Introduction

When people come to therapy feeling overwhelmed, stuck, or caught in a loop of self-doubt, they often expect change to follow a neat, linear path. In reality, the process is much more fluid. You move between awareness, understanding, skill-building, and action in a way that matches your situation, your values, and whatever life throws at you that week.

To show what this looks like in the real world, I want to share a case example.
Let’s call him David, (name and details changed for privacy).

David came to therapy feeling stressed, anxious, and constantly on edge at work. Although he was managing a team, he felt like an imposter who was just about holding things together, and understandably, that took a toll on his mood, sleep, relationships, and sense of control.

Here’s how we worked through the Four Steps, and how they overlap, loop, and reinforce one another.

Step 1: Growing Awareness - Seeing the Patterns Clearly

When David first arrived, everything felt tangled: stress, exhaustion, longer hours, irritability, feeling “not good enough,” and a creeping fear that someone would notice he wasn't coping.

We began by exploring the specifics:

What did the anxiety look like day-to-day?
What thoughts popped up in moments of pressure?
What behaviours kept the stress cycle alive?
When did he feel most like an imposter?
What was he doing to try and feel safer?

The clearer the picture became, the more he noticed a familiar loop:
the more he feared not being good enough, the more he avoided delegating, the more responsibility he took on, the more overwhelmed he felt, and the more the anxiety reinforced itself.

This early awareness wasn’t just “paying attention,” it was the start of perspective-taking, seeing thoughts and behaviours as patterns, not personal failures.

Step 2: Making Sense of the Patterns - Understanding Why You Get Stuck

As the awareness grew, we shifted into meaning-making.

Instead of treating his stress as evidence that he “couldn’t cope,” we explored what his anxiety was trying to achieve. We talked about:

the mind’s problem-solving bias
how anxiety overestimates threat
how it tries to protect us from the feeling of inadequacy
why overworking can feel safer than delegating
how shame and fear shrink our options
the threat–drive cycle that drains energy and increases pressure

We also used metaphors and imagery, personifying anxiety like an overprotective bodyguard, understanding feelings as signals with jobs, recognising the “hungry tiger” of perfectionism, and accessing the soothing/safeness system to rebalance the nervous system.

This helped David see what was happening with more compassion and accuracy.
Not “I’m a failure,” but “I’m stuck in a loop that makes sense given what I’m afraid of.”

That shift alone loosened the grip of shame and opened space for change.

Step 3: Building Skills - Creating a Different Relationship with Thoughts & Feelings

As soon as David had some understanding of the loop, we introduced skills, not in a rigid order, but as tools that matched what he needed in specific moments.

He practised:

Stepping back from thoughts (“There’s the ‘I can’t delegate’ story again.”)
Dropping anchor during intense moments
Grounding and attention-shifting to reduce overwhelming mental noise
Changing posture and breathing to regulate his body
Compassion-based imagery to activate soothing rather than threat
Reframing self-talk from “I must get this right” to “What’s workable here?”
Allowing discomfort rather than trying to remove it

None of this required him to feel confident.
It simply created psychological space, enough room to choose a different response instead of falling into old patterns.

Step 4: Action - Small Steps That Match His Values

Once he had clarity and skills to support him, we identified values to guide action:

leadership, not overworking
fairness and trust
collaboration rather than control
presence in relationships
caring for health and energy
engaging in life outside work

From there, action became less about fear and more about intention.

He started with tiny steps:

delegating one small task
resisting the urge to rewrite the team’s work
finishing work on time once or twice a week
restarting exercise
reconnecting with his partner
having honest conversations about pressure instead of hiding it

The aim was consistency, not perfection, and as he practised these steps, his confidence grew, slowly at first, then steadily.

What Changed for David

Over time, David noticed:

His approach to work became calmer
He took the pressure off himself rather than pushing harder
He worked more like a manager - leading, not rescuing
His sleep improved, and the early-morning dread eased
He re-engaged with exercise
He reconnected with his partner and friends
He felt less gripped by imposter feelings
He trusted himself more, even when doubt showed up
Stress reduced, and irritation stopped spilling out at work

The imposter thoughts didn’t vanish - they just stopped driving the bus.

How the Four Steps Interact in Real Life

David’s story is a good example of how these four steps actually unfold:

They are not linear.
You move between them constantly.
Awareness deepens as you take action.
Understanding grows each time you practise a new skill.
Actions become easier when you reconnect with your values.
Skills strengthen when you revisit awareness.
And the whole process loops, reinforces, and evolves.

This is what real psychological change looks like.

If you’re feeling stuck in your own loop, therapy can help you learn how to move through these steps in a way that works for your life, your values, and your goals.