Starting therapy can feel hard to explain.
Sometimes there is a clear reason. A loss. A breakup. Burnout. A period of anxiety that has become impossible to ignore.
Other times, the feeling is more subtle. Life may look fine from the outside, but something internally feels off. You may feel stuck, disconnected, overwhelmed, or simply no longer at ease in your own life.
For therapist Brooke Pomerantz, that in between space matters. It is often where the most meaningful work begins.
A licensed clinical social worker who has been in private practice since 2007, Brooke works with adults and young adults in Oakland and via telehealth. Many of the people she supports are highly capable, thoughtful, and outwardly successful, yet privately struggling with anxiety, perfectionism, burnout, or a deeper sense of dissatisfaction they cannot quite name.
What stands out most in Brooke’s approach is not just what she helps clients work through, but how she meets them there. Her philosophy is grounded in curiosity, patience, and the belief that every person deserves to be understood as an individual, not reduced to a category or rushed into change before they are ready.
Read More |
|
PLAY
|
Video Interview: Watch the Conversation with Brooke PomerantzHear Brooke discuss starting therapy, feeling safe with a therapist, and finding the right fit. |
Why starting therapy can feel so hard
For people starting therapy for the first time, I acknowledge that the experience can feel vulnerable and anxiety-inducing. That anxiety, she says, is not a sign that something is going wrong. It is often part of the process. A competent therapist can recognize this vulnerability and adjust the pace of treatment at a pace that works best for their client. This is why the initial sessions are a huge opportunity for both the individual and the therapist to assess if they are a good match and whether the individual has an agency in the process.
What to do if you feel anxious about therapy
It’s simple. Name the feeling. Saying “I feel anxious being here” can lead to a much deeper and sincere conversation. It gives both therapist and client somewhere real to begin. Instead of trying to arrive with everything figured out, a person can start from what is true in the moment. It also gives them a chance to notice if they feel safe, understood, and ready to share their experiences in a particular setup with the therapist in question.
A gentle first sentenceIf starting feels awkward, a simple sentence like “I feel anxious being here” can be enough to open the door. |
Can therapy help even if nothing feels wrong?
Yes. Therapy does not only belong to moments of crisis or chaos. It can also be a place to think more deeply about your life, understand your patterns, strengthen your relationships, and develop a more connected relationship with yourself. Even when someone says they are “fine,” there is often something underneath that is asking to be explored.
That idea makes therapy feel less like an emergency response and more like a meaningful form of self-reflection. It becomes a space to pause, take stock, and ask harder questions about how you are living and what you may need next.
What makes your practice unique, and how do you know if you’re a good fit for a client?
It is about being intentional about not getting ahead of the person in front of you. As therapists, we need to understand each person in the context of their own life, strengths, challenges, and readiness for change. That means honoring where someone is, instead of pushing them toward where they “should” be.
This way of working can be especially supportive for people who are used to pressuring themselves. Like many of my clients who are high functioning and driven. They may look successful on the outside while internally feeling exhausted, unhappy, perfectionistic, or chronically disconnected from their own needs. I also work with young adults who are having trouble launching into adulthood, perhaps having had setbacks like a mental health crisis, and need support navigating the transition.
How to cope when life feels emotionally overwhelming
When life feels overwhelming, it can help to slow everything down and focus on getting through one moment or one hour at a time. Reducing the size of the problem can make it feel more survivable. And when depression or hopelessness makes action feel nearly impossible, even a very small step can matter. A walk. A phone call. Any small movement or action can combat the tendency to retreat and feel paralyzed.
There is something deeply humane about that advice. It does not romanticize healing or pretends that change is easy. It simply offers a gentler entry point.
How to find the right therapist for your needs
Finding a therapist is rarely a one size fits all process. It is highly individual. People may begin by exploring therapist directories, asking for referrals from their community, or looking for someone with a shared background or area of expertise. What matters most is finding someone with whom you feel safe and someone you believe can understand you and help with the areas where you feel stuck.
