These expert-backed tips will help you open up, feel heard, and get the support you need.
By Savanah Harvey, AMFT • Clinically reviewed by the Headway Clinical Team
As a person with anxiety, sometimes the idea of talking to a therapist about your anxiety can make you feel more anxious. If you're having a hard time finding the words to express how you are feeling, here are 10 tips that can help you open up the conversation, feel heard, and get the support that you need.
If you feel yourself getting nervous before a session, just take a deep breath and remind yourself that you’re taking the right steps. This behavioral response may seem a bit ironic, especially when you’re talking with someone to lessen your anxiety. Think of it in terms of needing to go to the gas station when your car is out of gas: getting to the gas station still involves depleting your gas a little bit.
Therapists understand the nervousness and anxiety can spike when coming to see them for the first time. They know they’re a stranger — and they aren't sitting there judging you. This gives them insight into what you're going through on a daily basis. Being nervous doesn't mean that you aren't ready for therapy. It can mean that this is a new and slightly uncomfortable experience. Recognizing, naming, and accepting anxiety can be the perfect icebreaker for your first few minutes together.
You might have a preconceived idea that you need to show up to therapy perfectly, with a polished script, or all of your details in chronological order. You might worry if you don't use clinical terms or show up in a polished way that your therapist won’t understand you. You don’t need to prepare or say things “the right way” — your therapist will meet you where you are and help you make sense of things together.
With that in mind, you should speak however you feel most comfortable. Being authentically you is the most important thing and it's the therapist's job to put the puzzle pieces together. Your job is to show up as you are and provide the raw material. Together, with your therapist, you’ll build the narrative.
When a therapist asks, “What brings you to therapy?” it can feel like a loaded question. Instead of moving straight into your deepest childhood memories or traumas, you can start small as you begin to form a relationship with the therapist.
Saying, “I'm not sure where to start, but I have been feeling anxious a lot,” or “I'm having a hard time managing my racing thoughts,” are perfect places to begin. They give the therapist a clear understanding of where you are. Remember that your therapist is trained to keep the conversation going, so once that first sentence is out of the way, the rest will begin to flow naturally.
Anxiety looks different for everyone. For one person it might show up as sleepless nights, and for another person it’s a tight chest or a fear of social situations. To help your therapist understand how anxiety is showing up in your life, try to describe the physical, mental, and emotional sensations that you experience.
Do you feel it in your stomach? Do you lose your appetite? Do you “doom scroll” for hours to distract yourself? Or do you procrastinate through productivity, like cleaning the house to avoid one stressful email? Describing symptoms helps your therapist understand how anxiety specifically shows up in your life, moving the conversation from an idea to your true, lived experience. You can never be too specific or give too much detail, because the more you’re willing to share, the better your therapist can tailor their tools to help.
Your therapist doesn't know what you don't tell them. If you're worried about telling your therapist something that feels embarrassing, remind yourself that therapy is a unique place where you do not have to pretend or hide anything.
Showing up for your first therapy session can feel anxiety-inducing and a bit uncomfortable. After all, you’re in a new place with a complete stranger talking about your inner thoughts and experiences. Pay attention to the continuous thoughts that come to mind — that’s usually a sign that it’s something worth bringing up in session. Don’t worry about what your therapist will think, they have likely heard it all (and more) before and are there to provide you with a safe, non-judgmental space to process those thoughts.
Some find it helpful to show up to a session with a list of the different things they want to talk about. Whether you use your phone or a pen and paper, try jotting down three or four things that you’d like to discuss. These can be bullets or simple phrases like “conversation with Mom,” “the argument with my brother,” or “hard time falling asleep.” If you have written things down, you can show up to the session and tell your therapist, “I wrote a few things down over the week so I didn’t forget”. This shows that you're committed to the therapeutic process while taking the pressure off where to start the session.
You have probably been using self-regulating tools to try to manage your anxiety for a while now. Whether it's listening to podcasts, going for a walk, or deep breathing techniques, it's important that you tell your therapist about what you’ve tried so far.
Sharing what’s worked (and what hasn’t) gives your therapist insight into your current “toolbox” so they don’t spend time trying out “broken tools.” Speaking about what you’ve tried also opens the conversation around seeking additional support. For example, you might ask whether you should see a therapist or a psychiatrist for anxiety to explore if medication might support you.
In our day-to-day lives, “I don't know” is often not a valid answer. But in therapy, “I don't know” is a great answer. If your therapist asks when a certain feeling, sensation, or trigger began, and you genuinely can't pinpoint the start date, just say, “I don't know”.
Rather than looking at “I don't know” as an endpoint, think of it as opening doors to exploration and curiosity. These three simple words tell the therapist that they need to dig a bit deeper to find the root of the anxiety, as sometimes there is no specific logical cause for its beginning. Admitting that you're unsure allows you and your therapist to get curious about where the anxiety began, rather than leaving you feeling pressured to make up a beginning that might not truly be part of your story.
Reducing uncertainty is one of the best ways to lower your anxiety. If you're feeling anxious about how therapy works, just ask. You’re encouraged and welcomed to be an active participant in your treatment. Ask your therapist questions like "How have you treated anxiety in the past?” or “What will be a clear sign that I am getting better?”
Knowing what to expect from your first therapy session can help make the therapeutic process more manageable and inviting. It shifts the unpredictability in the room to a collaborative process where you are the one in control.
Scheduling the initial appointment is the hardest step to take. Then it’s showing up and talking about your anxiety. The first session is often the hardest one, but every time you show up after that, you’re building an “emotional muscle.” Even if you feel like you didn’t show up perfectly or emotions overtook you, you still showed up to put yourself first. Be proud of the fact that you are showing up for yourself, even when it is hard.
Facing anxiety is a lot easier when you’re working with the right provider. At Headway, we’re here to help you connect with a therapist who specializes in anxiety and feels like a good fit for you. Ready to open the conversation? Use the Headway directory to find a therapist who you feel can help you along your journey to feeling like yourself again.
This content is for general informational and educational purposes only and does not constitute clinical, legal, financial, or professional advice. All decisions should be made at the discretion of the individual or organization, in consultation with qualified clinical, legal, or other appropriate professionals.
© 2026 Therapymatch, Inc. dba Headway. All rights reserved. No part of this publication may be reproduced without permission.
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