Author: optimistxtechlab@gmail.com

Anticipatory grief is the mourning that begins before a death or major loss occurs, often while caring for someone with a serious illness. It can include sadness, anger, guilt, numbness, and exhaustion. It is a normal response, not a betrayal of the person you love, and it does not mean you have given up on them.

The Feeling Almost Nobody Warns You About

Your mother is still here. She is in the next room. And yet something in you has already started grieving, and you feel monstrous for it.

That experience has a name. It is called anticipatory grief, and it is one of the least discussed and most isolating parts of caring for someone who is seriously ill. People are prepared for grief after a death. Very few are prepared for grief that arrives months or years early, while the person is still alive, still needing them, still occasionally themselves.

In my work with patients in Santa Monica who are coping with illness in a parent, a partner, or a child, this is the thing that comes out last. It usually arrives in a session sideways, after forty minutes of logistics about medications and doctors, in a quiet sentence like: “Sometimes I wish it was over. What kind of person thinks that?”

A very ordinary one. Let me explain why.

What Is Anticipatory Grief?

Anticipatory grief is the emotional, cognitive, and physical response to an expected loss that has not yet happened. Clinicians sometimes use the related term anticipatory mourning to describe the broader process, which includes not just sadness about the future death but grief over losses that are already occurring in the present.

That second part is the one people miss. When someone you love is seriously ill, you are not only grieving a future event. You are grieving a stack of losses that are happening right now:

• The person’s independence, and your old relationship with them
• Conversations you can no longer have with them
• Your own routines, work, sleep, and social life
• The future you assumed you would have together
• Your role as child or spouse, replaced by the role of caregiver

Losing your relationship with someone while they are still physically present is close to what the researcher Pauline Boss named ambiguous loss, a loss without closure or clear resolution. It is particularly common in dementia, stroke recovery, and late stage illness, and it is far harder to process than a clean ending, precisely because there is nothing to finalize.

What Are the Signs of Anticipatory Grief?

Anticipatory grief rarely looks like crying. More often it looks like this.

Category	What it commonly looks like
Emotional	Sadness, irritability, anger at the illness or the person, dread, numbness, guilt
Cognitive	Rehearsing the death in your mind, difficulty concentrating, intrusive worst case scenarios
Physical	Exhaustion that sleep does not fix, appetite changes, headaches, weakened immunity
Behavioral	Withdrawing from friends, overworking, hypervigilance about symptoms, avoiding visits
Relational	Snapping at a partner, conflict with siblings over care decisions, feeling misunderstood

Two of these deserve special attention because they cause the most private shame.

Anger at the person who is ill. People find this unbearable to admit. It is extremely common. Illness disrupts every part of your life, and anger at a disruption does not stop being anger just because the disrupter is someone you love and did not choose this.

Wishing it were over. This thought arrives in most long caregiving situations at some point. It is almost never a wish for the person to be gone. It is a wish for the suffering to stop, for the waiting to stop, and for your own exhaustion to end. Naming it out loud, with someone who will not flinch, usually reduces its power considerably.

Is Anticipatory Grief Normal?

Yes. It is a recognized and well documented response to expected loss, described extensively in hospice, palliative care, and bereavement literature.

What it is not is a stage you pass through cleanly. The popular idea of grief moving through five orderly stages was never supported as a fixed sequence, and Elisabeth Kübler Ross, whose work introduced the framework, based it originally on observations of dying patients rather than on grieving families. Real anticipatory grief loops. You can feel acceptance on Tuesday and furious denial on Thursday, and both are legitimate.

One honest clarification worth making, because a lot of articles get it wrong: anticipatory grief does not reliably make grief after the death easier. The research on this is mixed. Some people find that a long illness gave them time to say what mattered. Others find the exhaustion of a long caregiving period leaves them with less capacity, not more, when the death finally comes. Do not assume you are doing it wrong if you grieve hard afterward anyway.

Why Guilt Is So Central

Guilt is the emotion that keeps anticipatory grief hidden, and it usually comes from a specific belief: that grieving someone who is still alive means you have already written them off.

That belief is worth examining, because it is not true. Grief is not a withdrawal of love. It is a response to loss, and loss is genuinely occurring in the present. You can grieve the mother who no longer recognizes you while loving and caring for the mother in front of you. Both are happening at once. The mind is fully capable of holding both, though it often needs help to stop treating one as a betrayal of the other.

In therapy, this is frequently where the real work sits. Not in managing the logistics of care, which most families handle competently, but in dismantling the private verdict people have handed down against themselves.

Practical Ways to Cope

These are not fixes. Nothing fixes this. They are the things that reliably reduce the damage.

1. Name it accurately

Saying “I am grieving” rather than “I am not coping well” changes what you do next. Poor coping suggests a personal failure to correct. Grief suggests a process that requires support. The second framing is both more accurate and more useful.

2. Separate the person from the illness

When anger rises, practice directing it at the disease, the system, the insurance company, or the situation. This is not denial. It is precision, and precision keeps the relationship intact during time you cannot get back.

3. Protect one thing that is yours

One hour, one activity, one relationship that has nothing to do with caregiving. Caregivers routinely dismiss this as selfish. It is closer to load bearing. People who abandon every part of their own life tend to collapse earlier and care worse.

4. Say the things now

If the person is still able to communicate, the four sentences that palliative care clinicians often point families toward are simple: thank you, I forgive you, please forgive me, I love you. Not every relationship allows all four. Say the ones that are true. Regret about what went unsaid is one of the heaviest parts of grief afterward.

5. Accept help specifically

“Let me know if you need anything” produces nothing. Give people concrete assignments. Wednesday pharmacy runs. A meal on Sundays. Two hours of sitting with your father so you can leave the house. Specificity is what converts goodwill into actual relief.

6. Bring hospice into the conversation earlier

Families often delay hospice because they read it as surrender. In practice, hospice and palliative care teams provide symptom management, practical guidance, and family support, and under the Medicare hospice benefit, bereavement support for the family is included and continues for a period after the death. Many families later say their only regret was waiting too long.

7. Handle siblings deliberately

Conflict between adult siblings during a parent’s illness is enormously common and rarely about the care plan itself. It is usually old family roles reactivating under stress. Scheduled check in calls with a set agenda, rather than reactive emotional texts at midnight, prevent a great deal of permanent damage.

What Not to Do

• Do not compare timelines. “It has been eight months, I should be handling this better” is a rule you invented. There is no schedule.
• Do not isolate. Grief before a death is socially invisible, which makes withdrawal easy and costly.
• Do not use alcohol to get through the evenings. It is the most common and least helpful coping mechanism in long caregiving periods, and it worsens both sleep and mood.
• Do not skip your own medical care. Caregivers routinely defer their own appointments for years.
• Do not make irreversible life decisions mid crisis. Quitting a job or ending a relationship during peak caregiving stress is worth delaying where possible.

When Is It Worth Talking to a Professional?

Anticipatory grief is not a disorder, and most people do not need treatment for it. But therapy helps meaningfully in certain situations.

Consider support if	Why it helps
You cannot function at work or at home	Restores basic capacity during a long haul
Guilt or anger feels constant and unmanageable	These respond well to being spoken aloud
The illness has reopened older losses	Past grief often resurfaces and needs its own space
Family conflict is escalating	A neutral space prevents permanent ruptures
You feel nothing at all for weeks	Numbness is protective but can become stuck
There is a child or teenager in the household	Children grieve differently and often silently

A note on children and teenagers, since this comes up constantly in my practice. Children rarely say they are grieving. It shows up as school trouble, irritability, stomachaches, regression in younger kids, or sudden withdrawal in teenagers. They also tend to hide it deliberately to avoid adding to a parent’s load. Age appropriate honesty, delivered calmly, consistently does better than protective vagueness. Children fill information gaps with something worse than the truth.

It is also worth knowing that Prolonged Grief Disorder was added to the DSM 5 TR in 2022 and appears in the ICD 11. It describes a persistent, impairing grief response continuing well beyond the expected period, and it is treatable. If grief after a death remains disabling a year or more later, that is a reason to seek help, not a character flaw.

Key Takeaways

• Anticipatory grief is mourning that begins before a loss, and it is a normal response to serious illness
• It includes grief for losses already happening now, not only for the future death
• Guilt, anger at the ill person, and wishing it were over are common and do not mean you love them less
• Grieving before a death does not reliably make grief afterward easier, and the research on this is mixed
• Naming it as grief rather than poor coping changes how you and others respond
• Involving hospice or palliative care earlier tends to help families more than they expect
• Children and teens in the household grieve too, usually through behavior rather than words
• Persistent, disabling grief a year or more after a death is recognized as Prolonged Grief Disorder and is treatable

Frequently Asked Questions

Can you grieve someone who is still alive?
Yes. Anticipatory grief is the recognized term for mourning that begins before a loss occurs. It is common among caregivers of people with terminal illness, dementia, or serious chronic conditions, and it reflects real losses happening in the present rather than a lack of hope.

