Walking into your first therapy session for anxiety can feel like stepping onto a moving walkway: you know it should carry you forward, but the motion under your feet is unfamiliar. The good news is that a thoughtful first appointment can set a sturdy foundation for everything that follows. A well run intake clarifies goals, reduces uncertainty, and starts to ease the body’s constant alarm. The following guidance draws on years of clinical work, feedback from clients after thousands of hours in session, and the practicalities that barely get discussed until you are already in the chair.
What “first session” typically means
Most providers schedule 50 to 60 minutes for the first visit. Some agencies block 75 to 90 minutes. That initial session often blends assessment and therapy. You share https://www.drericaaten.com/ a headline version of your story, the therapist asks questions to map patterns, and together you define an initial target. You should also hear about confidentiality, limits to privacy, fees, late cancel policies, and how emergencies are handled between appointments.
Expect a degree of structure. Many clinicians start with a short screener such as the GAD‑7 to quantify anxiety severity, then follow up with open questions: when did this start, what makes it worse, what helps a little, what does a good day look like. Do not be surprised if you also complete brief measures for depression or sleep. Anxiety rarely travels alone. When worries flood the day, appetite, motivation, and attention often carry a share of the load.
If you are seeking anxiety therapy while wondering about attention and neurodevelopment, say so early. It matters. Panic in a crowded classroom feels different when ADHD is part of the picture, and social burnout lands differently for autistic clients. Good therapists weave this context into the plan rather than trying to press everyone through the same set of steps.
Preparing without overpreparing
Many people wait years before booking. By the time they arrive, the impulse is to prepare a perfect summary, as if therapy were an exam. You do not need a flawless narrative. The first session rewards clarity over polish. Aim to bring a few key details and leave space for the therapist’s questions. If you freeze, that is useful information too. Therapists watch not just what is said, but how stories feel in the body as they are told.
A short list helps, but remember the goal is to anchor, not script. Capture the spikes and the stuck places. If your anxiety feels diffuse, pick a slice of life where it shows up predictably, like commuting, speaking up in meetings, or falling asleep.
Here is a compact checklist that clients find practical when getting ready for the first appointment:
- Three moments from the past month that show what your anxiety looks like in real time, with where you were, what you felt in your body, and what you did next Medications and supplements you take, plus any prior therapy or psychiatry experiences that helped or did not Sleep, caffeine, and substance patterns over a typical week, including vaping, alcohol, or cannabis A first draft of your priorities in therapy, even if you are not sure how to reach them Any logistics that could shape treatment, like work shifts, caregiving duties, transportation, or privacy at home for telehealth
You will note that none of those require perfection, only honesty. Therapists do not grade, they collaborate.
What happens once you sit down
Most therapists start with consent and confidentiality. Expect a brief, plain language review: your records are private, with exceptions for acute safety risks or rare legal circumstances. You can ask for details. If something is unclear, pause and clarify. This is not merely legal housekeeping. Consent sets the tone for transparent work.
After that, the conversation maps out your current anxiety. Clinicians differ in approach, but a common sequence looks like this:
- Symptoms and patterns, including triggers, physical sensations, and the thoughts that ride along Functioning: work or school performance, relationships, sleep, health, finances, and daily routines History: panic episodes, phobias, health anxiety, social fears, trauma exposures, and major turning points Safety and coping: what you do when anxiety spikes, whether avoidance has grown, and any self harm thoughts Goals and fit: what you hope therapy can change, how you learn best, and whether the plan feels like it matches you
Talk about the body. Many people minimize physical symptoms, then later realize the most helpful tools were the ones that calmed their physiology. Shaky hands during video calls, the drop in stomach during a commute, the late afternoon dread before childcare pickup, all give the therapist a map of the nervous system rhythms they need to respect and retrain.
Making space for coexisting concerns
Anxiety blends, and the blend matters. If focus is slippery, you lose track of tasks, or deadlines ambush you, ask whether ADHD Testing might make sense. Evidence based anxiety treatments such as exposure work and cognitive behavior therapy can help, but the pacing, task structure, and homework design often need adjustment when attention and working memory are stretched. A therapist who is comfortable with executive function strategies can fold calendar scaffolding or brief, frequent check ins into the plan so that therapy tasks do not become yet another source of shame.
