People channel anxiety in a variety of ways. Worries find expression in eating, drinking and smoking, in counting and checking rituals, and in shopping and hoarding - to name just a few.

I've worked with several clients who spend lots of time cleaning, vacuuming and ironing. Mostly women, the clients themselves rarely question these activities. It is more likely that they are seeking approval when they tell me that they don't go to bed at night until the whole house is vacuumed and underwear drawers are re-arranged. Whilst it isn't my job to make value judgments, I do listen carefully to how these activities impact people's lives and whether particular meanings attach for particular individuals.

A client I'll call Michaela comes to mind. She led a busy life with three children and a part-time job as a paralegal. She didn't seek counselling herself, which is always an interesting dynamic. She was referred to me because all of her children were diagnosed with ADHD and she was struggling to understand and cope. What's more, her husband came from a family of seven and wanted to have more children.

Michaela couldn't bear to leave home in the morning with a cup in the sink or a toy on a bedroom floor. I felt exhausted just listening to her description of a typical evening. Once she had fed and watered humans, dogs and rabbits, supervised homework, made packed lunches, read stories and washed and tidied up, it was nearing midnight. She would then invariably start on a pile of ironing which would take until 1 or 2am. The children were up at 5am - shrieking, wrestling, fighting over games consoles - and so it went on. Michaela never took a break from the ironing board. Clearing the basket before dropping into bed was something of a badge of honour.

Once she had the opportunity to sit back and think, Michaela realised that her household routines were an attempt to impose order on chaos. The chaos threatened her from the outside, but it was a constant battle to stay ahead in her inner world too. She felt powerless in the face of her children's symptoms and the doctors and psychologists who seemed to offer no insights or solutions. The head teachers of both of the schools the children attended were always on the phone. She was sick of them all. They didn't have a clue, she insisted. Nobody could help.

What surprised me was how difficult it was to engage Michaela on the subject of her own wellbeing. She fiercely resisted my concern for her lack of sleep, or gentle probes about whether she needed to set the domestic bar quite so high for herself.

Michaela wasn't keen on digging into her family history either, though she did acknowledge the significance of growing up in an environment where her mother went out to cleaning jobs several times a day whilst neglecting her own home.

Eventually, I set Michaela some homework. Could she maybe not iron pyjamas? At the next session, she sheepishly admitted that she couldn't do it. She had to follow the compulsion to iron every last item. I tried another tack. Could she sit on the sofa between jobs and have a quick cup of tea? The next week, she was cheered. The exercise threw up an unexpected bonus. She had enjoyed chatting to her husband over the cup of tea. They caught up with each other in ways that hadn't seemed possible in a long time. They joked around too. Among the playful banter, he told her he adored her and felt lucky to share his life with her. This led to an important disclosure. She had been really angry with her partner for having the capacity to relax in the evening - and for not washing dishes or tending to the pets, all of which were nominally his.

We discovered together that Michaela’s constant skivvying was almost a protest; a clean as opposed to a dirty protest. She wanted everyone to notice her hard work, her attention to detail, her enslavement, her martyrdom almost. But the plan wasn't working. The more she did, the more they took her for granted.

In the blink of an eye, it felt like a different woman was sitting opposite me. “I will always want a tidy home,” Michaela maintained, but there will be no more communicating through the medium of cleansing, clearing and bleaching.” She had been trying to make everything better by staying on top of a mess, just as she had tried to clean up her mum's act as a child. Details of how her mother operated something of an open house emerged. Neighbours knew that there was always a drink and a smoke and a dance to be had at Ivy’s, but in the morning, there was only Michaela to tidy up because Ivy was at work by 6am.

At last, Michaela was receptive to my empathy. I was a 'mother' who was gladly paying attention and putting her interests first. She did not need to keep herself and her environment squeaky clean to earn my esteem.

Our allotted time was running out. Michaela’s confidence was growing in parallel with her ability to switch off and rest. I was content with this outcome. But then it was my turn to be surprised. At our final session, Michaela told me that she had got what she actually came for: to feel more knowledgeable and in control of the ADHD bandwagon. Her new persona had created positive ripples at home. The kids were mirroring her and were less frenetic and distracted themselves. I do not know whether things changed so radically that the children shook off the ADHD tag (that’s a whole other debate anyway), but I do know that if a powerful matriarch can broadcast the message that she is pretty much at ease with herself and the world at large, the whole atmosphere in a home can shift to meet her there.

*Names have been changed for the sake of anonymity