Anxiety has a way of making itself at home. It shows up in the thoughts that will not settle at night, in the physical tension you carry without quite noticing, in the decisions you avoid because the risk of getting them wrong feels too high.
High-functioning anxiety can live alongside a busy, productive life – which makes it easy to dismiss and harder to address. The cost of it rarely shows on the outside, which means you often carry it alone.
Anxiety is not always the version most people imagine – the panic attack, the inability to function. For many people it is subtler, and it fits quietly into a life that looks fine from the outside.
It might look like:
Lying awake running through conversations, decisions, and worst-case scenarios that probably will not happen
A body that is permanently slightly braced – tight chest, tense shoulders, a low-level restlessness
Difficulty concentrating because your mind keeps pulling toward something unresolved
Struggling to make decisions because the fear of getting them wrong feels disproportionate to the situation
Avoiding people, situations, or conversations without being entirely clear on why
A sense of dread that arrives without an obvious reason
Irritability that feels out of proportion to what is actually happening
Physical symptoms – headaches, digestive discomfort, fatigue – without a clear physical cause
Telling yourself you’re fine while quietly exhausted by the effort of being fine
You may be capable, productive, and to all appearances doing well. High-functioning anxiety is its own particular experience. The outside and the inside do not match. And because the outside looks fine, it can feel hard to take seriously what you are actually carrying.
Anxiety counselling is not about learning to suppress what you feel. It is about understanding what is underneath – what the anxiety is responding to – and developing the insight and practical skills to live with less of it.
This takes time and honest work. But most people who engage genuinely with the process notice a meaningful shift – in how often anxiety shows up, how long it stays, and how much say it has over their decisions.
Sessions are built around two things that work together: understanding and practical tools.
The understanding side involves making sense of what your anxiety is actually about. Anxiety is not random – it is responding to something. Identifying what that is, where it comes from, and why it has the shape it has is often the beginning of real change. Narrative therapy, which is my primary approach, is particularly useful here – it looks at the stories you carry about yourself and the world, and asks whether those stories are serving you or running you.
The tools side is practical. Alongside the deeper work, sessions include concrete techniques for managing anxiety when it shows up. These might include:
Grounding techniques to bring you back to the present when your mind is running ahead to what could go wrong
Breathing and body-based approaches that work directly with your nervous system rather than trying to reason with the anxiety
Ways to notice and examine anxious thought patterns without being consumed by them
Communication and boundary approaches that reduce the interpersonal friction that often feeds anxiety
Practical frameworks for making decisions when anxiety is making every option feel dangerous
These are not techniques handed to you as a list and left to apply on your own. We work through them in sessions and I support you in adapting them to your actual life and the situations where anxiety shows up most.
Generalised anxiety and persistent worry
High-functioning anxiety – capable on the outside, exhausted on the inside
Work and performance anxiety
Social anxiety
Health anxiety
Anxiety following trauma or significant life events
Anxiety during major life transitions – emigration, career change, divorce, new parenthood
Anxiety connected to relationships and interpersonal patterns
If what you’re dealing with doesn’t fit neatly into those categories, reach out anyway. Anxiety rarely stays neatly in one box.
Stress is usually a response to a specific external pressure that eases when the pressure eases. Anxiety tends to persist beyond its original trigger, or attach itself to new things when one concern resolves. If you find yourself consistently worried, physically tense, or avoiding things even when there is nothing acutely wrong, that is more likely anxiety than ordinary stress.
High-functioning anxiety describes people who experience significant anxiety but continue to perform well – at work, in relationships, and in daily life. The anxiety often drives achievement, which makes it harder to identify as a problem and harder to take seriously. The cost is usually in the physical toll, the exhaustion of constant vigilance, and the quality of experience inside a life that looks successful from the outside.
Depending on what is most relevant for you, this may include grounding techniques for when anxiety spikes, breathing and body-based approaches that work with the nervous system directly, ways to examine anxious thought patterns without being consumed by them, communication and boundary frameworks, and practical decision-making tools. We work through these in sessions and adapt them to your actual life rather than providing a generic list.
Under the right circumstances. Counselling is an evidence-based approach to anxiety that many people find effective without medication. Some people use both counselling and medication – they are not mutually exclusive. The decision about medication is one for your doctor or psychiatrist. I work alongside medication when it is in place and can refer if that conversation is needed.
It varies. Some people notice meaningful change within eight to twelve sessions. Others prefer longer-term support, especially where anxiety is connected to deeper patterns or past experiences. We review progress as we go – there is no commitment to a fixed number of sessions.
Yes, via Zoom to clients across South Africa and internationally. Online counselling works well for anxiety – you work from your own environment, which for many people is where anxiety is most present and where the techniques are most immediately applicable.
Most major South African medical aids recognise sessions with an HPCSA-registered counsellor. I provide invoices with ICD10 codes; you submit directly to your medical aid. Contact your scheme to confirm what your specific plan covers.
