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Key points
- Effective anxiety therapists do not shy away from taboo thoughts; they treat them with a sense of humor.
- They know when to challenge clients and when to take things slow.
- They work towards long-term improvement, not short-term, temporary relief.
- They've seen the different ways anxiety can present many times and have experience with what works.
If you are seeking therapy for anxiety, the quality of your therapist matters. If you don't have a direct recommendation from someone you trust for a good anxiety therapist, it can be hard to know in advance how effective your therapist will be. Having trained dozens of anxiety specialists over the years, I have noticed a few important things that separate great anxiety therapists and lead to more effective treatment:
1. They do not shy away from taboos.
Great anxiety therapists understand that thoughts are just thoughts and words are just words. In anxiety, clients often get caught up in treating thoughts as more meaningful than they really are.
Most of the time, anxiety therapy involves confronting your fears directly, and with feared thoughts that trigger anxiety, what this means is allowing oneself to think and say undesired thoughts freely. This retrains the brain that such thoughts are not actually dangerous and that the brain does not need to ring the alarm bell of anxiety in response to such thoughts.
A great example is harm OCD, a form of OCD in which people experience recurring thoughts about harming other people and question whether the presence of these thoughts means they actually want to hurt people and are at risk of hurting them. In harm OCD, people have very distressing thoughts pop into their heads, like "Maybe I want to kill Bob." They then treat that thought as extremely dangerous and try not to think that thought, but the thing that helps people get over harm OCD is purposely moving towards thoughts like that. So, if you had this issue, an anxiety therapist would want you to think and even say out loud things like, "I do want to kill Bob; I would love to kill Bob! I hope I can kill Bob."
Those words don't actually mean anything at all; it's nonsense, and a good anxiety therapist will freely say and push you to say thoughts like that to teach your brain that it means nothing. Quite contrary to taking such thoughts seriously, great anxiety therapists have a sense of humor about seemingly taboo, dark thoughts like that.
2. They know how to balance the pace of therapy (pushing you vs. doing what you're ready for).
Anxiety therapy, with its typical emphasis on exposure to anxiety-provoking situations and thoughts, can be tough. While some clients are gung-ho about the process and ready to dive in feet first, it is more common for clients to be understandably hesitant and scared about doing exposures.
A great anxiety therapist knows when it is best to push a client to do more difficult things when they are stuck and when it is best to let the client go slowly and try easier exposures to build up to harder ones gradually. Part of this comes from good intuition about what clients will respond to best and when, but even more importantly, it comes from good flexibility and collaboration with the client on setting the pace of therapy. Good therapists listen to their clients.
3. They prioritize sustainable, long-term improvement over calming the client right now.
This is one of the biggest differences that I see between anxiety specialists and generalists. For the most part, therapists tend to be nice, caring, empathetic people who get into this line of work because they want to help others and make people feel good. That's great, but sometimes the desire to help clients feel good can be too short-term focused.
An effective anxiety therapist wants to help you feel better in the long term and recognizes that this sometimes means not feeling better in the immediate moment. The most important concept to know about anxiety is that short-term avoidance of anxiety leads to long-term increases in anxiety. This means that the things you do to try to make yourself calm down in the immediate short-term when you are anxious are typically counterproductive: even if they work right now to calm you down, this generates more anxiety the next time you are in a similar situation.
The way this shows up in therapy is the therapist has a natural tendency to want to help their clients avoid distress. Effective anxiety therapy, however, requires purposely facing your distress in the short term so that you get long-term relief.
I've noticed, therefore, that when I give talks to an audience of generalist therapists and I tell them about some of the things we do in exposure therapy that involve helping clients purposely go through distress in the short term, the generalists are often taken aback and have an automatic aversion to such ideas. When I talk to other anxiety specialists, however, they don't bat an eye—they take it as a given that this kind of thing is necessary for good anxiety treatment. A therapist who wants to simply help their client calm down and feel good right now does things like giving too much repetitive reassurance about clients' fears, overusing relaxation techniques (which can be counterproductive in the long run for anxiety), and shying away from pushing clients to confront their distress usefully.
Effective anxiety therapists offer support and encouragement rather than reassurance, practice of acceptance, and mindful observation of distress rather than relaxation techniques, and they are unafraid of short-term client distress.
4. They have lots of reps with anxiety problems.
This one may seem obvious, but great anxiety therapists tend to be those who specialize in anxiety. For any problem for which you are seeking therapy, anxiety or otherwise, you ideally want to be able to meet the therapist, tell them all about your problem, and have the therapist's reaction be, "Great, I've seen this problem a million times before. I know exactly what to do with this; here's what we do."
Your odds of having that happen for anxiety obviously go way up if the therapist spends most or all of their time treating anxiety disorders. While there are just a few main types of anxiety disorder, each of the major anxiety diagnoses has a million little unofficial subtypes within them that an anxiety specialist who sees lots of the same types of problem over and over will have seen many times before whereas a generalist may not have. A therapist who is sensitive to what works and what does not work with each type of presentation builds up a "catalog" in their head of past clients you remind them of, and they can refer back to what did and did not work with clients similar to you.
To find a therapist who treats anxiety, visit the Psychology Today Therapy Directory.
