Joshua Fletcher is a psychotherapist, author and media personality, who has written and tweeted extensively about his specialist subject, anxiety. Fletcher has experience from both sides of the couch, having suffered from acute anxiety and panic attacks.
Here, Fletcher tries to explain the basics of psychotherapy, using four real patients, with names and details altered to preserve confidentiality. We meet self-harming Noah, who hints cryptically at a dark secret in his past; famous actor Daphne, whose confident public persona is very much at odds with her private self. There’s nightclub doorman Levi, whose wife and community are convinced he is possessed by an evil spirit that must be exorcised through self-flagellation; and Zahra, a successful doctor whose crippling anxiety means she can barely leave the house.
Their interactions are written as direct dialogue between therapist and patient, akin to reading a play or a two-hander on TV, with the added insight of Fletcher’s internal responses to his patients’ confessions and behaviours. These veer from insightful to hilarious, depending on which of his inner voices is engaged.
The conversational tone ensures the book zips along, and Fletcher is a skilled enough writer that he engages us with each character, so we are anxious to see how their therapeutic journey works out. This is not fiction, though, so not every therapist-client relationship comes with a happy ending.
In between the spicy confessions and page-turning anecdotes, Fletcher delves into the origins of anxiety, the various modalities of therapy and their differences, as well as the evolution of the “fight or flight” response to now include “freeze or fawn”. He also writes beautifully and devastatingly about his own family history, especially a tragic event that contributed hugely to Fletcher’s own mental struggles.
Perhaps surprisingly, he also describes the positives of anxiety, its ability to “make life more fun”, from the thrill of scary movies to “the exhilarating frustration” of following competitive sport.
Fletcher’s writing has been compared to Adam Kay’s and while he is frequently funny, this ultimately feels more serious than Kay’s work (which itself makes some very telling points about how we treat and train medical professionals). Fletcher sets out to make anxiety approachable and to rid therapy of any taboos; on both counts, he very much succeeds.
