If you have never been in therapy, anxiety can make the unknown feel worse. You may picture lying on a couch, being told to calm down, or being handed a worksheet. In practice, therapy for anxiety is a structured conversation with a direction. This article describes how a psychologist with an insight-oriented, integrative approach, like Dr. Lehmann, typically works over the course of treatment. What happens in the very first appointment is covered in What Happens in a First Therapy Session?.
The first few weeks: mapping the anxiety
Early sessions are about understanding your particular anxiety, because it looks different in every person. Expect questions about when the worry shows up, what sets it off, what you do to manage it, and what it has cost you. NIMH notes that GAD symptoms often rise during times of stress, such as a physical illness or a conflict at home, so a psychologist will also ask what else is going on in your life.
The American Psychological Association (APA) describes the early stage of therapy as clarifying what is troubling you before moving into problem-solving. It also notes that a psychologist may suggest a physician visit to rule out medical contributors. By the end of the first few sessions, the APA says, you should have a new understanding of your problem and a working plan.
Some useful things to notice in these weeks: the times of day worry is worst, the thoughts that loop most often, and what you avoid. Jotting these down between sessions gives you and the psychologist real examples to work with.
Two threads that run through the work
Dr. Lehmann's approach is insight-oriented and integrative. In practice that means sessions tend to hold two threads at once.
Getting through this week
Anxiety lives in the present: the dread before a meeting, the 3 a.m. thoughts, the knot in your stomach. Part of therapy is practical feedback and coping skills for those moments, such as ways to settle your body, to notice when worry is running ahead of the facts, and to plan for situations you have been avoiding. NIMH lists coping and problem-solving strategies, along with relaxation and breathing techniques, among the common elements of psychotherapy.
Understanding where the pattern comes from
The second thread asks why. Anxiety often makes sense once you see its history: a childhood home where you had to stay alert, a parent who modeled worry, a past loss that taught you to expect the worst, or a role as the person who keeps everyone else okay. The APA describes insight-focused approaches as spending more time talking, sometimes about early experiences, to understand the root causes of current problems. Seeing the pattern clearly can give you more choice about how to respond to it.
NIMH notes that therapists may use one primary approach or combine elements of several, depending on their training and the person's needs. If you want to understand the general idea behind this kind of work, What Is Insight-Oriented Therapy? explains it.
What a typical session can look like
Sessions are usually less scripted than people expect. A session might start with how the week went, then follow whatever stood out: a panicky drive on I-696, an argument that left you shaken, a decision you keep putting off. The psychologist may connect that moment to patterns you have talked about before, offer a different way to see it, or work with you on what to try next time. Some weeks are more practical and some more reflective.
You set the pace for what you share. The APA notes that trust builds over time and that it is normal to share more as you feel more comfortable.
How progress is reviewed
Progress with anxiety is rarely a straight line. Early signs can be small: you fall asleep a little faster, you catch a worry spiral sooner, or you go to something you would have skipped. The APA encourages clients to help set goals, give feedback when a session did not feel useful, and talk openly if progress stalls. It also notes that strong feelings can come up as therapy goes deeper, and that this does not mean it is failing. How to Tell if Therapy Is Working has more on what to look for.
Where medication fits
NIMH explains that anxiety treatment typically involves psychotherapy, medication or both, and that finding the right plan can take some trial and error. Dr. Lehmann does not prescribe. If you take medication or want to ask about it, that is a conversation for your physician, psychiatrist or psychiatric nurse practitioner, and with your written permission she can coordinate with them. If you already take something, talk with your prescriber before changing anything.
The practical details
- Format: individual sessions at the Franklin office or by telehealth when you are in Michigan
- Schedule: daytime appointments Monday through Thursday; no evenings or weekends
- Frequency: most people meet regularly, often weekly at first; pace is something you decide together
- Fees: $220 per clinical hour private pay; in network with Blue Cross Blue Shield PPO; reduced-fee spots on a limited basis
- Cancellations: a $90 fee applies with less than 24 hours' notice, except for illness or an emergency
- Getting started: call, email or use the contact form with your name, how to reach you and your availability, and keep clinical details out of email
More about how Dr. Lehmann approaches worry, panic and stress is on the anxiety therapy page.