We interact with others through the medium of our identity; without it, I lost the capacity to interact and was suddenly beyond the reach of my family and my friends, who I felt were relating to a "me" that no longer existed. Even the art of writing, to which I'd devoted my life, seemed an empty exercise; I continued to write because it's my livelihood, but now the voice of my writing seemed the voice of a stranger--which was very nearly unbearable.

Teens and preteens today pulsate with anxiety in a pressure-cooker youth culture and an explosive world, ever at the edge. Not that you'd know it when you first meet them. For the most part, they don't act particularly scared. But for all their apparent bravado, kids need the felt presence of adults—the undeniable evidence that we can be emotionally there for them, keeping them safe and providing them with the structure and guidance they crave in a frighteningly chaotic world. Nothing less seems to hold their anxiety, or capture their digital-speed, supersaturated attention.

To focus on the unconscious psychological roots of an individual's anxiety has become an anachronism. But how many of us, with a toolbox full of today's methods, reliably bring about a decisive cessation of our clients' intense anxiety and panic? In the first few years of my clinical career, I found that with standard methods I could often help clients mildly relieve their anxieties, but that I rarely achieved a radical reduction of symptoms. Yet there were occasional sessions in which I abandoned conventional clinical wisdom and tapped into a deep layer of personal meaning in the symptoms. When I did that, clients' symptoms often ceased from one session to the next, and never recurred. For several years, I systematically examined what was different about those sporadic sessions that yielded such profound change. What I found was a surprise.

How does a therapist decide whether to use therapy, medications, or a combination of both to treat anxiety? How can a clinician determine whether the long-term use of medications might actually prevent a client from learning to conquer anxiety? The answer lies in recognizing the distinctions between different forms of anxiety and carefully assessing the client's own history to determine what kind or combination of anxieties he or she experiences.

While intense anxiety is often diagnosed as a disorder, fear is a normal human response when life is threatened, compelling us to pay attention in the interests of survival. Anxiety, worry, insomnia, nightmares, hypervigilance, and difficulties with concentration have become widespread in the current climate of color-coded terrorist alerts and bio/chemical/nuclear weaponry. These steps offer tools for paying attention to fear, building up one's fear tolerance, and letting fear be, which is the only true way to let it go.

My approach to helping clients deal with panic attacks and phobias focuses initially on teaching them breathing and relaxation exercises, and then encouraging them to gradually face the feared situation without getting so panicky. I often find it a very slow process. Is there any way to speed it up?

To the ordinary observer, people who are rude in a restaurant, obnoxious at their child's soccer game or overly exacting of their employees might seem simply self-centered. But often, these individuals are dealing with a wide variety of inner phantoms.

Perhaps depression is simply hard to convey--even, as Styron says, "indescribable." But I'd like to suggest another possibility: That what we call "depression," like the mythical black bile, is a chimera. That it is cobbled together of so many different parts, causes, experiences, and affects as to render the word ineffectual and perhaps even noxious to a full, true narrative.

Many walk into the therapist's consulting room exactly at the moment, and because of the moment, that they have been stripped to the core of their being. While not at the physical meeting-point of life and death, they are often at its emotional and spiritual equivalent. One element they seek and are desperate for, one element they usually feel they've lost, is beauty; they present a situation that's cut them off from experiencing beauty. They may not articulate it that way, but that's what's going on.

After two decades of working with people suffering from phobias and other expressions of disabling fear, I still remember clearly two clients whom I met more than 15 years ago.