Anxiety and depression
When the alarm will not switch off, or when nothing has felt like anything for months.
These two travel together far more often than the neat diagnostic categories suggest. Roughly half the people who arrive describing one of them turn out to be living with both.
Anxiety is usually about something
A lot of anxiety treatment starts from the premise that the alarm is faulty. Often it is not faulty, it is correct and inconvenient, and telling somebody to breathe through an accurate perception is not treatment.
If your Sunday evening dread is precise and reliable, the first useful question is not how to reduce it but what it knows about Monday. If panic arrives specifically when you are about to ask for something, that is worth understanding rather than only managing. Sometimes the anxiety is genuinely disproportionate and the work is to recalibrate. Very often it is proportionate to a situation you have been told to accept, and the work is to stop gaslighting yourself about it.
We do both. I will teach you concrete tools for acute panic, because a person mid attack needs a technique rather than a formulation. Then we look at what the alarm is responding to and what you want to do about it.
Depression that hides behind competence
The version I see most in this city is not the one in the leaflets. It is functional. It gets to work, hits the deadline, replies to the group chat with the right tone, and then sits fully dressed on the edge of the bed for forty minutes because the next action is unreachable. Nobody at work has any idea. Several friends would describe this person as the together one.
That version is often missed for years, partly because the sufferer discounts it themselves. If you are producing output, it can feel dishonest to call it depression. It is not dishonest. Anhedonia, flattened affect, exhausting internal effort to do ordinary things and a persistent sense of being at a distance from your own life are all real clinical features regardless of whether you are still hitting your targets.
What actually helps
Some of it is unglamorous and I will say it plainly: sleep, daylight, movement, and reducing alcohol usually do more in the first month than any amount of insight. I am not moralising about any of these and I will not lecture. I will just be honest that they change the baseline we are working from.
Beyond that, the therapeutic work is about the beliefs that keep the pattern in place. Rest has to be earned. Asking for help confirms I am a burden. If I stop performing, the whole structure collapses. Those rules were often learned early and are rarely examined in adulthood, and examining them changes things in a way that another productivity system will not.
On medication
I do not prescribe and I hold no position for or against. I have seen antidepressants take somebody from unable to function to able to use therapy properly, and I have seen prescriptions handed out in eleven minutes as a substitute for anybody actually listening. If a psychiatric assessment seems useful I will refer, and whatever you decide will not change how I work with you.
How the work goes
Treat the acute end quickly. Then go after what keeps producing it.
Steady the floor
Sleep, alcohol, food, daylight, movement. Not as a moral project, as a way of raising the baseline enough that everything else becomes workable.
Tools for the acute end
Concrete, practised techniques for panic and for 4am spirals. Rehearsed while calm so they are available when you are not.
Find what the alarm is about
Tracking when it fires, and with whom, until the pattern is visible. Frequently the trigger is relational and specific rather than general.
Change the rule underneath
The belief that rest must be earned, or that needing anything is a burden. This is the part that stops it coming back in a new outfit next year.
Questions
What people ask before starting.
Is my anxiety bad enough for therapy?
If it is shaping decisions, keeping you awake, or costing you things you wanted, it is bad enough. There is no severity gate, and waiting until it gets worse is a strategy that rarely pays off.
I have done CBT before and it did not stick. Now what?
Very common. Cognitive tools are excellent at the acute end and less effective when the underlying belief was formed in a relationship rather than in a thought. We keep what worked and go after what the tools were not designed to reach.
Can therapy help if my situation genuinely is the problem?
Yes, though the goal changes. If the job, the flat or the relationship is producing the distress, the work is about clarity and capacity to act rather than adjusting you to tolerate it indefinitely. I will not spend a year helping you cope with something that needs changing.
What about panic attacks specifically?
We treat those directly and fairly early, since they are frightening and they narrow a life quickly. Most people get meaningful relief from the acute attacks well before the wider work is finished.
Also here
Related work.
Individual Psychotherapy
Weekly one to one work that goes past coping strategies and into the patterns underneath them.
Read moreTrauma Therapy
For single incident trauma and for the long slow kind that came from growing up somewhere unsafe.
Read moreTherapy for Artists & Creatives
For people whose income, identity and self worth all sit inside the same fragile thing.
Read moreReady to bring yourself in the most self loving way
A first conversation costs nothing and commits you to nothing. Fifteen minutes on the phone is usually enough to tell whether we are a fit.