A simple way to begin is:
1. Read a few therapist profiles carefullyNotice how therapists describe their approach, specialties, and the kinds of clients they work with. |
2. Look for what feels alignedShared identity, expertise, communication style, or lived experience may all play a role in helping you feel understood. |
3. Take the next step to assess fitA consultation or follow up call can help you decide whether the connection feels right. |
This is one reason directories like GoodTherapy can be a helpful place to start. They make it easier to explore therapist profiles, understand different approaches, and find a therapist whose style feels aligned with what you need.
For therapists, it is also a reminder that a thoughtful profile matters. The clearer you are about your approach and who you help, the easier it is for the right clients to find and connect with you.
The right support can change everything
Brooke Pomerantz’s approach reminds us that therapy is not about having everything figured out before you begin. It is about making sense of your feelings and things that are weighing you down and channeling it into an effort to find a space where you can be honest and feel safe. Her reflections offer something deeply reassuring that growth can happen at your own pace, that support can be valuable even before a crisis, and that the right therapeutic relationship can help you move through life with greater clarity and self-awareness.
If Brooke’s words resonated with you, take a moment to explore her GoodTherapy profile and learn more about her approach. If you are still looking for the right fit, browse GoodTherapy’s therapist directory to find a provider whose style, perspective, and approach align with your needs.
FAQs
Ready to find the right therapist?Explore GoodTherapy’s directory of vetted professionals and find someone whose approach aligns with your needs. |
Back to top.
Anxiety is one of the most common human experiences and one of the most misunderstood. Most people hope therapy will help them get rid of anxiety. But what if anxiety as a signal isn’t simply a problem to eliminate, but a meaningful message that something in your life, body, or relationships needs attention, comfort, and care?
Therapy for Anxiety
Acceptance-based Skills
Want support with anxiety right now?
If anxiety is interfering with your life, you can explore the GoodTherapy directory to find a clinician who fits your needs: find a therapist near you.
In clinical practice and empirical research, anxiety is understood not just as distress but as a complex biopsychosocial response that tells a deeper story about how a person is experiencing safety, loss, connection, and threat. It reflects dynamic interactions between mind, body, and life circumstances that deserve compassionate understanding, not avoidance. For an overview of how anxiety is defined and experienced, see the American Psychological Association’s anxiety resource.
Key idea: When we treat anxiety as a signal, we shift from “What’s wrong with me?†to “What is my system trying to protect, and what does it need?â€
Anxiety as a Signal: More Than a Symptom
The American Psychological Association (APA) describes anxiety as feelings of worry, tension, and physiological arousal that prepare a person for potential threat. While anxiety can become overwhelming or distressing, it is also a normal adaptive reaction in many settings, alerting us to danger, motivating preparation, and facilitating problem-solving.
This adaptive potential suggests a departure from viewing anxiety solely as pathology. Instead, anxiety as a signal can be understood as meaningful internal communication, signalling what has been experienced as unsafe, unresolved, uncertain, or emotionally unmet.
If anxiety is impacting your relationships…
GoodTherapy has a helpful read on how anxiety can disrupt connection, and how to respond with more clarity: anxiety and relationships.
Anxiety and Emotional Loss
Anxiety is often rooted in anticipatory fear, the nervous system’s attempt to protect against unknown or painful experiences. Research commonly conceptualizes anxiety as a future-oriented state tied to anticipation and preparation for what may happen next (see, for example, Craske et al., 2017).
In clinical settings, many people with anxiety also struggle with unacknowledged loss, loss of identity, relationship changes, unmet needs, changes in health, or life transitions that have not been fully felt. When these losses go unexplored, the nervous system can stay activated, producing persistent vigilance and distress.
Therapeutically, when we begin to hold and explore these experiences with empathy, anxiety as a signal can lose its grip as a threat alarm and become a gateway to healing.
What anxiety might be protecting
- Connection you fear losing
- A role or identity that’s shifting
- Unmet needs you learned to ignore
- Grief you haven’t had room to feel
What to try (gently)
- Name the feeling (“This is anxiety.â€)
- Locate it in the body (tight chest? restless legs?)
- Ask: “What feels threatened right now?â€
- Ask: “What would help me feel 5% safer?â€
If loss is part of your story, you may appreciate this GoodTherapy piece on how grief can show up physically, and sometimes overlap with anxiety: the physical effects of grief.
