What makes a great anxiety therapist?
Psychologist at Leeds Anxiety Clinic
Published Wednesday, 1 October 2025
Over the past decade, I’ve worked with therapists of varying styles and effectiveness. Some of them have been truly exceptional. In this article, I will outline what, in my clinical experience, makes a brilliant anxiety therapist.
They take the time to understand the problem
Average therapists often treat all anxiety as the same thing. Great therapists take the time to understand the root cause of the issue so they can differentiate.
Let's take the examples of health anxiety and social anxiety. Someone struggling with health anxiety is likely to have terror of death or serious illness at the root of their emotional distress. With this client, I want to make them feel safe and increase their ability to tolerate fear.
With a client who is struggling with social anxiety, they are likely to have a fear of humiliation at the root of their emotional distress. With this client, I want to make them feel accepted and increase their ability to tolerate shame.
Applying the same generic therapy to both of these clients would miss the nuance of what they individually need. By taking the time to understand what underpins their emotional distress, the therapy can be much better targeted to their specific issue.
They avoid getting into arguments with the anxiety
Average therapists often get bogged down in debates about whether a fear is justified. Great therapists help a client to find a better way to be with their anxiety.
Let's say a client has a fear of eating at restaurants because they might get food poisoning. Some therapists may try to reassure them that the chance is very small, effectively labelling the worry as irrational.
Saying something like this has two problems. First, the client feels invalidated: the worry feels very real to them! Second, when someone engages us in debate, we often take up the opposite side, which can lead to clients arguing in favour of their worry.
Great therapists avoid this trap. They let the client know that their worry is real and work to support the client in finding new ways to be with the fear. This might involve the client developing their own thought challenges, but might instead involve whole new ways of looking at the problem, such as not even engaging in evaluating the worry and instead focusing on self-compassion.
Trying to "correct" a client's thinking often backfires, reinforcing the anxiety. Joining with them to develop new strategies helps them find ways of getting themselves unstuck.
They use a trauma-informed approach
Average therapists assume that every client who walks through the door can easily change their thinking. Great therapists understand that many people come to therapy with unresolved past experiences.
A great deal of therapy today is based on cognitive-behavioural principles. This has a focus on changing our thinking. CBT is highly useful and plays a big role in our therapy. But it only works when clients are willing and able to engage in such exercises.
This is a problem because many clients come to therapy with unresolved past experiences that still affect them emotionally and physically. This is known as a trauma. Trauma activates our defence mechanisms and shuts down our higher-level thinking. So, asking someone to do some clever thinking when they are experiencing trauma simply will not work.
To resolve this, the impact of trauma needs to be addressed. For some clients, this may involve treating the trauma directly. For others, it may involve learning self-soothing strategies to allow them to manage the effects of trauma so that they can focus on the issue that brought them to therapy.
Ignoring the effects of trauma altogether will ultimately render the therapy ineffective. By being aware of the impact of trauma, therapists can help clients manage it so that they can fully engage with the issue they want to address. Regardless of the type of therapy being used, trauma needs to be taken into account.
They use evidence-based approaches
Average therapists describe themselves as "integrative" but cannot always articulate what they are integrating. Great therapists have a clear rationale for what they are doing and why.
There are many different types of therapy available. For example, cognitive behavioural therapy (CBT), acceptance and commitment therapy (ACT), person-centred, family therapy, emotion-focused therapy, psychodynamic approaches, and many more.
Increasingly, therapists often describe themselves as integrative practitioners, using a range of approaches. There is nothing inherently wrong with an integrative approach, and it is something we do, but there does need to be a clear reason why the therapist is doing what they are doing.
Without this rationale, therapists risk putting together a mishmash of therapy techniques that do not work well together, or jumping from therapy to therapy as soon as they feel like things are not working, creating a confused and inconsistent experience for their client.
In contrast, therapists who utilise a properly thought-through integrative approach are likely to deliver a much more effective therapy. Your therapist should be able to explain what evidence-based theories they use and how they fit together. Do not be afraid to ask.
Conclusion
Your experience in therapy will vary widely based on how skilled your therapist is. While the overwhelming majority of therapists are lovely, caring people, they do not always have sufficient training or experience to produce meaningful change.
Exceptional anxiety therapists have a deep understanding of anxiety theory, can use that knowledge to identify underlying problems, and can build a therapy tailored to each specific client.
At Leeds Anxiety Clinic, we aim to embody these principles. While no therapy is 100% effective, our specialist knowledge can often help when other therapists have failed. If you are struggling with anxiety and would like to explore whether we can help, we would love to hear from you.