her next trip.