The Body and the Nervous System in Anxiety
Anxiety is not “just in your head.†It is deeply embodied and reflects how your nervous system has adapted to past and present experiences. Research consistently shows that anxiety activates physiological systems, heart rate, breathing, muscle tension, and vigilance, designed to protect the organism from danger (see, for example, Stein & Sareen, 2015).
This embodied aspect offers a powerful direction for therapy: instead of trying to control or suppress symptoms, therapeutic work often focuses on understanding and co-regulating the body’s signals. In this way, anxiety as a signal becomes a relational process between internal experience and external support.
A 60-second grounding reset (not a cure, just a reset)
-
Exhale first (a longer out-breath can soften arousal).
-
Place a hand on your chest or belly, wherever feels supportive.
-
Look around and name 5 neutral objects you can see.
-
Ask: “If anxiety as a signal had a message, what would it want me to notice?â€
Anxiety in the Context of Relationships
Human beings are relational by nature. Anxiety often arises in the context of relationship experiences, attachment history, interpersonal losses, uncertainty in connection, or ongoing interpersonal stressors. One consistent finding across psychotherapy research is that the quality of the therapeutic alliance is strongly linked to outcomes (see Wampold & Imel, 2015).
This aligns with what many clients report: anxiety often decreases when they feel genuinely heard, reflected, and cared for, a process that cannot be reduced to “techniques†alone but requires authentic engagement.
If you’d like a clear definition of what we mean by “alliance,†GoodTherapy’s PsychPedia entry is a great starting point: therapeutic relationship (therapeutic alliance).
Prefer skills + insight?
Many people benefit from a blend of approaches. You can explore therapy types and therapist specialties using the GoodTherapy directory.
What the Evidence Says About Effective Treatment
Clinical research recognizes multiple empirically supported treatments for anxiety, including cognitive-behavioral therapy (CBT), acceptance-based approaches, and psychodynamic therapies.
While CBT remains the most widely studied and traditionally recommended psychotherapy for anxiety (see Hofmann et al., 2012), research also supports the efficacy of relational and insight-oriented therapies that attend to underlying emotional experience and meaning (see Leichsenring et al., 2017).
Two evidence-based paths (often combined)
-
CBT-style approaches: Reduce avoidance and shift threat appraisal, often helpful when anxiety feels “loud†and repetitive.
-
Relational/psychodynamic approaches: Explore how anxiety as a signal connects to attachment history, conflict, loss, and meaning.
GoodTherapy also has a practical overview of CBT and anxiety here: CBT (and relaxation) for anxiety. Acceptance-based models can be especially helpful when you notice that fighting anxiety intensifies it. If you want to learn more about how avoidance can keep anxiety going, see: cognitive avoidance and acceptance-based behavioral therapy.
Anxiety as a Signal: An Invitation to Connection and Self-Understanding
When clients begin therapy, many feel overwhelmed by anxiety, yet at deeper levels, this emotional energy points toward what matters most. Anxiety as a signal often marks domains of life where a person:
- Fears loss of safety or connection
- Holds unprocessed grief or unmet attachment needs
- Has learned to anticipate threat based on past experiences
- Struggles to trust themselves or others with vulnerability
These experiences are not pathological weaknesses; they are meaningful emotional responses to life events that deserve recognition. When you shift your orientation from fighting anxiety to listening to anxiety, healing begins.
Sometimes anxiety as a signal was learned early, especially when caregivers were also overwhelmed. This GoodTherapy article describes how anxiety can function like a protective “alert system†in families: whose anxiety is it, anyway?
Therapy as a Place of Comfort and Exploration
Therapy offers more than symptom reduction. It offers a space where anxiety can be understood, held, and transformed. Instead of avoiding discomfort, we gradually build the capacity to sit with it, understand its origin, and learn new ways of relating to internal experience.
Together, we can explore:
- What your anxiety may be asking you to notice
- How past experiences shape present responses
- What relational patterns may contribute to distress
- Ways to tend to loss, unmet needs, and vulnerability
- How to cultivate deeper self-compassion and resilience
Looking for treatment options?