Is anticipatory grief the same as depression?
No, though they can overlap and can occur together. Grief tends to come in waves tied to reminders and situations, while depression is more persistent and typically involves global worthlessness. If low mood is constant and unrelenting for weeks, a professional assessment is worthwhile.

Why do I feel angry at someone who is sick?
Because serious illness disrupts every part of your life, and anger is a normal response to disruption and helplessness. It is not a measure of your love. Directing that anger toward the illness and the circumstances rather than the person helps preserve the relationship.

Does anticipatory grief make it easier after the person dies?
Not necessarily. Some people find the extra time allows important conversations and a sense of preparation. Others are so depleted by a long caregiving period that grief afterward feels harder. Both outcomes are normal and neither indicates you handled it wrongly.

How long does anticipatory grief last?
As long as the illness does, which may be months or years. It is not a phase with a fixed endpoint, and its intensity typically rises and falls with medical events, hospitalizations, and changes in the person’s condition rather than following a steady progression.

Should I tell my children their grandparent is dying?
Generally yes, in language matched to their age and delivered calmly. Children usually sense that something serious is happening and fill information gaps with fears worse than reality. Honesty paired with reassurance about their own safety and routine tends to reduce anxiety rather than increase it.

What is the difference between anticipatory grief and caregiver burnout?
Anticipatory grief is an emotional response to impending loss. Caregiver burnout is depletion from sustained caregiving demands, showing up as exhaustion, detachment, and resentment. They frequently occur together, and addressing practical load is often necessary before the grief itself can be processed.

Can therapy help while the person is still alive?
Yes, and starting during the illness is often more useful than waiting. Therapy provides a place to say things that cannot be said to family, reduces isolation, addresses guilt directly, and helps preserve your own functioning through what is usually a long period.

You Do Not Have to Carry This Quietly

Anticipatory grief is one of the loneliest experiences people go through, largely because it has no ritual around it. There is no service, no casserole, no time off work. People ask how your mother is doing. Almost nobody asks how you are doing.

If you are caring for someone who is seriously ill, or facing a diagnosis of your own, having one place each week where you can say the unsayable thing makes a real difference. Not because it fixes anything, but because carrying it alone makes everything else heavier.

I have practiced as a psychotherapist in Santa Monica since 1986, and coping with illness in yourself or a loved one is one of the areas I work with most. Because finding the right fit matters so much, I do not charge for the initial visit if you decide not to return for a second session.

If you would like to talk, you are welcome to call (310) 981-3509.

You likely need therapy if daily stress, anxiety, low mood, relationship conflict, or a major life change is affecting your sleep, work, relationships, or sense of self for more than two weeks. You don’t need a crisis to justify starting. Therapy is also useful for people who function well but want clearer thinking, better coping tools, and support working through a specific problem.

You Don’t Need to Be “Broken” to Start Therapy

If you’re reading this, some part of your life probably feels harder than it should. Maybe you’re more anxious than usual, going through a breakup, watching your teenager pull away, or just feeling stuck without knowing why.

A common misconception keeps people from getting help: the idea that therapy is only for a crisis. In reality, most people who benefit from therapy are simply dealing with ordinary, painful parts of life that have become too heavy to carry alone.

This guide walks through the clearest signs it’s time to see a therapist, what different types of therapy actually involve, common mistakes people make when deciding, and how to take the first step, whether that’s for yourself, your relationship, or your child.

9 Signs You May Need Therapy

Not every sign needs to be present. Even one or two, lasting more than a couple of weeks, is reason enough to consider talking to a professional.

1. Your Anxiety or Worry Feels Constant

Occasional worry is normal. It becomes a signal for therapy when it’s persistent, hard to control, or interferes with sleep, focus, or decision making. Racing thoughts at night, a tight chest before ordinary tasks, or avoiding situations out of fear are common patterns therapists help clients work through using approaches like cognitive behavioral therapy (CBT).

2. You’ve Lost Interest in Things You Used to Enjoy

A flattened mood, low motivation, or pulling away from friends and hobbies can point to depression, even without obvious sadness. Many people describe it as feeling numb or going through the motions rather than feeling actively upset.

3. A Relationship Keeps Hitting the Same Wall

If you and a partner keep having the same argument, feel more like roommates than partners, or struggle to rebuild trust after a betrayal, relationship counseling gives you a structured, neutral space to work through it together rather than in the heat of the moment.

4. You’re Going Through a Major Life Transition

Divorce, a new diagnosis, a career change, becoming a parent, or an empty nest can all shake your sense of identity, even when the change is positive. Therapy helps you process the transition instead of just pushing through it.

5. You’re Grieving a Loss

Grief doesn’t follow a schedule, and there’s no timeline you’re supposed to meet. If grief is affecting your ability to function months after a loss, or if you feel isolated in it, a therapist experienced in grief and loss can help you find a way through, not around it.

6. Your Child or Teen Has Changed

A noticeable drop in grades, new social withdrawal, irritability, sleep changes, or a shift in a child’s usual personality often signals something they don’t have the words for yet. Child and adolescent psychotherapy gives kids a safe, age appropriate space to express what’s going on, with parent consultation built into the process.

7. You’re Repeating a Pattern You Can’t Explain

Choosing the same type of partner, sabotaging opportunities right when things go well, or reacting more intensely than a situation seems to call for are often signs of deeper patterns, sometimes rooted in earlier experiences. A therapist trained in psychoanalytic or attachment based approaches can help you understand where the pattern comes from and how to change it.

8. Physical Symptoms Have No Clear Medical Cause

Chronic headaches, stomach issues, fatigue, or muscle tension that a doctor can’t fully explain are sometimes the body’s way of carrying emotional stress. This is worth discussing with both your physician and a therapist.

9. You Just Want to Understand Yourself Better

You don’t need a diagnosis to benefit from therapy. Many clients start simply because they want more clarity, better tools for handling stress, or a thinking partner for a big decision. This is one of the most overlooked but valid reasons to begin.

What Actually Happens in a Therapy Session?

The first session usually focuses on your history, your current concerns, and what you’re hoping to get out of therapy. There’s no test to pass and nothing you need to prepare. A good therapist listens first and builds a treatment approach around your specific situation rather than a one size fits all script.

Sessions typically run 45 to 50 minutes, weekly at the start, tapering as you make progress. Many practices, including in person offices in Santa Monica, now also offer secure Zoom sessions, which makes consistency easier for people with tight schedules.

Common Types of Therapy Explained

Approach	Best For	What It Looks Like
Cognitive Behavioral Therapy (CBT)	Anxiety, depression, specific fears	Identifying and reshaping unhelpful thought patterns with practical tools
Psychoanalytic / Insight Oriented	Repeating patterns, self understanding	Exploring how past experiences shape present choices
Attachment Based Therapy	Relationship difficulties, trust issues	Understanding early relational patterns and how they show up now
Family and Relationship Therapy	Couples, parenting conflict	Structured sessions focused on communication and rebuilding connection
Child Psychotherapy	Kids and adolescents	Age appropriate techniques, often paired with parent consultation

Most experienced therapists don’t use just one method. They draw from several based on what actually fits the person in front of them.

Common Mistakes People Make When Deciding About Therapy

• Waiting for a crisis before reaching out, when earlier support is usually easier and faster
• Assuming one bad fit with a therapist means therapy doesn’t work
• Expecting results after a single session instead of giving the process a few weeks
• Choosing based on convenience alone rather than experience with your specific concern
• Not asking about approach, licensing, or experience before booking

How Much Does Therapy Cost, and Is It Worth It?

Costs vary by location, therapist experience, and whether insurance is involved. In the Santa Monica and greater Los Angeles area, private pay sessions commonly range from 150 to 300 dollars, though many therapists offer a reduced rate or a free initial consultation so you can assess fit before committing financially. When weighed against the cost of unresolved anxiety, a struggling relationship, or a child falling behind emotionally, most clients find the investment pays off well beyond the session itself.

Key Takeaways

• Persistent anxiety, low mood, relationship conflict, grief, or a rough life transition lasting more than two weeks are strong signals to consider therapy
• You do not need a crisis or a diagnosis to benefit from starting
• Different concerns respond better to different approaches, such as CBT for anxiety or attachment based work for relationship patterns
• Children and teens often show emotional struggles through behavior changes rather than words
• A free or low cost first session is a low risk way to see if a therapist is the right fit

Frequently Asked Questions

How do I know if I need therapy or just a bad week?

If low mood, anxiety, or stress lasts more than two weeks and starts affecting sleep, work, or relationships, it’s worth talking to a therapist. A single hard week rarely needs professional support, but a pattern that keeps repeating usually does.

Is therapy only for people with a mental illness?

No. Many clients in therapy don’t have a diagnosis at all. People seek therapy for relationship guidance, grief, life transitions, parenting stress, or simply wanting better coping tools and self understanding.

How long does therapy usually take to show results?

Many clients notice initial relief within 4 to 8 sessions, though deeper patterns, especially those tied to relationships or long standing anxiety, often take a few months of consistent work to shift meaningfully.

