Anxiety - what to expect from your therapist

Anxiety is a symptom of several conditions, including panic disorders, phobias, post-traumatic stress disorder (PTSD), and social anxiety disorder (SAD).


The symptoms could be psychological or physical, and they can display symptoms such as a lack of concentration, trouble sleeping, dizziness, heart palpitations, or involuntary bowel issues. Some people may describe themselves as having a panic attack, which is commonly described as being unable to breathe, heart palpitations, feeling sick, and passing out (or that they may pass out).

Over the past 60 years or so there has been a huge increase in reported cases of anxiety, and in 1980 the 'generalised anxiety disorder' was named. It is believed that social problems have contributed to the increase. Some experts believe that there is a far deeper issue and that modern technology is to blame. It’s thought that our inability to 'switch off' is aggravating the issue.

The chief executive of Anxiety UK, which is the UK’s main charity for anxiety, believes that anxiety has always existed but was simply unnamed. Those who suffer from depression can also suffer from anxiety. The two are not necessarily always linked; however, there is still a link between the two, as some of the symptoms are very closely associated. There are ways to change your life which will aid the recovery. Some examples of this would be exercise, diet, and counselling. UCOPE would be a useful tool with depression, stress, and anxiety.

Talking therapies are regarded as excellent strategies for those suffering from anxiety and depression. According to the National Institute of Health and Care Excellence, cognitive behavioral therapy (CBT) is one of the most effective therapies for depression. Other therapies include psychodynamic therapy, interpersonal therapy, behaviour activation, and counselling.

It is more often the case that the client has an underlying reason for their issue, and it is important to get to the root cause in order for therapy to be successful. As well as this, understanding the client’s aspirations, or lack of them, can prove fruitful to their treatment.

Clients suffering from anxiety may not always know that we have plans for the future until asked, but by looking at the plan, the counsellor can then ascertain if the presenting issue is holding them back from achieving their future aspirations. It is very important for a therapist to make themselves aware of where the client is at in their present, as this can then be looked at every couple of sessions to discover if the client is beginning to move forward with their plans and life or if they are struggling and still at a standstill.

By gaining a good rapport with the client, the therapist will then be able to judge if they are able to look towards the future. Clients with anxiety, depression or stress, for example, may find this too overwhelming, so therefore the counsellor would not ask them to do this. The reason for this would be that someone suffering these issues may not be able to see tomorrow, let alone a long-term goal, and this could be very distressing or debilitating for them.
An uneasy feeling in the pit of the stomach is how some people may describe anxiety, but severe anxiety is much worse and completely terrifying. Some of the symptoms of severe anxiety may create the feeling of a heart attack, or even make you feel like you're dying. Panic attacks and depression are often linked with anxiety, but they are separate conditions. "Like anxiety, the term is overused, often describing a situation that the individual is particularly unhappy about" (Reeves, n.d.).

Anxiety is well known to affect many parts of a person’s life; this may include relationships, over or under eating, sleeping issues, work problems, and routine problems. "Anxiety affects what we do and how we lead our lives: our behaviour" (Sanders and Wills, 2003). It is one of the most common reasons that people seek therapy or counselling. The therapist will work with their client to discover the root of the anxiety; getting to the root cause is the key to moving forward. This can then assist the client in working on those deeper concerns. Counselling aims to identify and address the source of the issue, and then therapy will subsequently help the client to understand their issue, unravel it, and then finally find ways to work through the anxiety and to help the client bring their anxiety to a close.

As a therapist, it is extremely important to be on the offensive right from the start of session one. They must be aware and be on the lookout for foreseeable conflicts, discuss them in a frank but polite manner, and be professional with clients as well as respectful. As well as this, the therapist will need to discuss their clients with colleagues whilst maintaining confidentiality.

Therapists should always have good communication and build up a good rapport with clients and colleagues to avoid hurt feelings, misunderstandings, and sticky situations. It is imperative that the therapist always aims to have a good ethical and therapeutic practice rather than worry about where the next disaster should strike. Being vigilant, reading signals, always listening, and being aware of the clients’ body language are all good ways of being professional and on the ball. A good risk management is required to ensure safety at all times.

It is the job of the therapist to always have good communication with their supervisor. The supervisor will be experienced and will be able to offer advice and support when needed. If the therapist is ever unsure or has to question themselves about their client or their own practise, then it’s always a good idea to take it to supervision to be discussed. The code of ethics says that therapists should avoid relationships that could impair their professional performance or could harm the other party. In other words, the therapist has the right not to treat a client. If they feel that they are not able, not experienced enough, or the rapport doesn’t build, it is their right to refer them on to someone else. I understand that it may not be good for the client, but at the same time, the client has the right to see a therapist that they can work with too.

A therapist will need to be clear to the client, especially one with severe anxiety, how long the session will last as there will then be no awkward moments as the session draws to a close. It would be a good idea to state this at the beginning of the first meeting, and also to be written into the client/therapist contract. It must be made clear and agreed between the client and the therapist how often they meet. An anxious client would most certainly appreciate this, as if this was not discussed, it could mean a miscommunication, and the client with anxiety could be even more anxious if they don’t know when their future sessions are going to be. As well as establishing ground rules at session one, it is important to terminate the relationship with the same respect and authority. It must be made clear that the sessions are now over, and agreed with the client. The therapist must ensure that the client is clear and sure of what the rules are at all times to avoid misunderstandings and confusion.

Confidentially is extremely important, whether the client has anxiety or not. The therapist should tell their client the confidentiality policy; they should discuss the limits of the confidentiality and the safe storage of confidential records. A client who has anxiety will definitely find this comforting, and it will help reduce their anxiety about others finding out about their personal issues and reassure them that they can trust the therapist completely.

The views expressed in this article are those of the author. All articles published on Counselling Directory are reviewed by our editorial team.

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Telford, Shropshire, TF2
Written by Nicki Cawley
Telford, Shropshire, TF2

As I counsellor and psychotherapist I understand the issues in the articles I write. I try my best to keep my writing as simple as possible to allow anyone to have a read. No jargon needed! I feel passionate about all of my articles and write them so that I can help as many people as possible. Thank you for reading.

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