For general clinical guidance on anxiety treatment, you can review trusted overviews from NIMH, Harvard Health, or Mayo Clinic.
Putting Research Into Practice
Evidence supports that psychological treatments are effective for anxiety, and that the quality of connection between therapist and client plays a central role in outcomes. My approach integrates evidence-based techniques with relational depth, recognizing that anxiety as a signal is not merely something to suppress, but something to understand and transform.
An Invitation
If anxiety has been a persistent companion, interfering with your relationships, daily function, or sense of peace, I want you to know that your experience is valid, meaningful, and worthy of care. You do not have to navigate it alone.
Therapy is a space where your anxiety can be listened to with empathy, your history honoured with nuance, and your inner life gently supported toward healing.
About the Author
David Rothman, Licensed Professional Counselor
David is a Licensed Professional Counselor based in Louisville, Colorado (with telehealth available). He works with adults and couples navigating anxiety, relationship stress, life transitions, and the painful feeling of disconnection.
His approach is calm, supportive, and collaborative, moving at a pace that feels right for you. Drawing from relational and psychodynamic work, Emotion Focused Therapy, AEDP, and depth therapy, David helps clients explore the patterns beneath the surface and move toward steadier, more authentic connection.
References
- American Psychological Association. (n.d.). Anxiety
- American Psychological Association. (2017). Clinical practice guideline for the treatment of posttraumatic stress disorder (PTSD) in adults
- Craske, M. G., Stein, M. B., Eley, T. C., Milad, M. R., Holmes, E. A., Rapee, R. M., & Wittchen, H.-U. (2017). Anxiety disorders. Nature Reviews Disease Primers, 3, 17024. https://doi.org/10.1038/nrdp.2017.24
- Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research, 36(5), 427–440. https://doi.org/10.1007/s10608-012-9476-1
- Immordino-Yang, M. H., Darling-Hammond, L., & Krone, C. R. (2019). Nurturing nature: How brain development is inherently social and emotional, and what this means for education. Educational Psychologist, 54(3), 185–204. https://doi.org/10.1080/00461520.2019.1633924
- Leichsenring, F., Abbass, A, Hilsenroth, M. J., Leweke, F., Luyten, P., Munder, T., Rabung, S., & Steinert, C. (2017). Psychodynamic therapy meets evidence-based medicine: A systematic review using updated criteria. The Lancet Psychiatry, 2(7), 648–660. https://doi.org/10.1016/S2215-0366(15)00155-8
- National Institute of Mental Health. (2023). Anxiety disorders
- Stein, M. B., & Sareen, J. (2015). Generalized anxiety disorder. The New England Journal of Medicine, 373(21), 2059–2068. https://doi.org/10.1056/NEJMcp1502514
- Thwaites, R., & Freeston, M. H. (2005). Safety-seeking behaviours: Fact or function? How can we clinically differentiate between safety behaviours and adaptive coping strategies across anxiety disorders? Behavioural and Cognitive Psychotherapy, 33(2), 177–188. https://doi.org/10.1017/S1352465804001985
- Wampold, B. E., & Imel, Z. E. (2015). The great psychotherapy debate: The evidence for what makes psychotherapy work (2nd ed.). Routledge. https://doi.org/10.4324/9780203582015
Starting therapy might feel like opening a door you’ve been staring at for a long time — equal parts relief, curiosity, and uncertainty. What will it be like? Will your therapist understand you? Will it actually help? If you’re new to therapy, these unknown elements can stack up and exacerbate anxieties surrounding meeting your therapist and beginning treatment. But the first sessions aren’t about solving everything at once: they’re about laying the groundwork for real, lasting change.Â
Knowing what to expect from your first sessions can alleviate some of that first-time therapy anxiety and nervousness. Let’s break down what you can expect as you’re getting comfortable with your therapist and how to make the most of those early sessions.
Related: A Step-By-Step Guide to Finding the Right Therapist
Table of Contents:
- Preparing for Your First Therapy Session
- What Typically Happens During a First Therapy Session?