What’s the difference between a therapist, psychologist, and psychiatrist?

A therapist or psychologist provides talk therapy and behavioral strategies. A psychiatrist is a medical doctor who can prescribe medication. Many clients work with a therapist alone, while others combine therapy with psychiatric care for medication management.

Can therapy help my child even if they don’t want to talk about their feelings?

Yes. Child and adolescent psychotherapists use age appropriate methods, including play, structured activities, and indirect conversation, so kids can express what’s going on without needing to name their emotions directly.

Do I need to be in a crisis to book a first session?

No. A first session is simply a conversation to understand your situation and see if the fit feels right. Many people start therapy proactively, before things reach a breaking point.

Is online therapy as effective as in person sessions?

Research generally shows comparable outcomes for many concerns, particularly anxiety, depression, and life transitions. In person sessions can offer added benefit for certain relationship or child focused work, so it’s worth discussing which format fits your situation.

How do I choose the right therapist for my specific issue?

Look for a therapist with direct experience in your concern, whether that’s anxiety, couples work, or child psychotherapy, and ask about their approach during a consultation. Comfort and trust with the therapist matter as much as their credentials.

Take the First Step Toward Feeling Better

Recognizing the signs is the hardest part. Reaching out is usually easier than people expect. If any of the patterns above sound familiar, whether it’s anxiety that won’t quiet down, a relationship that needs support, or a child who seems different lately, a conversation with a licensed therapist can help you get clarity on next steps.

Sally Hackman, PhD, MFT, is a licensed psychotherapist in Santa Monica, CA, with over three decades of experience helping individuals, couples, adolescents, and children navigate exactly these kinds of challenges. In person and Zoom sessions are available, and your first session is free if you decide therapy isn’t the right fit.

You improve communication in a relationship by slowing down conversations, listening to understand rather than to respond, and replacing blame with specific requests. Most communication problems are not about a lack of love, they are about unspoken assumptions, timing, and old patterns that get triggered under stress. Couples therapy can help when these patterns repeat despite good intentions.

Introduction

Almost every couple argues about the same handful of topics: money, chores, time, family, and feeling unheard. What separates couples who grow closer from couples who grow apart is usually not the topic itself, it is how they talk about it.

If conversations with your partner keep turning into arguments, or you have stopped bringing things up at all, this guide breaks down why communication breaks down, what actually helps, and when it makes sense to bring in a professional. It reflects patterns commonly seen in relationship counseling, including the practice of Dr. Sally Hackman, a licensed psychotherapist in Santa Monica, California.

Why Does Communication Break Down in Relationships?

Communication usually breaks down for a handful of predictable reasons, not because partners stop caring.

• Different conflict styles. One partner may want to talk things through immediately, while the other needs time to process, which can look like avoidance or dismissal.
• Flooding. When a nervous system becomes overwhelmed during conflict, people say things they do not mean or shut down entirely.
• Unspoken expectations. Assuming a partner should “just know” what you need often leads to disappointment and resentment.
• Old patterns from earlier relationships. Many adults unconsciously repeat communication habits learned in their family growing up, even when those habits do not serve their current relationship.
• Timing and setting. Important conversations that happen when tired, rushed, or in front of others rarely go well.

Signs of a Communication Breakdown

You may be dealing with a communication breakdown if you notice:

1. The same argument repeating with no resolution
2. One or both partners withdrawing or giving the silent treatment
3. Conversations escalating quickly into criticism or defensiveness
4. Avoiding certain topics entirely to prevent conflict
5. Feeling more like roommates than partners
6. Assuming the worst about your partner’s intentions

Relationship researcher John Gottman’s work has identified specific patterns, often called criticism, contempt, defensiveness, and stonewalling, as strong predictors of relationship strain when they become habitual rather than occasional.

7 Practical Ways to Improve Communication

1. Use a soft startup. Begin difficult conversations with how you feel and what you need, rather than an accusation. “I felt overlooked when plans changed without a heads up” lands differently than “You never think about me.”
2. Set a time to talk. Agree on a moment when both partners are calm and available, rather than raising sensitive topics in passing or during an already tense moment.
3. Practice reflective listening. Repeat back what you heard before responding. This slows the conversation and confirms you understood correctly before reacting.
4. Take a break when flooded. If either partner’s heart rate spikes or the conversation feels unproductive, pause for at least twenty minutes before continuing, rather than pushing through.
5. Make specific requests. “Can we plan Sunday dinners together” is easier to act on than “You never make time for us.”
6. Separate the person from the problem. Focus on the specific behavior or situation rather than character judgments like “you always” or “you never.”
7. Schedule regular check ins. Short, low pressure conversations about how the relationship is going can prevent small frustrations from building into larger conflicts.

Communication Habits: Helpful vs Unhelpful

Helpful habit	Unhelpful habit
Using “I” statements	Leading with blame or “you always”
Taking a break when overwhelmed	Continuing to argue while flooded
Asking clarifying questions	Assuming you know what your partner meant
Addressing one issue at a time	Bringing up past unrelated conflicts
Validating feelings before problem solving	Jumping straight to solutions or defending yourself

When Should You Consider Couples Therapy?

Self help strategies work well for many couples, but professional support is worth considering when:

• The same conflict has repeated for months without improvement
• One or both partners feel consistently unheard or resentful
• Trust has been broken, such as through infidelity or dishonesty
• Conversations quickly turn into shouting, stonewalling, or shutting down
• You want an objective third party to help identify patterns you cannot see on your own

Couples therapy is not only for relationships in crisis. Many couples attend proactively, before a marriage, during a major transition such as a new baby, or simply to strengthen a relationship they already value.

What Happens in Couples Counseling?

A typical first session usually includes the following steps.

1. Joint intake. The therapist meets with both partners to understand the relationship history and current concerns.
2. Identifying patterns. Rather than assigning blame, the therapist helps both partners see the cycle that keeps repeating, such as one partner pursuing and the other withdrawing.
3. Building new skills. Sessions often include structured communication exercises practiced both in session and at home.
4. Individual sessions when useful. Some approaches include occasional individual sessions to explore how each partner’s history shapes their communication style.

Common Mistakes Couples Make When Trying to Communicate Better

• Trying to “win” the conversation instead of trying to understand each other
• Bringing up multiple grievances at once, which overwhelms the original issue
• Waiting until resentment builds before raising a concern
• Assuming therapy is a last resort, when earlier support often prevents bigger problems

Key Takeaways

• Most communication breakdowns come from mismatched conflict styles, flooding, and unspoken expectations, not lack of love.
• Recognizable patterns such as criticism, contempt, defensiveness, and stonewalling are strong signs communication needs attention.
• Soft startups, reflective listening, and specific requests are practical tools that improve most conversations.
• Couples therapy helps most when the same conflict repeats over time or when trust has been broken.
• Couples counseling focuses on identifying cycles and building new skills, not assigning blame.

Frequently Asked Questions

How do I get my partner to communicate better if they shut down during conflict?

Shutting down is often a stress response, not disinterest. Try pausing the conversation and revisiting it later when both partners are calmer, and ask directly what would help them feel safe enough to stay engaged.

Is it normal for couples to argue often?

Occasional disagreement is normal and even healthy. What matters more is how conflict is handled. Frequent arguing becomes a concern when it involves contempt, stonewalling, or the same unresolved issue repeating without progress.

Can bad communication habits actually be changed?

Yes. Communication patterns are learned, which means they can be unlearned with consistent practice. Many couples see meaningful improvement within a few months of applying new skills and, when needed, working with a therapist.

What is the difference between individual therapy and couples therapy for relationship issues?

Individual therapy focuses on one partner’s patterns, history, and reactions. Couples therapy involves both partners together and focuses on the dynamic between them. Some people benefit from both at different times.

How long does couples therapy usually take?

This varies by couple and goals. Some couples see improvement in a few sessions focused on a specific issue, while deeper patterns tied to trust or long standing conflict often take several months of consistent work.

Should we wait until things get really bad before starting couples therapy?

No. Couples therapy tends to be most effective when started before resentment builds significantly. Many couples benefit from starting during a difficult transition or a pattern of recurring conflict, rather than waiting for a crisis.

Can one partner attend therapy alone if the other refuses to go?

Yes. Individual therapy can still help you understand your own patterns, communicate more effectively, and decide how to approach the relationship, even without your partner present.

Conclusion

Better communication rarely comes from trying harder in the moment. It comes from understanding the patterns underneath the arguments and practicing new habits consistently over time. If the same conflicts keep resurfacing despite your best efforts, that is a common and treatable pattern, not a sign the relationship is broken.

Dr. Sally Hackman has worked with couples in Santa Monica for over three decades, helping partners rebuild communication and reconnect using approaches grounded in attachment theory and relational therapy. If recurring conflict has you and your partner feeling stuck, reach out to schedule a free first session and see how couples counseling could help.

