It is 3am and you are wide awake, rehearsing a conversation that hasn't happened, or replaying one that has, or running through everything that could go wrong tomorrow in high definition. By morning you are exhausted before the day begins. If you have found your way to anxiety counselling, you probably already know that being told to relax, or to stop worrying, is about as useful as being told to stop being tall.

In a long career I have sat with every shape anxiety takes: the low constant hum of worry that touches everything, the panic attack that arrives out of a clear sky, the health anxiety that turns every twinge into a search engine spiral. Anxiety is exhausting, but it is also one of the most workable things people bring to me.

The shapes anxiety takes

Anxiety is a good servant and a terrible master — a certain amount keeps us alive; too much takes over the house. It might look like:

  • Generalised worry — a mind that scans constantly for what could go wrong, never quite able to rest even when everything is fine
  • Panic attacks — the pounding heart, tight chest and certainty that something terrible is happening, often followed by fear of the next one
  • Health anxiety — checking, googling, seeking reassurance that soothes for an hour and then wears off
  • The 3am spirals that leave you facing the day already spent

Many people carry this for years while looking, from the outside, entirely fine. The performance is its own exhaustion.

How I work with anxiety

My approach is person-centred and compassion-focused. That second part matters more than it might sound: most anxious people are ferociously hard on themselves, adding a second layer of suffering — being anxious about being anxious, ashamed of the worry, cross with their own mind. We work on both layers. Anxiety usually makes a kind of sense once we understand what it is trying, clumsily, to protect you from, and it responds far better to being understood than to being fought.

Where anxiety has roots in old frightening experiences — and it very often does — I bring in trauma-focused work. A nervous system that learned early to stay on guard doesn't stand down just because life is safer now; it needs help to learn that the emergency is over.

What sessions are like

Sessions are 60 minutes, weekly or fortnightly. There is no homework you'll be scolded for skipping and no lecture about breathing techniques — though we may well work on practical ways to steady yourself, they come as part of a conversation, not a worksheet. Mostly, you get an hour where the worry can be said out loud, in full, to someone who is not alarmed by it. Anxious minds are often deeply relieved by that alone: the thoughts are much less frightening outside your head than in it.

Online or in person, in South Africa or abroad

I offer online counselling for anxiety over video call to people across South Africa, the UK, Ireland and Europe — anxiety work suits the format well, and for some people not having to travel anywhere unfamiliar removes a barrier all by itself. You can read about how video sessions work on my online counselling page. If you are in Johannesburg and would rather sit in a room with a counsellor for anxiety, I see people in person in Fairmount.