- Common Questions Therapists May Ask
- Questions You May Want to Ask Your Therapist
- What To Do After Your First Therapy Session
- Therapists Share What to Expect in Your First Session
- The Second and Third Sessions: Deepening Understanding
- Finding the Right Therapist for You
Preparing for Your First Therapy Session
Embarking on your first therapy session is like opening a new chapter in your journey towards understanding and healing. To make the most of this initial meeting, it’s helpful to come prepared with a few essentials and a willingness to be open and share. Consider the following:
- What to Bring: Come with an ID card and insurance card if you plan to use insurance, along with any documents detailing your mental health history. A notebook can be invaluable for jotting down thoughts and topics you wish to discuss.
- How to Mentally Prepare: Think about questions you’re curious to explore with your therapist and write them down. Consider questions about their approach or how therapy can best support your goals.Â
- Preparing for Virtual Therapy: If your session is virtual, ensure you find a quiet, private space where you can speak freely and without interruption. Test your internet connection and video call software ahead of time to prevent technical glitches.Â
Remember, getting ready for your first therapy session is a step towards creating a space where you can engage openly and comfortably and foster a relationship grounded in understanding and support. It’s okay to be nervous about your first few sessions, and preparing for them can ease your anxieties.
Read More: Thinking About Starting Your Therapy Journey? Now’s the Time
What Typically Happens During a First Therapy Session?
Stepping into your first therapy session can be nerve-wracking, but once you get through it, you’ll feel more at ease about the whole process. If you’re attending a session in person, you’ll likely check in at the front desk and spend a few moments in the waiting area when you arrive. In this moment, provide a brief pause to center yourself.Â
When the session begins, you’ll probably exchange introductions with your therapist to set a foundation for open communication. Your therapist will likely start by exploring the reasons you’re seeking therapy, delving into any past approaches you’ve taken towards mental health, and discussing ways to set goals in therapy.Â
Remember, therapy is a collaborative dialogue where setting realistic goals becomes a shared focus. The initial meeting is just the beginning, and you’re not expected to unpack everything at once. It’s an opportunity to lay the groundwork for a supportive relationship where your therapist is there to guide you and ensure you feel heard, understood, and ready to embark on this journey together.
Common Questions Therapists May Ask
During the initial meeting, your therapist may pose a range of questions designed to gently uncover the layers of your current experience. These inquiries might touch on why you’ve chosen to seek therapy now, what specific concerns you’re facing, and any relevant aspects of your personal history. Remember that you’re not expected to divulge every detail immediately; this is the beginning of a relationship rooted in trust and mutual respect.Â
Some initial questions they might ask you could include:
- Have you attended therapy in the past?
- What are your symptoms?
- Do you have any mental health issues in your family history?
- How is your home life?
- Do you have a history of suicidal ideation?
- Do you have a history of self-harm?
- What do you hope to get from therapy?
- What do you want to accomplish in sessions?
As you navigate these questions, you’ll also have the opportunity to learn about your therapist’s approach and clarify any logistical details, such as confidentiality and session structure. This dialogue sets the stage for a collaborative process, ensuring you feel comfortable and engaged as you move forward on this path of self-discovery and healing.
Questions You May Want to Ask Your Therapist
During your first few sessions, it’s perfectly natural to have questions swirling in your mind. Finding the right therapist is about building a relationship with them, so you should ask your therapist questions, too. Asking your therapist questions helps clarify any worries or concerns you may harbor about the treatment process. You can ask questions like:
- Is this confidential?
- When would you need to break confidentiality?
- How long have you been a therapist?
- Do you have any experience with my specific type of mental health issues?
- Have you ever been to therapy yourself?
- What kind of things should I plan to do between our sessions?
Voicing these inquiries can provide clarity and comfort. Remember, this is your space to explore and understand. Allow yourself the grace to ask freely, fostering an environment where your healing journey can unfold with openness and understanding.
