The first session is assessment. You will spend most of it answering questions, and it can feel anticlimactic if you arrived hoping to start work. The reason is that the treatments for the different anxiety disorders diverge, and picking the wrong one costs months.
What gets asked
What brings you now, and specifically why now rather than a year ago — the answer is usually informative. When it started. What it looks like physically. What sets it off.
Then, if the clinician is any good, a detailed pass on avoidance: what you’ve stopped doing, what you only do with a precaution attached, what you’ve arranged your life around. This is where the treatment plan comes from.
Also sleep, alcohol, caffeine, medication, medical history, and whether anyone in the family has had similar difficulties. Plus risk — whether you’ve had thoughts of harming yourself — which is asked of everyone as a matter of routine and isn’t a judgment about you.
Measures
Expect a questionnaire, probably several: the GAD-7 for generalised anxiety, the PHQ-9 for mood, and something disorder-specific. They’re used to establish a baseline and track change, and they’re genuinely useful, because progress in anxiety treatment is often invisible from inside. A score that has fallen eight points is hard to argue with in week ten.
What to bring
A list of what you’ve stopped doing. Write it in advance — you won’t produce a good one under questioning. Medication names and doses. Any previous therapy, what it was, and what did or didn’t help, which is the single most useful piece of history you can supply.
And the thing you’re most embarrassed about. The panic on the school run, the vomiting phobia, the fact you haven’t driven in four years. Whatever it is, it’s ordinary in this room.
What to ask them
What do you think this is, in diagnostic terms? What treatment do you propose and what is the evidence for it in this condition? Roughly how many sessions? How will we know it’s working? And what will I be doing between sessions?
A clinician who can answer all five is working to a protocol.
Judging fit at week three
Not week one — first sessions are awkward for everyone. By week three you should have a formulation you recognise, a plan you could describe to someone else, and something specific to do between sessions.
If instead you’re three weeks into unstructured conversation about how the week went, that’s worth raising directly. Say you would like a more structured, exposure-based approach and ask whether that’s something they do. The answer will settle it, and either outcome is useful.