In-person in Houston, online across Texas • In-network with Aetna, BCBS, Cigna, UHC/Optum, Tricare, Curative, Oscar • Therapy in English, Spanish, Portuguese, Farsi
Anxiety & Overthinking
Anxiety Therapy in Houston, TX
The term anxiety covers a range of clinically distinct states: a persistent alertness that does not resolve, dread on waking with no identifiable object, high functioning accompanied by an internal sense of pursuit, rumination that prevents sleep. Panic disorder, generalized anxiety, social anxiety, health anxiety, and obsessive-compulsive presentations each have a distinct structure and history.
We do not begin from a symptom checklist, but by establishing when the anxiety started, what precipitates it, what it may be defending against, and what it has arranged in the person's life so that certain things need not be confronted. Anxiety therapy in Houston at Real Talk is provided in person and online across Texas by doctoral-level clinicians.
Anxiety is frequently a signal of something that is being approached, or avoided, that the person has not been able to formulate. The treatment works toward that formulation, at a pace that permits it, with a clinician who is not attempting to reduce distress at any cost. Symptoms suppressed quickly tend to return, often in altered form.
Where clinically indicated, structured interventions are integrated into the treatment. Exposure-based work for OCD and specific phobias, and interoceptive and cognitive strategies for panic, are used within the broader treatment.
Presentations We See
Generalized anxiety disorder, in which worry attaches successively to whatever is nearest. Panic disorder with and without agoraphobia, including patients who have restricted driving, travel, or public settings. Social anxiety disorder, which is often less about other people than about the experience of being observed. Illness anxiety and somatic preoccupation. Obsessive-compulsive disorder, including intrusive thoughts and ritualized behavior that has come to occupy substantial parts of the day. Performance anxiety in people whose work requires performance. And anxiety that is the presenting face of something else, such as unresolved grief, burnout, or trauma.
What We Pay Attention To
We pay attention to what the anxiety protects and what it prevents. We attend to the decisions and relationships it has come to govern, frequently without the person recognizing that a choice was made. And we listen for onset, for what was occurring in the person's life when the anxiety began, and for the distinction between anxiety with an object and anxiety without one, since these require different clinical work.
Why Doctoral Training Matters for Anxiety: Doctoral training matters most when anxiety is comorbid with depression, burnout, or trauma, when it is of early onset, when the diagnosis is uncertain, and when previous treatment reduced symptoms without altering what sustained them. Distinguishing panic from a medical presentation, distinguishing obsessional thinking from a psychotic process, and recognizing when psychiatric consultation is warranted are clinical judgments that no protocol can make.
Our clinical director reads every inquiry and recommends a clinician within minutes on weekdays, hours on weekends.
Do you teach coping strategies?
Where they are useful, yes, and without representing them as the whole treatment. A technique that reduces panic in the moment can make deeper work possible.
Do you treat OCD?
Yes. Several of our clinicians work with OCD.
Will I need medication?
We do not prescribe. If psychiatric consultation would be helpful, we say so and coordinate with a prescriber of your choosing.
Alexandra Schwartz. Improving Ourselves to Death.
The New Yorker, 2018. Read here.
Olivia Laing. The Future of Loneliness.
The Guardian, 2015. Read here.
Zadie Smith. Generation Why?
The New York Review of Books, 2010. Read here.
From Our Journal
Why Do I Feel Bad Without a Reason? You Might Not Need to Know
The Pressure to Be Happy: It Wasn’t Meant to Be a Job.