What To Do After Your First Therapy Session
As you step out of your first therapy session, it’s important to take a moment for self-reflection and consider how you felt during the meeting. Evaluating your comfort level with your therapist is a crucial part of the process, but don’t forget that change and comfort will be gradual. It’s completely normal if you don’t feel an immediate sense of transformation.Â
During or right after your first therapy session is a good time to schedule follow-up sessions and address any initial concerns you might have had. Your therapist may also suggest “homework” activities — such as journaling your thoughts, practicing mindfulness exercises, or engaging in self-care routines — which are designed to deepen the work you do in sessions. These tasks are not about adding pressure but rather about nurturing your growth between meetings. Allow yourself to engage with these activities at your own pace, embracing the gradual process of healing and learning about yourself.
Therapists Share What to Expect in Your First Session
Navigating the uncharted waters of a first therapy session can stir a mix of emotions, where your uncertainty and curiosity can intertwine. To help illuminate this experience and guide you when preparing for a therapy session, several professional therapists share insights into what typically unfolds when welcoming newcomers into their practice.
Marla B. Cohen, PsyDTherapist Marla Cohen: In your first session, your therapist will spend some time getting to know you and the issues that brought you into treatment. He or she may use a formal, structured interview, or it may just feel like a more free-flowing conversation. The therapist will ask questions about your presenting concerns, as well as your history and background. Most likely, you’ll find yourself talking about your current symptoms or struggles, as well as saying a bit about your relationships, your interests, your strengths, and your goals.
Most importantly, in that first session, you will begin making a connection with your therapist. You should feel safe, accepted, respected, and relatively comfortable. Not all therapists are right for every person, so use your first session to assess whether or not the therapist you chose feels like a good match for your personality.
Lynn Somerstein, PhD, E-RYT: Usually, in your first session you will be invited to be seated comfortably. The therapist will usually begin with some initial small talk to help you feel at ease. I usually make reference to the scariness of starting therapy, since I like to honor the feelings that are present. That’s a feature of therapy: find out where the person is and start there.
Sometimes people have lots to say and start talking right away, pouring out their thoughts and feelings, and sometimes their fears and tears, too.
Other people find it very hard to speak, so I’ll ask questions about how they decided to come to therapy, why therapy with me and not somebody else, whether they have been in treatment before, and whether there is something in particular troubling them. Each statement the person in therapy makes leads to many other questions.
I say what my expectations are: that people come on time, that they pay on time, that they say what is on their minds—even if it sounds silly to them. In fact, especially if it sounds silly; those silly ideas are frequently the best things to talk about because they often lead to issues that need to be explored.
Toward the end of the first session, I also always thank the person for coming, say that I’ve asked a lot of questions (if indeed I have), and invite the person in therapy to ask me questions. Sometimes people feel it’s not polite, and they are afraid. So, then I say not to worry about courtesy, that I’ll probably feel comfortable answering, but that if, for some reason, I don’t want to answer something, I’ll say so and we’ll move on.
Then we discuss whether we’d like to meet again and, if so, when. I’ll say how often I think we should meet, and we’ll talk about that too.
The Second and Third Sessions: Deepening Understanding
As you continue to meet, your therapist will start to get a clearer picture of who you are and what you’re hoping to change or understand. These early sessions often focus on identifying patterns in your thoughts, behaviors, or relationships. They may also explore past experiences that have shaped you.
This is a great time to reflect on what’s coming up for you emotionally. Are you feeling guarded? Relieved? Anxious? Sharing these reactions can help your therapist tailor their approach to your needs.
Finding the Right Therapist for You
Venturing into therapy is a brave step, one that speaks volumes about your commitment to growth and healing. Just as each person is unique, the connection with your therapist should feel supportive and aligned with your needs. It’s crucial to find someone with whom you feel a genuine rapport, as this relationship forms the foundation for meaningful progress.Â
While it’s normal to take a few sessions to feel comfortable, pay attention to how you feel with your therapist. If you consistently feel unheard, judged, or unsafe — or if your therapist crosses professional boundaries — it’s okay and encouraged for you to seek another provider. A good therapeutic relationship is grounded in respect, empathy, and ethical care.
It’s perfectly okay to explore different options until you find the right fit. GoodTherapy’s directory of expert, highly-rated therapists helps you find the right person to guide you on your personal mental health journey. This experience is yours, and finding the right therapist is a vital part of embracing the transformative process.
Ready to start your therapy journey? Find a licensed therapist in your area to support your mental health journey.