Jack Szary

Anxiety is a system doing its job too well. It scans for threat, demands certainty before you act, and pushes you toward whatever makes the discomfort stop fastest. That usually means avoidance, over-preparation, reassurance-seeking, or working harder. Each of those works in the moment, which is exactly why the pattern holds. The relief teaches your brain that the threat was real and that the coping strategy saved you. So my approach targets the pattern rather than the feeling. We identify what you are doing to manage anxiety and what that management is costing you. Then we work on tolerating the discomfort instead of resolving it, because the goal is not to feel calm before you act. It is to act while anxious and let the anxiety recalibrate on its own. I draw on ACT for the relationship you have with anxious thoughts, CBT for testing the predictions that drive them, and DBT skills for the moments when you are too activated to think clearly. I will tell you which one we are using and why. Progress usually does not show up first as feeling less anxious. It shows up as scope. You send the email without rewriting it four times. You sit in a meeting without rehearsing your contribution. You stop canceling things. The anxiety may still be present, but it has stopped setting the terms. Later, the intensity does come down, because you are no longer feeding it with avoidance. Clients often notice it in retrospect: something that would have consumed a week now takes an afternoon. The endpoint is not a life without anxiety. It is anxiety that no longer decides what you do.

Stress becomes a clinical problem when it stops being a response to something and starts being your baseline. You adapt to a level of load, then adapt again, and a year later you are running at a pressure you would have called unsustainable if someone had described it to you in advance. Most people I work with are not in crisis. They are depleted in a way that sleep and vacations no longer touch. My approach starts with an honest inventory. What are you actually carrying, and how much of it is structural versus self-imposed? A lot of the load turns out to be discretionary: standards you set years ago and never revisited, work you take on because delegating feels riskier than doing it yourself, an inability to let something be finished at good enough. That is workable. The parts that are genuinely fixed we treat differently, by building recovery around them rather than pretending they will change. From there we work on boundaries, on tolerating the discomfort that comes with disappointing people, and on separating urgency from importance, which under stress stop feeling like different things. I use CBT for the beliefs driving the overfunctioning, DBT skills for the acute moments, and Stoic-informed frameworks for the distinction between what is yours to control and what is not. Progress tends to show up in small structural changes before it shows up in how you feel. You stop checking email at eleven at night. You say no without a paragraph of justification. You take a full day off and it does not cost you three days of anxious catching up. Then the depletion lifts. Not because the demands disappeared, but because you finally built margin back in.

CBT starts from a simple observation: the way you interpret a situation drives how you feel about it and what you do next. Two people get the same terse email from a manager. One reads it as a workload issue and moves on. The other reads it as evidence they are about to be pushed out, spends the afternoon rewriting a reply, and sleeps badly. The email is identical. The interpretation is not. What makes those interpretations sticky is that you rarely test them. You act on the prediction, the discomfort drops, and the belief goes unchallenged. Over time it stops feeling like a thought at all and starts feeling like an accurate read on reality. In session, the work is fairly concrete. We slow down a specific moment from your week and take it apart: what happened, what you thought, what you felt, what you did. Once the pattern is visible, we examine the thought itself. What is the evidence for it? What is the evidence against it? What would you tell someone else in the same position? The goal is not forced positivity. It is accuracy, and accuracy is usually less catastrophic than the original read. Then we test it in the real world. If you believe that setting a boundary will damage a relationship, we design a small experiment and find out what actually happens. Behavioral work is where the belief change sticks, not the conversation about it. Expect to track things between sessions, at least early on. It does not have to be elaborate, but written records beat memory, because memory rewrites itself to match the belief. I usually pair CBT with ACT and DBT rather than running it as a protocol.

Most of the hesitation I hear is some version of "it is not bad enough." You are functioning. You are meeting your obligations. Compared to what other people are dealing with, it feels indulgent to take up an hour talking about yourself. So you wait, and the bar for what counts as bad enough keeps moving. Here is what I would tell you: therapy is not a last resort. It works better before you are in crisis, not after. Waiting until the exhaustion is unmanageable does not make you tougher. It just means you are starting the work with fewer resources. The second thing I hear is skepticism about the process itself. You are analytical, you have already thought about your problems from every angle, and you do not see what talking about them again is going to do. That is fair. But insight and change are different things. Understanding why you avoid conflict has never once made someone stop avoiding conflict. What changes it is practice, with someone tracking the pattern alongside you and telling you the truth about what they see. My advice is practical: talk to two or three therapists before deciding. Most of us offer a free consultation. Pay attention to whether the person feels like someone you could be honest with, because fit predicts outcome more than any credential on the page. If it does not feel right, that is information about the match, not a verdict on therapy. And you are allowed to try it and stop. Deciding to have one conversation is not a commitment to eighteen months.

ACT starts from a different premise than CBT. Instead of asking whether a thought is accurate, it asks how much authority you are giving it. You can know intellectually that you are competent at your job and still spend every Sunday convinced you are about to be found out. Arguing with that thought rarely wins. What changes things is the relationship you have with it. The acceptance side is about stopping the fight with your internal experience. Anxiety, self-doubt, and discomfort are not problems to solve before your life can start. Most of the cost in what brings people to therapy comes from the effort to avoid those states: the overpreparing, the canceling, the working late so you never have to sit still. When you stop spending energy on control, you get that energy back. The commitment side is where the work becomes concrete. We clarify what you actually value, not what you think you should value or what would look good on paper, and then we look at whether your behavior lines up with it. Usually there is a gap, and the gap is where the discomfort lives. In session, expect a lot of noticing. We practice observing a thought as a thought rather than a directive, which sounds abstract until you are doing it in the moment and it is not. We use exercises, sometimes metaphor, sometimes brief experiential work. Then we pick specific actions you will take this week that move toward what matters, with the anxiety present rather than resolved. ACT tends to land well with people who have already analyzed their problems thoroughly and have not gotten free of them. Insight was never the missing piece. Willingness to act without waiting to feel ready usually is.

The first session is mostly me listening and asking questions. I want to understand what brought you in now, what you have already tried, and what you want to be different. By the end of that hour we will have a working sense of the pattern we are targeting and where to start. You do not need to arrive with your history organized or your goals clarified. That is part of the work. After that, sessions have a structure. We check in on the week, look at what happened between sessions, and spend most of the time on the pattern itself rather than recapping events. If you are avoiding something, we look at the avoidance. If your internal critic is running the show, we examine what it is protecting. I will name what I am seeing directly, including when it is uncomfortable, because you are not paying me to agree with you. Most sessions end with something concrete to practice. Skills only work if you use them when you are actually stressed, not when you are sitting in a session talking about being stressed. I draw on ACT, CBT, and DBT, and I will tell you which framework we are using and why rather than running something on you without explanation. All sessions are virtual, fifty minutes, and typically weekly to start. Some clients move to every other week as things stabilize. You will not be a passive participant here. If you want someone to think alongside and push back when it is useful, that is what this is.