Anxiety therapy in Santa Monica typically combines talk therapy approaches such as cognitive behavioral therapy (CBT), psychodynamic work, and attachment based methods to help you understand and reduce anxious thoughts and physical symptoms. A licensed psychotherapist works with you individually, often over eight to twenty sessions, to build coping skills, address root causes, and restore a sense of control over daily life.

If anxiety has started interfering with your sleep, work, relationships, or ability to enjoy everyday moments, you are far from alone, and you do not have to figure it out by yourself. Anxiety is one of the most common mental health concerns in the United States, and Santa Monica residents face the same pressures as anyone else: demanding careers, high costs of living, family responsibilities, and the general pace of life in Los Angeles County.

This guide explains what anxiety therapy actually involves, what to expect from a first session, how long treatment usually takes, and how to choose a therapist who is the right fit for you.

What Is Anxiety, and When Does It Become a Problem?

Anxiety is your body’s natural alarm system. It becomes a clinical concern when it is persistent, disproportionate to the situation, or when it interferes with daily functioning.

Common signs that anxiety may have crossed into a treatable condition include:

• Racing thoughts or constant worry that is hard to switch off
• Physical symptoms such as a tight chest, rapid heartbeat, or stomach upset
• Avoiding situations, people, or responsibilities out of fear
• Trouble sleeping or staying asleep
• Irritability, restlessness, or feeling “on edge” most days
• Panic attacks that seem to come without warning

According to the National Institute of Mental Health, anxiety disorders are among the most prevalent mental health conditions in the country, affecting people of all ages and backgrounds. Recognizing the pattern is the first step. A licensed clinician can help you determine whether what you’re experiencing fits a diagnosable condition such as generalized anxiety disorder, social anxiety, panic disorder, or situational anxiety tied to a specific stressor.

What Types of Anxiety Therapy Are Available?

There is no single “correct” way to treat anxiety. Effective therapy is usually tailored to the person, not the other way around.

Cognitive Behavioral Therapy (CBT)

CBT focuses on identifying distorted or unhelpful thinking patterns and replacing them with more balanced, realistic ones. It is one of the most researched approaches for anxiety and often includes practical tools you can use between sessions, such as thought records or gradual exposure exercises.

Psychodynamic and Insight Oriented Therapy

This approach looks at how earlier experiences, family dynamics, and unconscious patterns shape present day anxiety. Rather than only managing symptoms, it aims to understand where the anxiety originates so the underlying pattern can genuinely shift.

Attachment Based Therapy

Anxiety is often connected to how we learned to relate to others early in life. Attachment focused work examines relationship patterns and helps build a more secure internal foundation, which in turn reduces chronic worry and reactivity.

Integrative Approaches

Many experienced therapists, including those with decades of clinical training, blend CBT, psychodynamic insight, and attachment theory rather than relying on one method alone. This allows treatment to address both immediate symptoms and longer term causes.

What Should You Expect in Your First Therapy Session?

Your first session is mainly about building trust and gathering context. Expect the therapist to ask about your history, current stressors, and what you’re hoping to get out of therapy, with no judgment involved.

A typical first appointment usually covers:

1. Your current symptoms and how long they’ve been present
2. Relevant history, including family background and past significant events
3. What has and hasn’t helped so far
4. Your goals for treatment
5. Practical details such as session frequency, format (in person or via Zoom), and confidentiality

Many practices, including Dr. Sally Hackman’s Santa Monica office, offer a free first session so you can determine fit before committing further. This matters because the relationship between therapist and client is one of the strongest predictors of successful outcomes in psychotherapy.

How Long Does Anxiety Therapy Take?

There is genuine variation here, and any therapist who promises a fixed timeline before meeting you should be viewed with some skepticism.

Situation	Typical Length
Situational anxiety tied to a specific event	A few weeks to a few months
Generalized anxiety disorder	Several months to a year or more
Anxiety layered with deeper patterns (trauma, attachment wounds)	Ongoing, longer term work

Progress is rarely linear. Most clients notice initial relief within the first several sessions as they build coping tools, while deeper, more lasting change tends to unfold gradually over time.

In Person Therapy vs. Zoom Sessions: Which Is Better for Anxiety?

Both formats are legitimate and research supports the effectiveness of telehealth therapy for anxiety. The right choice depends on your circumstances.

In person sessions can feel more grounding for people who benefit from a dedicated, therapy only space away from home distractions. Santa Monica clients often appreciate a short commute that also functions as transition time before and after a session.

Zoom sessions offer flexibility for busy schedules, reduce travel time, and can feel more comfortable for people whose anxiety includes social or performance related fears. Many therapists, including Dr. Hackman, offer both formats so clients can choose or switch based on what a given week requires.

Common Mistakes People Make When Seeking Anxiety Treatment

• Waiting too long to start. Anxiety rarely resolves entirely on its own, and untreated symptoms often intensify.
• Expecting instant results. Real change takes consistent work, not a single breakthrough session.
• Choosing a therapist based only on price or availability. Fit and clinical training matter more for long term outcomes than convenience alone.
• Relying solely on self help content. Books, podcasts, and apps can support therapy, but they are not a substitute for personalized clinical care, especially when anxiety is significant.
• Stopping treatment as soon as symptoms ease. Consolidating gains often requires a few additional sessions after you start feeling better.

How to Choose the Right Anxiety Therapist in Santa Monica

Look for these signals when evaluating a potential therapist:

• Licensure and credentials. Confirm the therapist is licensed in California (LMFT, LCSW, PhD, or PsyD) and check how long they’ve been practicing.
• Relevant experience. Ask whether they regularly treat anxiety specifically, and what approaches they use.
• Comfort and rapport. Notice how you feel during a consultation. Do you feel heard, or dismissed?
• Practical fit. Consider location, session format options, availability, and whether they offer an initial consultation.
• Clear communication about approach. A good therapist should be able to explain their treatment style in plain language, not just clinical jargon.

Dr. Sally Hackman, PhD, MFT, has practiced in Santa Monica since 1992, holding a PhD in Clinical Child Psychology and a master’s degree in Marriage and Family Therapy. Her background spans academic medicine, community mental health, and decades of clinical practice treating anxiety, depression, and relationship difficulties in adults, teens, and children.

Key Takeaways

• Anxiety becomes a clinical concern when it is persistent, disproportionate, or interferes with daily life.
• Effective treatment often blends CBT, psychodynamic insight, and attachment based approaches rather than relying on one method alone.
• A first session should focus on history, goals, and building trust, not immediate pressure to commit long term.
• Treatment length varies widely, from a few weeks for situational anxiety to ongoing work for deeper patterns.
• Both in person and Zoom therapy are legitimate options; the right choice depends on personal preference and circumstances.
• Choosing a therapist based on licensure, experience, and genuine rapport matters more than convenience alone.

Frequently Asked Questions

What is the best therapy for anxiety? 

There is no single “best” therapy for everyone. Cognitive behavioral therapy has strong research support for symptom reduction, while psychodynamic and attachment based approaches help address root causes. Many clinicians combine methods based on individual needs.

How much does anxiety therapy cost in Santa Monica? 

Costs vary by provider, session length, and whether insurance is used. Many therapists offer a free initial consultation so you can discuss fees and fit before committing to ongoing sessions.

Can anxiety therapy be done over Zoom? 

Yes. Telehealth therapy for anxiety is well supported by research and offers flexibility for people with busy schedules or transportation limitations. Most therapists, including Dr. Hackman, offer both in person and Zoom sessions.

How do I know if I need therapy for anxiety, or if I can manage it myself? 

If anxiety is affecting your sleep, relationships, work performance, or ability to enjoy daily life, or if self help strategies haven’t provided lasting relief, it’s a reasonable time to consult a licensed therapist for an assessment.

How many sessions does anxiety therapy usually take? 

It depends on the type and severity of anxiety. Situational anxiety may improve within a few weeks to months, while generalized anxiety or anxiety connected to deeper patterns often benefits from longer term, ongoing work.

Is medication necessary for anxiety, or is therapy enough? 

Many people manage anxiety through therapy alone. Others benefit from a combination of therapy and medication prescribed by a psychiatrist or physician. A therapist can help you decide whether a referral for a medication evaluation makes sense for your situation.

What’s the difference between a psychologist, a psychiatrist, and a licensed marriage and family therapist (MFT)? 

Psychiatrists are medical doctors who can prescribe medication. Psychologists (PhD or PsyD) and licensed MFTs provide talk therapy; psychologists have doctoral level training, while MFTs typically hold a master’s degree with specialized training in individual and relational treatment. All three can play a role in anxiety care depending on your needs.

Does anxiety ever fully go away? 

For many people, anxiety symptoms reduce significantly and become manageable rather than disappearing completely. The goal of therapy is usually to build lasting skills and insight so anxiety no longer controls daily decisions, not to eliminate all worry permanently.

Conclusion

Anxiety can feel overwhelming, but it responds well to the right kind of support. Whether your anxiety is tied to a specific life transition, ongoing relationship stress, or a longer standing pattern, working with an experienced, licensed psychotherapist can help you understand what’s driving it and build real, lasting tools to manage it.