Similarly, if you have wondered whether you sit on the autism spectrum, say so. Formal autism testing is not about a label for its own sake. It gives language to sensory sensitivities or social energy limits that change what a realistic exposure looks like. For an autistic client, the goal might not be tolerating a loud happy hour, but finding two socially sustainable spaces and building confident routines inside them. Eye contact expectations, directness, and pacing can be tailored once neurotype is clear.
Intrusive thoughts deserve special mention. Clients walk in terrified to say them aloud. A therapist trained in OCD therapy will not flinch at harm obsessions or blasphemous ideas. The difference between classic generalized anxiety and OCD lies in the function of thoughts and the compulsions that try to neutralize them. If you notice ritualized checking, reassurance seeking, mental reviewing, or avoidance that eats hours, flag it during intake. This steers the therapist toward exposure and response prevention or related protocols that target those loops directly.
Past adversity shifts the ground as well. If trauma has touched your life, the therapist should ask about it with care and respect. Trauma therapy can run in parallel with anxiety work, or be integrated. Some clients need to stabilize sleep and reduce daily panic before touching trauma memories. Others find that safely approaching a few key trauma cues deflates overall anxiety faster than anything else. Either path can be correct. The choice is tailored to the nervous system sitting in the room, not to a manual.
Telehealth or in person
Both formats work. Data from recent years shows comparable outcomes, especially for anxiety disorders, when sessions are consistent and the technology is stable. In person visits help when body based interventions, like paced breathing or interoceptive exposure, benefit from live coaching in shared space. Telehealth helps clients who need childcare nearby, have long commutes, or simply feel safer at home at the start. If you are unsure, try each format across the first month and pay attention to what your body tells you after sessions. Do you leave more settled, more energized, or more raw, and how does that line up with your goals.
For remote work, set up a place where you can speak freely without someone drifting past the door. A parked car can be an excellent temporary office. Bring water, tissues, and a notepad. Headphones help maintain privacy, and they often improve sound quality enough to reduce the subtle strain of mishearing.
What a solid therapist will explain
You should hear a sketch of the treatment model and how it links to your symptoms. If the therapist proposes cognitive behavior therapy, they might explain how thought patterns, behaviors, and physiology reinforce one another, and where you will interrupt the cycle. If they favor acceptance and commitment work, they will talk about values, psychological flexibility, and experiments in moving toward what matters even as anxiety chimes in. For panic disorder, expect interoceptive exposures that retrain the body’s interpretation of benign sensations like dizziness or breathlessness. For social anxiety, plan for graduated behavioral experiments and attention retraining. For OCD therapy, exposure and response prevention will focus on staying with a feared thought or cue without performing the compulsion that temporarily lowers fear but keeps the trap in place.
Medication sometimes belongs in the conversation. Not because therapy cannot work without it, but because for some clients, a modest dose of an SSRI or SNRI smooths the physiological spikes enough to allow learning to take root. Your therapist may not prescribe, but they should be comfortable referring to a psychiatrist or primary care clinician when symptoms are severe, sleep is broken, or repeated attempts at therapy stall because arousal is too high. If you are already taking medication, bring the prescriber’s contact information so coordination can be seamless.
How to tell your story without feeling lost
A common worry sounds like this: I have twenty years of anxiety, ten turning points, and a hundred little episodes. How do I pick. Consider this framing. First, name the present problem in a sentence. Second, offer a short timeline with two or three major beats. Third, give one fresh example from the past week. For instance: I avoid leading meetings at work because I shake and blank out. This started in college after a lab presentation went badly, then worsened after a layoff three years ago. On Tuesday I skipped a client call and spent two hours rewriting an email to avoid sounding foolish.
That gives your therapist enough to follow up. They may ask about the shake, where it starts, how you breathe, what you notice in your shoulders and throat. They might ask about self talk in that moment, and whether you believe those thoughts or simply feel hijacked by them. The story becomes a living case example, not an archive.
If emotions run hot and words disappear, you can switch to anchors like numbers and simple labels. Zero to ten scales for fear, shame, or anger help. So does describing a symptom with sensory words rather than judgments. My chest felt tight and hot is more useful than I was a mess. Therapists can work with sensation. They cannot adjust a self insult.
