• Anxiety is a common reason that people may seek therapeutic support – but how do you know which type of therapy is right for you?

  • Therapist Kate Graham explains how her modality, integrative therapy, works with anxiety

  • If you are struggling with anxious thoughts or feelings – find a therapist or counsellor here 

If you are experiencing some form of anxiety, whether panic attacks, obsessional behaviour, social anxiety, phobias, or continual feelings of dread, it is generally recommended to see a talking therapist, and particularly so if you have been prescribed medication.

What to expect from therapy

This can be hard to pin down, as there are so many different types of therapy out there, some much more clearly defined than others. For example, with cognitive behavioural therapy (CBT) you might expect to be looking at the way your thoughts affect your feelings, and how different behaviours can trigger or calm your anxiety. 

With a hypnotherapist, you would anticipate being tranced out and moved into a more resourceful state, so that you become less triggered. And with an art therapist you would expect some creative expression. But what would you expect from an integrative psychotherapist such as myself? Would it be a mixture of the above, or would there be something rather more structured to it?

Integrative psychotherapy theory

Integrative psychotherapy starts from the perspective that the difficulties that you are experiencing now have their roots in unconscious relational patterns laid down through your life, particularly (but not exclusively) in infancy. This applies to teenagers as well as adults, being simply less hidden in younger people. 

These patterns were established in response to relational deficit with someone who mattered, such as those times when a carer didn't notice when you were hungry; or a parent was too tired or distracted to pay you any attention, or got cross with you when you wanted help; or when you were abandoned by a close friend or early lover. 

Over time you built some internal rules, a life script, that made sense of all of this, incorporating unconscious beliefs such as “It’s better if I don't feel anything” or “ I have to sort this all out on my own” or “If I'm very good maybe she will love me” or “I'm just not good enough” and so on.

Over time these beliefs sink into our bodies, the way we relate to other people, our closest relationships, and the extent to which we can look after ourselves.

The goals of integrative psychotherapy then are to help you connect with your self, to uncover these unconscious beliefs, and to give you the choice as to which beliefs  and “rules” you want in your life going forward, integrated into your sense of self and how you are in the world.

How integrative therapy works

The way we do this is holistic, exploring the impact of your difficulties on your body, on your thoughts, on your beliefs, your sense of self, your behaviours and your soul. So any work I do with someone is at a number of different levels, and this is particularly the case with anxiety.

Anxiety is a very physical experience and so connecting to your bodily sensations is important, as are simple physical approaches to calming down, such as breathing patterns and grounding exercises.   

Our bodies are busy trying to tell us that we are not safe, so calming this flight-fight response allows the thinking part of our brain, our executive function, to come back into play. Paying attention to the feeling we hold in our body when experiencing anxiety both helps to soothe the feeling and helps us to understand it.

There is often a lot of detective work with anxiety, exploring what iceberg lies below the immediate symptoms. I often use a form of narrative therapy to explore how, when, and where anxiety is triggered and what effects the anxiety has on you and your relationships. 

We might give anxiety a name, to help separate it from you. Externalising the issue, so that it can be looked at dispassionately, helps make it more normal and less intimidating. We can then look at the exceptions, where you can control the anxiety, and also start to observe what positive purpose it serves for you.

Some of the clues in this detective work will come up in our own relationship, what you are experiencing as you come into the consulting room (virtually or otherwise), as you and I talk, as you gradually show me what you have learnt unconsciously about relationships. I will be noticing my experience of you, the thoughts and feelings appearing for me, and checking these out with you, as we build an understanding together of what is going on for you. 

For example, many anxious clients are concerned with being a “good” client, and may spend time before the session worrying about what they will say, and whether they will get it right, and whether they can avoid any awkward silences. So when this is acknowledged, we can explore it, and see how it might feel not to be a “good” client, not to know what will be said, and whether silences can be comfortable or deepening spaces, rather than awkward.

The role of self-compassion

I am a strong believer in making friends with the part of you that is expressing anxiety, whatever form it is in, seeking to understand its positive intention. By welcoming it rather than fighting it, we move to greater self-acceptance, compassion and integration. 

Mindfulness is helpful here, as many people are anxious or cross about their anxiety, and this really doesn’t help at all. An early step is to accept that we are anxious, and just notice how we get into that state and what happens then.

It is also useful to look at how different parts of ourselves are in conflict. Internal conflicts between different parts of ourselves  (e.g., the part that wants to go out and have fun, and a part that feels safer at home studying, but is lonely) are a frequent cause of anxiety. I make use of techniques such as NLP and meditation to help to hear these parts’ different views and to find an integration.

Making sense of the past

Some of the people I work with who are experiencing anxiety are in clearly stressful situations, and much of our work together is about managing their relationship to what is around them, accepting what they can’t do and making the most of what they can. This is particularly the case with refugees and teenagers.

With many adults however I find a narrative journey through their birth and early childhood, their school life and first experiences of love and intimate relationships starts to help things fall into place. Unconscious patterns come to the fore, and choices can be made.

What is underneath the anxiety

Through all these processes we will uncover the base emotion beneath the anxiety, whether fear from a past trauma, current challenge, life transition, or death; unexpressed anger, shame, sadness; or some mixture of these. And as this is safely experienced and survived – held in our therapeutic relationship – the need for the protection that the anxiety has offered is lessened, and your choices increase.

What I have learnt over the years is that what presents as anxiety is often the result of deep levels of loss and sadness and somehow learning along the way that you were 'less than', not good enough, not worthy of someone ‘s full attention. And when we are very small, that attention is key to keeping us safe. So we carry an unconscious narrative that tells us that we have to work very hard to keep safe, to make sure that we have got things right for people and that we are seen as good and nice and generally satisfactory to the world.

Each person is different and each person expresses their anxiety in a different way, and it comes from many causes. I work differently with each person, but at the same time there are common themes, with the surface experience and at depth, with the immediate and the past, with the thoughts, the feelings, beliefs, behaviours and, where this is available, the soul. I have found that, especially with older people, anxiety can be triggered by the big existential questions about ageing, life and death, and that at this point, connecting to our soul’s expression and needs is vital.

And it isn’t a life sentence: things do get better. If you are struggling with anxiety or low moods, why not reach out to a therapist today?

Kate Graham is a verified welldoing.org therapist in Ilkley and online

Further reading

4 myths about anxiety

Trying different types of therapy

How to overcome your anxiety triggers

The lasting impact of adverse childhood experiences

Practical tips to manage coronavirus anxiety