Dr. Sally Hackman, PhD, MFT, has provided anxiety therapy to individuals, couples, teens, and children in Santa Monica since 1992, offering both in person and Zoom sessions with a free first appointment. If you’re ready to take the first step, reach out to schedule a consultation or learn more about her approach to anxiety and depression treatment.

Life brings inevitable changes, challenges, and moments of uncertainty. Whether it is adjusting to a major transition, managing stress, navigating relationships, or facing unexpected difficulties, our ability to respond emotionally can shape how we move through these experiences.

This ability is known as emotional resilience the capacity to understand our emotions, recover from challenges, and continue moving forward while maintaining a sense of balance and self-awareness.

Emotional resilience does not mean avoiding difficult feelings or pretending everything is fine. Instead, it means developing the inner resources to acknowledge challenges, process emotions, and respond in healthier ways.

What Is Emotional Resilience?

Emotional resilience is the ability to adapt to stressful situations while maintaining emotional well-being. Resilient people still experience sadness, frustration, fear, or disappointment, but they are better able to recognize these emotions and find constructive ways to cope.

Resilience develops over time through experiences, relationships, self-reflection, and the skills we learn throughout life. It is not a personality trait that someone either has or does not have. It is something that can grow.

A person with stronger emotional resilience may be better able to:

• Recognize and express emotions clearly
• Recover after difficult experiences
• Maintain perspective during stressful situations
• Ask for support when needed
• Adapt to changes and uncertainty
• Learn from challenges rather than feeling defined by them

Why Emotional Resilience Matters

Emotional challenges are a normal part of being human. Everyone experiences setbacks, conflicts, losses, and periods of stress. The difference is often found in how we respond.

Developing emotional resilience can support:

Better Emotional Awareness

Understanding emotions allows people to recognize what they are feeling and why. Instead of reacting automatically, they can pause, reflect, and choose how they want to respond.

For example, frustration may sometimes be connected to feeling unheard, overwhelmed, or uncertain. Identifying the deeper emotion can create opportunities for healthier communication and problem-solving.

Healthier Responses to Stress

Stress cannot always be removed from life, but people can develop healthier ways to manage it. Emotional resilience helps individuals approach stressful situations with greater flexibility instead of feeling completely controlled by them.

Healthy coping strategies may include:

• Taking time to reflect before reacting
• Maintaining supportive relationships
• Practicing mindfulness and relaxation
• Creating routines that support well-being
• Recognizing personal limits

Stronger Relationships

Emotional resilience also affects the way we connect with others. When people understand their own emotions, they often become better able to listen, communicate, and respond with empathy.

Healthy relationships are built on emotional awareness, trust, and the ability to navigate disagreements with respect.

How Emotional Resilience Develops

Building emotional resilience is a lifelong process. Small changes in daily habits and self-understanding can create meaningful improvements over time.

1. Practice Self-Awareness

Self-awareness is the foundation of emotional growth. Paying attention to thoughts, feelings, and reactions can reveal patterns that influence behavior.

Questions that encourage self-awareness include:

• What emotions do I experience most often?
• How do I usually respond when I feel stressed?
• What situations tend to trigger strong reactions?
• What helps me feel calm and supported?

Understanding yourself creates the opportunity for change.

2. Learn to Accept Difficult Emotions

Many people try to avoid uncomfortable emotions, but emotions provide important information. Feeling sadness, anger, fear, or disappointment does not mean something is wrong.

Learning to acknowledge emotions without judgment can help people process experiences more effectively.

3. Build Supportive Connections

Strong relationships are an important part of emotional resilience. Having trusted people to share experiences with can reduce feelings of isolation and provide valuable perspective.

Supportive connections may include family members, friends, mentors, or other trusted individuals who offer encouragement and understanding.

4. Develop Flexible Thinking

Challenges can sometimes make situations feel overwhelming or permanent. Resilient thinking involves looking at difficulties from different perspectives.

Instead of asking:

“Why is this happening to me?”

A more flexible question may be:

“What can I learn from this experience, and what support might help me move forward?”

This shift does not remove challenges, but it can change how we approach them.

Emotional Resilience in Children and Adolescents

Children and teenagers also experience stress, uncertainty, and emotional challenges. Developing emotional resilience during childhood can help young people build confidence, understand feelings, and develop healthy ways to handle difficulties.

Children often learn resilience through:

• Feeling understood and supported
• Having opportunities to express emotions
• Learning problem-solving skills
• Receiving guidance while developing independence

Parents and caregivers can support resilience by creating an environment where emotions are acknowledged rather than dismissed.

Common Misunderstandings About Resilience

“Resilient people do not struggle.”

Resilience does not mean someone never experiences hardship. Even emotionally resilient people face difficult moments.

“Being strong means handling everything alone.”

Seeking support is often a sign of resilience, not weakness. Connection and communication are important parts of emotional health.

“Resilience means staying positive all the time.”

Real resilience includes accepting difficult emotions while still finding ways to move forward.

Small Daily Practices That Strengthen Emotional Resilience

Building emotional resilience does not require dramatic changes. Small, consistent practices can make a difference:

• Notice and name your emotions
• Take breaks when feeling overwhelmed
• Maintain meaningful relationships
• Create healthy routines
• Practice self-compassion
• Reflect on lessons from difficult experiences
• Allow yourself time to adjust during transitions

Final Thoughts

Emotional resilience is an ongoing process of understanding yourself, adapting to challenges, and developing healthier ways to respond to life’s experiences.

Everyone encounters difficult moments. What matters is not avoiding every challenge, but developing the emotional tools and support systems that help you navigate them with greater awareness and strength.

By building emotional resilience in everyday life, we create a stronger foundation for personal growth, healthier relationships, and lasting emotional well-being.

A child saying, “I do not want to go to school today,” is not necessarily unusual.

Children get tired. They have difficult mornings. They worry about tests, arguments with friends, unfamiliar teachers, and days when they simply do not feel like leaving home.

But what happens when not wanting to go becomes crying every morning?

What if your child suddenly starts complaining of stomach pain before school, begs to stay home, has trouble sleeping on Sunday night, or becomes extremely distressed as soon as school is mentioned?

For some families, these behaviors may be connected with school refusal anxiety.

School refusal is generally used to describe persistent difficulty going to school or remaining at school. It is not itself a single mental health diagnosis. Instead, it can be a sign that a child is experiencing emotional distress that needs to be understood. Anxiety is one possible factor, but social problems, academic difficulties, family changes, depression, bullying, and other concerns may also contribute.

The most useful question is therefore not simply, “How do I make my child go to school?”

A better question is, “What is making school feel so difficult for my child right now?”

Understanding that difference can completely change the way a parent responds.

What Is School Refusal Anxiety?

School refusal anxiety describes significant emotional distress connected with attending or remaining at school.

A child experiencing it may genuinely want to attend school and still feel unable to walk through the door.

The American Academy of Pediatrics describes school avoidance as a pattern in which a child regularly resists attending school. Some children refuse directly, while others repeatedly complain of vague physical symptoms or find other reasons to remain home.

This is one reason parents can become confused.

A child may look completely healthy on Saturday afternoon and suddenly develop a stomachache on Monday morning.

That does not automatically mean the child is pretending.

Emotional distress can have very real physical effects.

For some children, the thought of entering school creates enough worry that their body begins responding to the fear.

School Refusal Is Not Always the Same as Truancy

This distinction matters.

A child who deliberately skips school to spend time elsewhere is experiencing a very different situation from a child who becomes tearful, frightened, physically uncomfortable, or overwhelmed at the thought of attending.

School refusal can be associated with anxiety disorders, depression, adjustment difficulties, social anxiety, specific fears, and other emotional or behavioral concerns.

That means treating every case as laziness or disobedience can miss what is actually happening.

Parents still need boundaries and expectations, but boundaries tend to work better when they are paired with curiosity.

Instead of immediately asking:

“Why are you doing this again?”

Try asking:

“What part of school feels hardest today?”

That small change invites information instead of defensiveness.

Common School Anxiety Symptoms Parents May Notice

School anxiety does not always begin with the words “I am anxious.”

Many children do not yet have the language to explain what they are feeling.

Instead, parents may notice changes in behavior.

Possible school anxiety symptoms can include:

1. Frequent stomachaches or headaches before school
2. Crying while getting ready
3. Repeated requests to stay home
4. Difficulty sleeping before school days
5. Irritability on Sunday evening or weekday mornings
6. Clinging to a parent before leaving home
7. Panic or extreme distress at the school entrance
8. Frequent visits to the school nurse
9. Asking to be picked up early
10. Becoming unusually quiet when school is discussed
11. Avoiding classmates or social activities
12. Sudden changes in academic performance
13. Emotional outbursts during the morning routine
14. Complaints that seem to improve once staying home becomes certain

The American Academy of Pediatrics notes that children experiencing school avoidance may complain of vague symptoms and resist attendance even when a clear physical illness cannot be identified.