What if panic hits during the session
It happens. I have had clients stand, step to a window, and ask to take two minutes without talking. That is wise. In those moments, a good therapist slows everything down. You might place both feet on the floor and notice which one feels heavier. Try a slow exhale that counts to six. If the rush still crests, agree on a small task, like naming five blue objects in the room. None of this is a trick to avoid anxiety. It is a way to keep your prefrontal cortex in the game so that the learning you do in session sticks.
If you fear having a panic attack in session, name that at the very start. Make a plan. Know how to signal you need a break. Decide together whether the therapist will invite you to stay with the sensation for a few minutes to gather new evidence that it will peak and fall, or whether, early on, you prefer brief grounding and a return to discussion.
Paperwork that actually matters
Intake forms feel bureaucratic, but a few fields are particularly useful. Contacts and releases of information allow your therapist to coordinate care with a prescriber or a school counselor. Measurement scales such as the GAD‑7 or the Panic Disorder Severity Scale provide a baseline. If trauma is in the mix, a careful discussion about whether and how to use tools like the PCL‑5 matters. Some clients find symptom checklists validating. Others feel flooded by them. It is fine to say, I would rather talk this through for now.
If you are seeking autism testing or ADHD Testing, ask about the pathway. Some practices complete full evaluations in house. Others refer out. A comprehensive ADHD evaluation typically includes clinical interview, rating scales from you and someone who knows you well, and a review of developmental history. Autism evaluation often adds structured interaction tasks and sensory questionnaires. Results help fine tune therapy strategy. For example, time blindness in ADHD changes how we design exposure practice and how long we expect tasks to take between sessions. Sensory sensitivities in autism shift the types of social exposures we choose.
Money, scheduling, and what consistency buys
Therapy costs vary widely. Private pay rates often fall between 100 and 250 dollars per session in many regions, with lower fee options at community clinics. Insurance coverage depends on plan details. Call your insurer for copay and deductible information before the first visit if possible. Ask the therapist’s office whether they verify benefits, and how out of network claims are handled. If the numbers feel tight, discuss frequency options. Weekly sessions create momentum early on. After five to eight weeks, many clients step down to every other week while maintaining gains. If travel or costs make weekly visits hard, a therapist who gives focused homework and brief check ins by portal messages can keep traction between sessions.
Consistency matters, especially for anxiety therapy. The brain learns safety through repetition. A single exposure might provide relief for a day. Five exposures across two weeks begin to retrain threat systems so that the body no longer moves straight to alarm.
The first homework, and why it is small on purpose
Do not expect a three page assignment after session one. A better start is a small, doable task: a daily two minute breathing drill tied to an existing routine, a five minute worry scheduling window each evening, or one short behavioral experiment like making brief eye contact with a barista and noticing your body’s sensations for ten seconds before looking away.
The size is intentional. Clients who arrive with high standards often try to ace therapy by doing everything at once. That revs the same perfectionism that drives anxiety. The first goal is to build a habit of gentle, consistent practice. Success grows not from aggression, but from repetition with curiosity and tolerable discomfort.
Questions to bring that help you judge fit
Therapist fit predicts outcomes as much as the modality. You do not need to like every element of a plan, but you should understand it and feel respected. A few simple questions reveal a lot. How will we know if this is working. What would a first sign of progress look like. If I struggle with homework, how will you help me adjust. If my anxiety worsens for a few weeks, what should I expect you to do. Listen for collaboration and flexibility. Beware rigid scripts or a one size fits all stance.
Cultural fit can be as important as clinical fit. Share values, identities, or experiences that matter. If you are a caregiver, a first generation student, a veteran, or an LGBTQ+ client, small nuances in language and examples can shape how safe a session feels. If something lands wrong, say so. Most therapists welcome corrective feedback and will adjust in real time.
Special notes for OCD therapy and trauma therapy starts
If you suspect OCD, the first session often ends with an initial hierarchy: a list of feared situations or thoughts, ranked by how much distress they provoke. Your therapist might ask you to track compulsions for a week. Try to capture just the first few seconds after a trigger. That helps identify micro choices where response prevention starts. Clients sometimes worry that exposures will be reckless. They should not be. Good ERP is precise, ethical, and paced so that you can learn and continue showing up.
