Anxiety: How can therapists help?

By Jeff Duke, MSW, RSW

Over the years I have been in practice as a therapist, I have found that one of the most common concerns people have sought assistance for is anxiety.

People who have conditions that fit under the umbrella term Anxiety Disorders can be understood to have flight or fight response systems that are more sensitively attuned to their environments than others. This explanation; however, does not explain why anxiety can prove to be so troubling or debilitating.

When experiencing a strong anxiety attack people may find that their:

  • Heart starts to beat so fast they believe they are about to have a heart attack;
  • Breathing becomes so shallow that they become very light-headed leading them to think they are about to faint;
  • Bodies become so tense that it is difficult or near impossible to move certain muscle groups; or
  • Stomachs cramp up so much that they feel like they are going to be sick.

Under such circumstances it is not surprising that people often miss work while in the midst of an anxiety attack. When these people go to the doctor they are told there is nothing physically wrong with them and often they begin to feel like they must be going “crazy.”


This situation is often very distressing and in most other circumstances such distress would lead people to seek professional advice. Unfortunately due to the stigma attached to mental health issues, people tend to avoid calling counsellors and therapists and usually wind up hoping the anxiety will just go away and life will return to normal. What often happens is the anxiety persists and becomes more intense and debilitating over time as it combines with the fear and distress of feeling out of control and the belief that they are “crazy.” As a result by the time someone does build up the courage to ask for help the anxiety has become so intense that it has become a crisis.

A counsellor/therapist can be instrumental in alleviating their clients’ anxiety in the following ways:

  1. Compassionately deescalating the crisis – Therapists are trained to supportively reduce crises and can provide assurance that the person is not “crazy,” rather they have a finely tuned flight or fight response system that can be managed. This is important because people are more likely to commit to the process when they feel assured that change is possible.
  2. Conducting a full case history and assessment – Following this step allows the therapist to look for events in the client’s past that have contributed to the development of their anxiety concerns. Pointing these out can help reduce the person’s sense of being “crazy.”
  3. Develop and execute a client centred treatment plan – The assessment along with the client’s stated goal for therapy can help the therapist determine an appropriate treatment plan. The plan may include using Cognitive Behavioural Therapy, examining the root causes of the anxiety concerns, looking for areas of strength the person has that can be used to reduce their anxious feelings, etc. The plan should be client centred in that it takes into account who the client is as a person, their family and social circumstances, recognizes where the client is in the treatment process, and what they want to get out of the therapeutic process.
  4. Being flexible and open minded – Counselling and psychotherapy is not a one size fits all process because every client is a unique individual. As a result no two therapeutic relationships (between client and therapist) are the same with unique issues arising over the course of treatment, new treatment goals being set, referrals being made to resources in the community, and old treatment plans being revised as the client grows.

These factors that the therapist contributes to the process are very important to the client’s recovery, and should be taken into consideration when selecting a therapist and continuing to work with him/her. Anxiety if left untreated can be very distressing and at times debilitating depending on its severity. However, if help is sought from a compassionate/client centered therapist a person can learn to manage their anxiety concerns and go on to lead a happy and productive life.