How to overcome the anxiety of starting therapy

The initial step can often be the most challenging when it comes to many things in life. Signing up for counselling or therapy is no exception.

For some people, the idea of spending an hour each week with a psychotherapist can feel unappealing at first. Often, it is when it comes to a stage when personal circumstances make professional mental health support unavoidable that people find themselves in a therapy space.

The stiff upper lip: The weight of staying strong

Currently in the UK, although it is possible to self-refer to NHS Talking Therapies without going to a GP first, these services operate within defined eligibility criteria and time-limited frameworks due to high demand.

As a result, people who are seeking longer-term or more exploratory therapy, or who wish to focus on personal growth and quality of life rather than symptom management alone, may find themselves looking to private therapy instead. What this propagates is a widely held belief that someone has to have a ‘serious breakdown’ to go for therapy.

The societal narrative around psychotherapy, therefore, becomes one where someone who has voluntarily signed up for professional support to improve their mental health is perceived as having “something wrong with them” If not, why would they be in therapy?

The stigma, therefore, is attached to seeking help itself. It is no wonder that people are driven to avoid therapy when they are sometimes stigmatised more for seeking help than for having an issue and not seeking treatment. Trying to deal with a psychological issue by themselves is thus wrongly commended as “being resilient/strong enough to take care of things independently”

When "handling it" becomes too much

For those who are wary of how they are viewed by others, effort is expended to avoid therapy to prove how ‘successful’ they are at handling things on their own, rather than invest in their mental health. A sequence of events that is avoidable but often all too common is that trying to solve mental health challenges on your own can make things worse and prolong challenges for longer than if help is sought early enough.

Even once the decision is made to explore the suitability of therapy, there are also concerns of trust and judgment to be overcome. Confidentiality is one thing, but a therapy client can be apprehensive of ‘baring their soul’ to a stranger. What if therapy stirs up issues that you have been trying to (even unconsciously) avoid, as they are too shameful for you? Therapy requires relinquishing a degree of control, which can be unappealing for people accustomed to managing their environment (or at least trying to) in order to retain a greater degree of certainty in their lives.

As a psychotherapist, I have seen how accepting that you may not have as much control over your thoughts, your environment and others’ behaviours is challenging too. It is opening the door to accepting your own vulnerability as a human being, which is all too tempting to deny.

Which therapist might work best

If you have decided that your mental health does deserve attention through therapy privately, the last hurdle often is who and what sort of therapy would suit your specific circumstances best.

There is no easy answer to this, except that finding a credentialed professional who has expertise in helping clients address similar issues can be a safe option. When overcoming the trepidation of entering therapy, it may be helpful to seek out a therapist who offers a complimentary introductory chat before paid consultations. This is not a session; it's a conversation, where a prospective client gets to hear the therapist's voice and see if they seem like someone you could relax and be honest with.

The initial consultation can thus play the part of a ‘two-way interview’ where the therapist and client mutually decide whether they are a good fit, what the issues to be addressed are and crucially, whether the client can be comfortable sharing highly personal details with the person in front of them. If the connection feels right – if the therapist sounds warm, non-judgemental, and potentially someone you could be vulnerable with, it can be reassuring and give the confidence needed to commit to a therapeutic relationship. A lot of therapists offer open-ended therapy, which means that the client can decide how long they need therapy for.

Dealing with not knowing what to expect

Uncertainty about the process, what a therapist will ask, whether it will be effective, and how long it will take to feel better, all can cause anxiety to varying degrees. This is a common barrier, which can be reassured by having an introductory consultation, where any doubts can be cleared up with the therapist themselves.

Other than the initial no-obligations consultation, something I also use as a therapist is a pre-therapy assessment in the form of a document that can be filled out, which plays a role in easing what is usually the hardest part – the initial disclosure of the core problem – without having to look someone in the eye. It allows clients to focus expectations and share the essence of challenges they are facing on a page before having to speak them aloud, ensuring that when we sit together for the first time, the hardest part is already behind us.

This allows the first session to be spent on discussion of the issues faced and potential strategy, rather than agonising over the reveal, significantly lowering the anxiety of being judged in person at the outset.

Finding your treasure

Going to places psychologically which are uncomfortable – in this instance, within the therapy space – to reap the rewards is captured beautifully in the quote "The cave you fear to enter holds the treasure you seek", attributed to mythologist Joseph Campbell.

This emphasises how valuable insights that lead to personal growth and greater fulfilment (the treasure) can be found by confronting aspects of ourselves that we are reluctant to explore (the cave).

This understanding can be used to give impetus to the start of your therapy journey. Ultimately, putting in place as many factors as needed to increase the comfort of entering therapy can make the difference between trying to grapple with life’s more vexing problems on your own and taking the crucial first steps to invest in mental health more effectively.