One symptom alone does not establish a problem.

The pattern matters.

Ask yourself whether the behavior is occasional or becoming persistent, whether it is becoming more intense, and whether it is interfering with your child’s everyday life.

Why Would a Child Suddenly Refuse to Go to School?

There is rarely one universal explanation.

Two children can show almost identical behavior for completely different reasons.

One child may fear separating from a parent.

Another may be worried about being laughed at during lunch.

Another may understand very little of what is happening in math class and be terrified that somebody will notice.

Another may be dealing with a difficult friendship that has never been mentioned at home.

Understanding the reason behind school avoidance in children is therefore essential.

1. Separation Anxiety

For some younger children, leaving a parent or caregiver can feel frightening.

The child may worry that something bad will happen while they are apart or simply feel unable to settle once the parent leaves.

This can become especially noticeable after a long vacation, illness, family disruption, or another period when the child has spent more time at home.

2. Social Anxiety

School contains countless social situations.

Walking into a classroom.

Finding somewhere to sit at lunch.

Answering a question in front of other students.

Joining a group.

Starting a conversation.

Speaking during a presentation.

For a child struggling with social anxiety, these ordinary moments may feel enormous.

Social anxiety and peer difficulties are already areas closely related to Dr. Sally Hackman’s work with children and adolescents. Her practice approaches these concerns by looking both at emotional patterns and at the practical skills children need for healthier connection.

3. Friendship Problems or Bullying

Sometimes the problem is not school itself.

It is what happens at school.

A friendship may have ended.

A child may feel excluded.

Someone may be teasing them.

They may be worried about sitting alone during lunch.

Children are not always quick to tell parents about social humiliation. Some feel embarrassed. Others fear that involving adults will make the situation worse.

A sudden change in school attendance can therefore be worth exploring carefully.

4. Academic Pressure

Imagine spending six hours every day somewhere that constantly reminds you of something you believe you cannot do.

That is how school can feel for a child struggling academically.

Reading difficulties, attention problems, learning differences, missed lessons, demanding coursework, or fear of making mistakes may gradually turn school into a source of anxiety.

The child may say, “School is boring,” when what they actually mean is, “I feel embarrassed because everyone else seems to understand this.”

5. Fear of Failure

Children who place intense pressure on themselves can struggle even when their grades look excellent.

A high achieving student may become terrified of getting something wrong.

Tests, presentations, competitions, college concerns, and expectations from adults can all contribute to anxiety about going to school.

These children are sometimes overlooked because they appear successful.

Academic performance does not always reveal emotional wellbeing.

6. Changes at Home

Children do not leave family stress at the school gate.

Divorce, illness, grief, relocation, conflict at home, financial concerns, or changes in family routines can affect how safe and settled a child feels.

Sometimes remaining at home feels emotionally necessary because the child is worried about what might happen while they are away.

7. Anxiety or Depression

Persistent school refusal can sometimes occur alongside broader emotional concerns.

NIH clinical information notes associations between school refusal and conditions including social anxiety, generalized anxiety, depression, adjustment difficulties, and other mental health concerns.

This does not mean every child who refuses to go to school has a mental health disorder.

It means persistent refusal deserves attention rather than assumptions.

Start by Listening Before Trying to Fix It

When school mornings become stressful, families naturally focus on the immediate goal.

Get dressed.

Eat breakfast.

Find the backpack.

Get into the car.

Get through the school gate.

But the urgency of the morning can make meaningful conversation almost impossible.

A distressed child is unlikely to provide a thoughtful explanation while everyone is already late.

Choose a calmer moment.

You might say:

“I have noticed mornings have been really hard recently. I am not angry. I want to understand what school feels like for you.”

Then listen.

Do not rush to correct every fear.

If your child says, “Everyone hates me,” immediately responding with, “That is ridiculous, everyone likes you,” may close the conversation.

Instead, try:

“What has been happening that makes it feel that way?”

You are not agreeing that everyone hates your child.

You are showing that you are willing to understand the experience behind the statement.

Look for Patterns

Parents can learn a great deal by paying attention to when anxiety becomes strongest.

Does it happen every day?

Only on Mondays?

Before physical education?

On presentation days?

Before a particular class?

After lunch?

After weekends spent with another parent?

Before seeing a particular group of students?

When certain patterns repeat, they can provide clues.

You may discover that the child is not afraid of school as a whole.

They are afraid of one particular part of their school day.

That is a much more manageable problem to explore.

Talk With the School

Parents see one side of a child’s experience.

Teachers see another.

Your child may appear extremely anxious at home but settle shortly after entering class.

Or the opposite may be happening.

Your child may leave home calmly but become withdrawn during school.

Speak with the teacher, counselor, or another appropriate school professional.

Useful questions include:

“What have you noticed recently?”

“Does my child seem comfortable with classmates?”

“Have there been any changes in participation?”

“Is there a particular part of the day that seems difficult?”

“Have you noticed problems with schoolwork?”

A coordinated picture is often much more useful than relying on one person’s observations.

AACAP guidance emphasizes early attention and a consistent plan when school refusal becomes persistent.

Avoid Turning Every Morning Into a Battle

When parents are worried about attendance, it is understandable to become frustrated.

But shouting, threatening, lengthy arguments, and repeated negotiations can make school mornings even more emotionally charged.

Try to keep the routine predictable.

Prepare clothing and school materials the night before.

Keep morning instructions simple.

Acknowledge the feeling without allowing every decision to revolve around anxiety.

For example:

“I know going in feels scary today. We are going to work through this together.”

This communicates two things at the same time.

Your child’s feelings matter.

Their feelings do not have to control every action.

Be Careful About Making Home the Escape From Every Difficult Feeling

When a distressed child stays home, anxiety often decreases quickly.

The relief can be powerful.

The child learns that avoiding school makes the uncomfortable feeling disappear.

This can make returning the next day even harder.

That does not mean parents should physically force a severely distressed child into school without understanding what is happening.

It means repeated avoidance should not become the only strategy.

Professional guidance on school refusal commonly emphasizes addressing the source of distress while developing a realistic plan for returning to school.

The goal is not to eliminate every uncomfortable feeling before a child returns.

Children also need opportunities to discover that they can experience anxiety and still move through difficult situations safely.

Help Your Child Put Feelings Into Words

Children often act out feelings they cannot describe.

A younger child may draw what happened.

Another may communicate through play.

A teenager may be more willing to talk while driving than during a formal conversation at the kitchen table.

Give them different ways to express themselves.

Ask specific questions rather than demanding a complete explanation.

“What part of tomorrow are you worried about?”

“Is the hardest part the work, the teacher, other students, or leaving home?”

“When during the school day do you feel most comfortable?”

“When do you wish you could disappear?”

The purpose is discovery.

You are helping the child turn a large, undefined feeling into something understandable.

When Should Parents Become More Concerned?

Every child has difficult days.

The question is whether the difficulty is becoming a pattern that interferes with normal life.

Consider seeking professional guidance when:

1. School refusal continues rather than improving
2. Your child’s distress becomes increasingly intense
3. Anxiety interferes with sleep, eating, friendships, or family life
4. Your child frequently experiences physical complaints before school
5. Attendance is declining significantly
6. You suspect bullying, depression, severe anxiety, or another emotional concern
7. The family feels unable to manage school mornings despite consistent efforts
8. Your child seems unusually withdrawn or hopeless
9. Your child talks about hurting themselves or someone else

Persistent school refusal may require assessment to determine what is driving the behavior. Early support can help families understand whether the issue is primarily emotional, social, academic, developmental, or a combination of several factors.

Any concern about immediate safety requires prompt professional or emergency support.

What Can Therapy Explore?

When school refusal anxiety continues, therapy is not simply about convincing a child to attend school.

The first task is understanding the child.

What happens internally when school is mentioned?

What does the child expect will happen?

Is there a fear of embarrassment?

Separation?

Failure?

Rejection?

Conflict?

Loss of control?

Has something changed recently?

For children who struggle to explain themselves verbally, play and art can sometimes provide additional ways to communicate emotional experiences.

Dr. Sally Hackman’s approach to child psychotherapy reflects this developmental perspective. Her background includes a PhD in Clinical Child Psychology, experience as an elementary school teacher, work with children and families, and more than three decades in private practice.

That combination is especially relevant when school problems involve both emotional development and the realities of everyday school life.

The Goal Is Understanding, Not Blame

When a child repeatedly refuses school, everyone can begin feeling blamed.

Parents blame themselves.

Children feel blamed by parents.

Parents blame the school.

The child blames a teacher.

Teachers become frustrated with attendance.

The morning becomes the center of family life.

Yet blame rarely reveals the solution.

Curiosity is far more useful.

Ask:

“What changed?”

“What is my child’s behavior communicating?”

“What happens immediately before the distress?”

“What helps?”

“What makes it worse?”

“Who else can help us understand what is happening?”

School refusal is a behavior.