For trauma therapy, early work balances stabilization and approach. Many clients have already tried white knuckled exposure that retraumatized them. The first session should include a conversation about titration, consent to pause, and what it means to stay within your window of tolerance while still moving toward memory or cues that hold power. There are times when treating hyperarousal with grounding and sleep interventions first is the wisest course. Other times, a carefully planned narrative or sensory exposure allows the nervous system to stop predicting danger in places where it no longer lives.
If you have tried therapy before and felt disappointed
Bring that story too. What helped even a little. What felt performative or rote. I have met clients who were told to breathe without anyone addressing the thought loops that kept triggering adrenaline, and others who spent months analyzing childhood without ever learning what to do at 2 a.m. When fear spiked. A skilled therapist will acknowledge those gaps and offer a different path. It is fine to ask, How will this be different from what I did last time.
Progress does not look like a straight line
Early wins tend to show up in small places. You notice that you made a phone call you would have avoided, or you recovered from a spiral in twenty minutes rather than three hours. Sleep stretches a little. Your shoulders sit an inch lower at the end of the day. Keep an eye on these. Clients often miss them because they are scanning for a total absence of anxiety. The target is trust in your ability to ride the waves and keep moving toward what you value. When that grows, anxiety can visit without running the show.
Expect a bump in discomfort when you start changing avoidance patterns. The body reads novelty as risk. That is not failure, it is the nervous system learning. The key is staying connected with your therapist during those bumps. Report what got hard, and ask for micro adjustments, like practicing at a time of day when your baseline is calmer, or breaking a step in half.
When to consider a different provider
If, after two to four sessions, you feel talked at, dismissed, or unclear about the plan, you can switch. Therapy is not a marriage. It is a service, and a relationship you get to choose. Most clinicians respect a direct message: I appreciate your time, and I am going to look for a different fit. If you are comfortable, offer one sentence about why. That feedback helps them grow, and it helps you practice self advocacy, which is itself an anxiety skill.
A brief story from the room
A client I will call Maya arrived with daily dread before morning standups. She spent hours scripting answers at night, then avoided eye contact on the call. In her first session, we drew a quick map. Anxiety spiked at 8:40 a.m., she drank two coffees fast, and by 8:55 her heart pounded. She stopped breathing from the diaphragm and clutched her jaw. She told herself, If I pause I will sound stupid. We designed a micro experiment for the week: one decaf before 8:30, one sentence she would read during the first check in, and a body cue to notice, the sensation of her feet on the floor. No heroics. By the second week, she rated her dread a six instead of an eight. By week four we added a gentle exposure: volunteer a small update first instead of last. Maya still felt anxious at times, but she no longer rearranged her life around that meeting. That is the arc to watch for, not magic, but capacity.
The quiet skill you are already practicing
By showing up, you have already contradicted a core lie that anxiety tells: that you cannot handle this and must avoid. The first session is the first repetition of a new behavior. You gathered information, tolerated uncertainty, and asked for help. That matters more than whether your story came out neatly or whether you cried. If you leave with a clear next step, a sense of collaboration, and one small practice to test, you are on track.
Finally, give the process a fair window. Three to six sessions provide enough data to tell whether this approach is gaining traction. Along the way, remember that specialized help exists for the nuances inside anxiety. If your attention profile suggests ADHD Testing would sharpen the plan, ask for it. If your sensory world points toward autism testing, say so. If your worries spiral into compulsions, seek a clinician skilled in OCD therapy. If the roots run through trauma, make sure trauma therapy is part of the scaffold. Anxiety is common, but your map is individual. The first session is where the map starts to take shape.
Phone: 309-230-7011
Website: https://www.drericaaten.com/
Email: [email protected]
Hours:
Sunday: Closed
Monday: 9:00 AM - 5:00 PM
Tuesday: 9:00 AM - 5:00 PM
Wednesday: 9:00 AM - 5:00 PM
Thursday: 9:00 AM - 5:00 PM
Friday: 9:00 AM - 5:00 PM
Saturday: Closed
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Dr. Erica Aten, Psychologist provides online therapy and autism/ADHD evaluations for adults in Oregon and Washington.
The practice focuses on neurodivergent adults, especially late-diagnosed and self-diagnosed women, nonbinary, and femme-presenting clients who want affirming care.