The important information is often underneath it.

A Child Who Says “I Cannot Go” May Be Telling You Something Important

It can be tempting to hear school refusal as defiance.

Sometimes children certainly test limits.

But when refusal is accompanied by persistent fear, physical symptoms, tears, withdrawal, panic, or major changes in behavior, something more may be happening.

Your child’s distress does not always need to make perfect sense from an adult perspective before it deserves attention.

School may appear safe to you and still feel frightening to your child.

Listening does not mean removing every challenge.

Supporting a child does not mean allowing anxiety to make every decision.

The balance is helping children feel understood while gradually building their confidence to face situations that feel difficult.

That process begins with discovering what the child is actually afraid of.

Frequently Asked Questions About School Refusal Anxiety

Is school refusal anxiety a diagnosis?

No. School refusal is generally considered a description of behavior rather than a specific mental health diagnosis. It can occur alongside anxiety, depression, social difficulties, adjustment problems, and other concerns.

Why does my child’s stomach hurt only before school?

Emotional distress can be experienced physically. Children who are anxious about school may report stomachaches, headaches, nausea, or other physical discomfort, particularly before school. Medical concerns should still be appropriately evaluated rather than automatically attributed to anxiety.

Is my child just being lazy?

Persistent distress around school should not automatically be interpreted as laziness. Look at the full pattern, including emotional reactions, physical complaints, social changes, academic difficulties, and what happens when school is discussed.

Should I let my child stay home because of anxiety?

There is no single answer that fits every situation. Frequent avoidance can make returning more difficult, but severe distress also needs to be understood properly. When school refusal becomes persistent, work with the school and an appropriate health or mental health professional to identify the cause and create a suitable plan.

Can bullying cause school avoidance?

Yes. Social conflict, exclusion, bullying, and other difficult peer experiences can contribute to a child’s reluctance to attend school. That is why understanding what is happening socially is an important part of evaluating a sudden change in attendance.

Can teenagers experience school refusal anxiety?

Yes. School refusal can affect children and adolescents. For teenagers, concerns may involve academic pressure, peer relationships, social anxiety, depression, identity concerns, family stress, or other emotional difficulties.

How can I help a child with school anxiety?

Begin by listening calmly, identifying patterns, communicating with the school, maintaining predictable routines, and trying to understand the specific source of distress. If the problem persists or significantly interferes with daily functioning, professional assessment can help clarify what support is appropriate.

Moving From “Why Won’t You Go?” to “What Is Making This Hard?”

When mornings become difficult, parents naturally want an immediate solution.

But lasting change often begins with understanding.

A child who refuses school may be struggling with anxiety, a friendship, academic pressure, separation, family stress, fear of failure, or something they have not yet found the words to explain.

Instead of treating the behavior as the entire problem, look beneath it.

Listen.

Observe.

Ask questions.

Talk with the school.

Notice patterns.

And when the struggle persists, seek support rather than allowing the family to become trapped in the same exhausting morning battle.

For families in Santa Monica and the greater Los Angeles area who are concerned about persistent school difficulties, anxiety, or changes in a child’s emotional wellbeing, Dr. Sally Hackman, PhD, MFT, brings extensive experience working with children, adolescents, parents, and families. Her practice emphasizes understanding what lies beneath a child’s behavior and helping families respond in ways that support healthier emotional development.

Sometimes the most important shift is also the simplest:

Stop asking only how to get your child through the school door.

Start asking what is making that door feel so difficult to walk through.

Therapy progress does not always arrive as a dramatic breakthrough. Sometimes it appears as a calmer response to a difficult conversation, a boundary you were previously afraid to set, or the ability to recognize an emotional pattern before it takes control.

This can make it difficult to determine whether therapy is helping, especially during periods when change feels slow. You may understand yourself better while still experiencing anxiety, grief, relationship problems, or uncertainty. You may also encounter setbacks that make you question how far you have come.

Learning how to know if therapy is working means looking beyond whether every symptom has disappeared. Meaningful progress can include changes in awareness, emotional regulation, behavior, relationships, daily functioning, and your ability to respond to challenges.

Here are 12 signs that may indicate therapy is helping.

1. You Can Describe Your Feelings More Clearly

Many people begin therapy with a general sense that something is wrong but have difficulty identifying what they are experiencing.

You might initially describe yourself as feeling “bad,” “overwhelmed,” or “stressed.” As therapy progresses, you may become better able to distinguish between anxiety, disappointment, shame, grief, anger, loneliness, and exhaustion.

Having more precise language for your emotions does not automatically make difficult feelings disappear. It can, however, help you understand what those feelings may be communicating and determine how you want to respond.

This increased emotional awareness is one of the less obvious signs therapy is working.

2. You Recognize Patterns Earlier

Therapy often helps people notice recurring patterns in their thoughts, emotions, choices, and relationships.

For example, you may recognize that you withdraw whenever you fear criticism, agree to requests because you are uncomfortable disappointing others, or become defensive when you feel misunderstood.

At first, you might recognize a pattern only after it has occurred. Later, you may notice it while it is happening. Eventually, you may recognize the trigger early enough to choose a different response.

The pattern may not disappear immediately. Recognizing it earlier is still meaningful therapy progress because awareness creates an opportunity for change.

3. There Is More Space Between a Feeling and Your Reaction

Strong feelings can sometimes create an immediate urge to act. You may send an angry message, avoid an uncomfortable situation, make an impulsive decision, or say something you later regret.

As therapy helps you understand and tolerate your emotions, you may begin to experience a pause between the feeling and your reaction.

During that pause, you can ask yourself:

• What am I feeling?
• What triggered this reaction?
• What do I need?
• Will my immediate response help the situation?
• Is there another way I could handle this?

Even a brief pause can represent important progress. The goal is not to stop having emotions, but to have more choice in how you respond to them.

4. Difficult Emotions Feel More Manageable

Therapy does not eliminate sadness, anxiety, frustration, grief, or fear from life. Instead, it can increase your capacity to experience difficult emotions without becoming completely overwhelmed by them.

You may still have anxious thoughts but recover more quickly. You may be able to stay present during an uncomfortable conversation instead of leaving or shutting down. You may experience sadness without immediately trying to suppress or escape it.

When evaluating what progress in therapy looks like, consider not only how often an emotion occurs but also:

• How intense it feels
• How long it lasts
• How much it disrupts your day
• How quickly you recover
• Whether you can respond in a healthier way

A difficult emotion becoming more manageable can be just as meaningful as experiencing it less often.

5. Your Symptoms Are Changing

A reduction in symptoms is an important measure of therapy progress, although it is not the only one.

Depending on why you entered therapy, you may notice:

• Fewer periods of intense anxiety
• Less persistent sadness or hopelessness
• Better sleep or concentration
• Reduced avoidance
• Fewer conflicts with other people
• Less emotional reactivity
• Greater motivation
• Improved ability to complete everyday responsibilities

Symptom changes may happen gradually. Instead of asking only whether a symptom is completely gone, consider whether its frequency, intensity, duration, or effect on your life has changed.

6. You Are Practicing New Behaviors Outside Therapy

Insight is valuable, but change also occurs through what you do differently in everyday life.

Perhaps you have started expressing your needs, attending activities you previously avoided, responding more calmly during disagreements, or making time for rest without feeling guilty. You may also be applying coping strategies discussed during sessions.

New behaviors can feel unnatural at first. This does not mean they are ineffective. It often means you are moving beyond a familiar pattern.

One way of measuring progress in psychotherapy is to identify specific actions you can now take that previously felt difficult or impossible.

7. Your Relationships Are Becoming Healthier

Emotional patterns often become most visible in relationships. For that reason, therapy progress may appear in how you communicate, manage conflict, establish boundaries, and choose whom to trust.

Possible signs include:

• Expressing concerns more directly
• Listening without immediately becoming defensive
• Saying no when necessary
• Asking for help
• Recognizing unhealthy relationship dynamics
• Recovering from disagreements more constructively
• Becoming less dependent on another person’s approval
• Allowing appropriate closeness and vulnerability

Progress does not necessarily mean that every relationship will continue. Sometimes greater self-awareness helps a person recognize when a relationship needs different boundaries or is no longer healthy.

People whose primary concerns involve recurring interpersonal patterns can learn more about individual therapy for relationship difficulties. Couples who want to work on their patterns together can explore relationship counseling.

8. You Treat Yourself With More Compassion

Many people enter therapy with a harsh internal voice. They may respond to mistakes with shame, view ordinary needs as weaknesses, or hold themselves to standards they would never impose on someone else.

A meaningful sign of progress is being able to take responsibility without attacking your worth as a person.

Self-compassion is not avoiding accountability or pretending that mistakes do not matter. It means acknowledging what happened, understanding the circumstances, making repairs when necessary, and learning from the experience.

You may notice that you:

• Recover from mistakes more quickly
• Compare yourself with others less often
• Recognize unrealistic expectations
• Speak to yourself more respectfully
• Allow yourself to have needs
• Accept that growth does not require perfection

These changes can affect emotional well-being, relationships, and the willingness to take healthy risks.