Services listed on the site include anxiety therapy, trauma therapy, OCD therapy, LGBTQ+ affirming therapy, autism and ADHD support, and evaluations.
Because the practice works virtually, clients can access care from home without adding commute time or an in-person waiting room to the process.
The site also lists evidence-based approaches such as ERP, inference-based cognitive behavioral therapy, cognitive processing therapy, and prolonged exposure therapy.
Dr. Erica Aten describes the work as supportive, neurodivergent-affirming, and focused on helping clients unmask, build self-trust, and live more authentically.
The official site presents Portland, Oregon and Washington State as the public service-area anchors for this online practice.
To ask about fit or scheduling, call 309-230-7011, email [email protected], or visit https://www.drericaaten.com/.
For public listing reference and map context, see https://www.google.com/maps/place/Dr.+Erica+Aten,+Psychologist/@47.2174931,-120.8825225,7z/data=!3m1!4b1!4m6!3m5!1s0x85dd18267af833d1:0xc46dc79a2debb4e5!8m2!3d47.2174931!4d-120.8825225!16s%2Fg%2F11x_c1z_h0.
Popular Questions About Dr. Erica Aten, Psychologist
What services does Dr. Erica Aten offer?
The official site lists anxiety therapy, trauma therapy, OCD therapy, LGBTQ+ affirming therapy, autism and ADHD support, autism testing, ADHD testing, clinical supervision for mental health professionals, and business development consultations.Is this an in-person or online practice?
The site describes the practice as online and virtual, including online therapy and evaluations for Oregon and Washington residents.Who does the practice work with?
The website says Dr. Erica Aten works with neurodivergent adults, especially late-diagnosed and self-diagnosed women, nonbinary, and femme-presenting clients, along with high-achievers, perfectionists, and burned-out people pleasers.What states are listed on the site?
The contact page and location pages say services are offered to residents of Oregon and Washington.What treatment approaches are mentioned?
The site lists ERP Therapy, Inference-Based Cognitive Behavioral Therapy, Cognitive Processing Therapy, and Prolonged Exposure Therapy among the main modalities.Does the practice offer autism or ADHD evaluations?
Yes. The website includes dedicated autism testing and ADHD testing pages and describes those evaluations as online for Oregon and Washington residents.Is there a public office address listed?
I could not verify a public street address from the official site. The business appears to operate as an online practice, and the public listing pages describe a service area rather than a walk-in office address.How can I contact Dr. Erica Aten, Psychologist?
Call tel:+13092307011, email mailto:[email protected], visit https://www.drericaaten.com/, or follow https://www.instagram.com/drericaaten/.Landmarks Near Portland, OR Service Area
This is a virtual practice, so these Portland references work best as service-area landmarks rather than walk-in directions.Washington Park — One of Portland’s best-known park destinations and home to multiple major attractions. If you are near Washington Park or the west hills, online therapy and evaluations are available through https://www.drericaaten.com/.
Portland Japanese Garden — A major Portland landmark within Washington Park and a strong reference point for west-side Portland service-area copy. If this is part of your regular area, the practice serves Oregon residents online.
Powell’s City of Books — Powell’s on West Burnside is one of the city’s most recognizable downtown landmarks. If you are near the Pearl District or Burnside corridor, online appointments remain available without a commute.
Alberta Arts District — Alberta Street is a familiar Northeast Portland destination for shops, galleries, and neighborhood activity. If you live near Alberta or nearby NE neighborhoods, the practice offers online services across Oregon and Washington.
Mississippi Avenue — North Mississippi is a well-known Portland corridor for restaurants, retail, and local events. If you are based around Mississippi, the practice’s virtual format keeps access simple from home or work.
Laurelhurst Park — Laurelhurst Park is one of Portland’s best-known neighborhood parks and an easy reference point for Southeast Portland. If you are near Laurelhurst, the practice’s online model can help reduce travel and sensory demands.
Tom McCall Waterfront Park — This downtown riverfront park is a common Portland landmark for locals and visitors alike. If you are near the waterfront or central city, the site provides direct access to consultation and scheduling details.
Oregon Convention Center — A major venue in the Lloyd District and a practical East Portland reference point. If you use the convention center area as a local landmark, the practice still serves the wider Portland area through virtual care.