9. Your Choices Reflect Your Values More Often

Anxiety, guilt, fear of rejection, and pressure from others can influence important decisions. Therapy can help you clarify what matters to you and recognize when your choices are being controlled primarily by fear or old expectations.

Progress may mean making decisions that align more closely with your values, even when those decisions are uncomfortable.

You may become more intentional about your work, relationships, health, time, or personal boundaries. You may also become better able to accept that a thoughtful choice can still involve uncertainty.

10. Everyday Life Feels More Manageable

Some changes are practical rather than dramatic. You may find it easier to get out of bed, organize your responsibilities, concentrate at work, attend social events, care for your health, or make decisions.

These functional improvements matter. Emotional well-being influences daily life, and daily functioning can offer concrete evidence that something is changing.

When considering how to know if therapy is working, compare your current functioning with where you were when you started—not with an idealized version of where you believe you should be.

11. Setbacks Do Not Erase All Your Progress

Therapy progress is rarely a straight line. Stress, loss, illness, relationship conflict, major transitions, and old triggers can temporarily reactivate familiar feelings or behaviors.

A setback does not necessarily mean therapy has failed.

Progress may be visible in how you respond to the setback. You might recognize what is happening sooner, ask for help, use a coping strategy, or recover more quickly than you would have in the past.

Rather than asking, “Why am I back at the beginning?” it may be more useful to ask:

• What is different about how I am handling this now?
• What did this experience teach me?
• Which tools are helping?
• What additional support do I need?
• Is there something important to discuss in my next session?

The ability to repair, reflect, and continue is itself a form of growth.

12. You Can Be More Honest With Your Therapist

The therapeutic relationship can provide important information about your progress.

You may initially feel pressure to be agreeable, avoid certain subjects, or present yourself in the way you think your therapist expects. Over time, you may feel safer expressing disappointment, confusion, anger, embarrassment, or disagreement.

Being able to tell your therapist that a session did not feel helpful—or that you do not understand the direction of treatment—can be a meaningful step.

Effective therapy should allow room for questions and feedback. Honest conversations about your experience can help clarify goals, identify obstacles, and strengthen the work you are doing together.

What Therapy Progress Can Look Like at Different Stages

There is no universal order or schedule, but progress may take different forms as therapy develops.

Stage	Possible signs of progress
Early therapy	Feeling understood, identifying concerns, establishing goals, and becoming more comfortable speaking honestly
Developing work	Recognizing triggers, connecting current reactions with recurring patterns, and learning new ways to respond
Applying change	Practicing different behaviors, setting boundaries, communicating more directly, and tolerating difficult emotions
Maintaining growth	Recovering from setbacks more effectively, making values-based choices, and using what you have learned independently

Some people move between these stages rather than progressing through them in a fixed sequence. A stressful event may temporarily require more support even after substantial growth has occurred.

Can Therapy Feel Worse Before It Feels Better?

Therapy sometimes brings greater awareness to feelings or experiences that have been avoided. Discussing grief, trauma, conflict, shame, or painful memories can leave you feeling emotionally tired or unsettled after a session.

Temporary discomfort can be part of meaningful work, but worsening symptoms should not automatically be dismissed as proof that therapy is working.

Tell your therapist if sessions regularly leave you feeling overwhelmed, unsafe, unable to function, or unclear about what is happening. The pace or focus may need to be adjusted. Your therapist should be willing to discuss your concerns and help you understand the purpose of the work.

How Long Does Therapy Take?

There is no single answer to how long therapy takes. The timeline can depend on:

• The concerns bringing you to therapy
• How long those concerns have been present
• Your goals
• Current stress and support
• Session frequency
• The type of therapeutic work
• Whether new concerns emerge
• The fit between you and your therapist

Some people seek help with a specific, current problem. Others want to understand long-standing emotional or relationship patterns. Those goals may require different amounts of time.

Instead of expecting a fixed number of sessions, consider establishing specific therapy goals and reviewing them periodically with your therapist.

How to Track Your Therapy Progress

Progress can be easier to recognize when you define what change would look like in your daily life.

Establish a Starting Point

Before or during early sessions, write down the concerns that led you to therapy. Consider their frequency, intensity, and effect on your relationships, work, sleep, health, and everyday responsibilities.

Choose Two or Three Meaningful Goals

Goals should be personally relevant and observable. Examples might include:

• Attending social activities twice a month
• Expressing concerns without withdrawing
• Recovering more quickly after an anxious episode
• Establishing a consistent sleep routine
• Making a decision without repeatedly seeking reassurance
• Setting one necessary boundary

Record Real-Life Examples

Keep brief notes about situations you handled differently. Specific examples are often more useful than trying to decide whether you generally feel “better.”

Use a Simple Rating

You might rate anxiety, mood, confidence, or daily functioning from 0 to 10 once a week. The goal is not to judge yourself but to notice changes and patterns over time.

Review Your Goals Regularly

Ask your therapist to review your goals every few weeks or months. You can discuss what has changed, what remains difficult, and whether the treatment focus still reflects what you need.

Questions to Ask Your Therapist About Progress

You do not have to evaluate therapy alone. Consider asking:

• What changes have you noticed since we started?
• How are we measuring progress toward my goals?
• What patterns do you think we are working on?
• What can I practice between sessions?
• Is our current approach still appropriate for my concerns?
• Should we adjust the frequency or focus of sessions?
• What would indicate that I am ready to reduce or finish therapy?

These questions can create a more collaborative conversation about therapy expectations and progress.

What If Therapy Does Not Seem to Be Working?

If you have concerns about your progress, begin by discussing them directly with your therapist. Sometimes the issue is an unclear goal, a mismatch in expectations, a pace that needs adjustment, or a topic that has not yet been addressed.

It may help to:

1. Clarify what you hoped would change.
2. Identify what has and has not improved.
3. Discuss what happens during sessions.
4. Ask about the therapist’s approach.
5. Revise your goals or treatment plan.
6. Consider whether another type of professional support is needed.

Not every therapist or approach will be right for every person. If concerns remain after an honest conversation, it is reasonable to consider a consultation with another qualified professional. Choosing a different therapist does not mean you failed at therapy.

Progress May Look Different for Adults, Couples, Teens, and Children

The meaning of progress depends partly on who is receiving therapy and why.

For adults, progress may include emotional awareness, symptom reduction, better boundaries, improved relationships, or more effective decision-making. Learn more about adult psychotherapy.

For couples, progress may involve interrupting cycles of blame and withdrawal, communicating needs more clearly, rebuilding trust, or managing disagreements more constructively. More information is available on the relationship counseling page.

For teenagers, progress may include improved communication, greater emotional regulation, healthier independence, or better functioning at home and school. Read about adolescent psychotherapy.

For children, changes may appear through play, behavior, emotional expression, relationships, and feedback from parents or caregivers. Learn more about child psychotherapy.

Frequently Asked Questions

How do I know if therapy is helping?

Look for changes in awareness, emotional regulation, behavior, relationships, symptoms, and daily functioning. Progress may also mean recovering from difficult experiences more effectively, even if those experiences still occur.

Should I feel better after every therapy session?

No. Some sessions may feel relieving, while others may feel tiring, uncomfortable, or emotionally challenging. A single difficult session does not determine whether therapy is effective. Persistent distress or worsening symptoms should be discussed with your therapist.

What if I understand my problems but still cannot change them?

Insight and behavior change do not always occur at the same pace. Recognizing a pattern is often an early step. Changing it may require practice, emotional work, and repeated experiences of responding differently.

Is it normal to have setbacks in therapy?

Yes. Progress is often uneven, especially during stressful events or major life changes. Consider whether you recognize setbacks earlier, respond with more awareness, or recover more effectively than before.

Can I ask my therapist whether I am making progress?

Yes. Progress, goals, and treatment direction are appropriate topics to discuss. Asking for feedback can help you and your therapist evaluate the work collaboratively.

Does changing therapists mean therapy failed?

No. The relationship between therapist and client matters, and not every match is suitable. Discussing your concerns first may help, but seeking another professional can be an appropriate decision.

When should therapy end?

Therapy may end when you have met your goals, feel able to maintain progress independently, or agree with your therapist that sessions are no longer necessary. Some people finish gradually by reducing session frequency.

Understanding Your Own Progress

Knowing how to know if therapy is working requires looking at both internal and external changes. You may not feel completely different from one week to the next, but over time you may notice that you understand yourself more clearly, respond with greater flexibility, communicate more directly, and recover more effectively from stress.

Therapy progress is personal. What matters most is whether the work is helping you move toward the emotional, behavioral, and relationship changes that are meaningful to you.

Dr. Sally Hackman provides psychotherapy for adults, couples, adolescents, and children, with in-person sessions in Santa Monica and telehealth appointments available throughout California. You can learn more about Dr. Hackman’s background and approach or contact the practice to discuss scheduling an appointment.