The patterns we think about, named — in case you didn’t know they had names.
Maybe you arrived here looking for one of these. Maybe you arrived here looking for a feeling and one of these names it. Most of what people bring to therapy is not a diagnosis — it’s a pattern with no name yet. Here are the ones we’ve learned how to think about.
These are grouped by the larger pattern they belong to. Each entry has a short note and a link — either to a specialty page where the larger pattern lives, or to a Field Notes essay if we’ve written about that specific everyday version. If you don’t see your version of one of these here, write to us. We’ll know what to do with it.
the 3 a.m. spiral
Anxiety & Overthinking
Read the full page on anxiety & overthinking therapy.
- Awkward Silence — the kind that lives in your throat after a meeting. Often anxiety, sometimes social attunement working overtime.The Zoom that ran two minutes long because no one wanted to be the first to leave.
- Crowded Places — the body that goes loud when the room does. Sensory-anxiety overlap.The Trader Joe’s parking lot on a Sunday at noon.
- Difficulty Sleeping — the brain that won’t close the tabs. Anxiety lives in the falling-asleep window.2:14 a.m., re-reading the email you sent at 4 p.m.
- Distractions — when focus has become impossible. Not laziness — usually unmet anxiety.Seventeen browser tabs open, and the deep-work doc not among them.
- Forgotten Appointments — the calendar that betrayed you. Working memory under load.The dentist office calling at 9:07 to say you were supposed to be there at 9.
- Forgotten Birthdays / Anniversaries — guilt-spirals that aren’t about caring less.The text you drafted at 11:47 p.m. and didn’t send.
- Misplaced Items — keys, again. Often a marker of cognitive overload.The phone in your hand while you look for the phone.
- Missing Deadlines — when the avoidance has become structural.The Friday email you couldn’t open all weekend.
- Overcommitting — saying yes from anxiety, not desire.Three things on Saturday you don’t actually want to do.
- Procrastination — fear of doing it badly, dressed up as time management.Reorganizing the spice drawer instead of opening the document.
- Smartphone Addiction — the scroll that’s actually anxiety regulation.The thumb that finds Instagram before the brain finishes the question.
- Stressful Environments — open offices, family kitchens, group chats.The chat that’s pinging while you’re trying to think.
- Unfinished Projects — the half-built shelf, the half-finished essay. Often perfectionism.The novel you’ve been writing since 2019.
- Unread Emails — 14,000 of them. The mounting that becomes shame.The inbox you stopped opening on weekends.
- Unreturned Calls — paralysis dressed up as procrastination.Your mom’s voicemail from Tuesday, still unplayed.
the loop
Relationship Anxiety
Read the full page on relationship anxiety therapy.
- Being Ghosted — when the not-knowing is louder than the loss.Three weeks of read receipts and one unanswered question.
- Breakups — the grief that comes in waves you didn’t schedule.Their hoodie in the hall closet, still folded.
- Canceled Plans — the small rejections that aren’t small.The Friday dinner moved twice, then quietly never rescheduled.
- Conflicts with Partner — the same fight, different costume.The fight that started about the dishwasher and ended somewhere your parents used to live.
- Difficulty Forming Meaningful Relationships — the wall that wasn’t there before.Three coffee dates you didn’t book a second time, and couldn’t say why.
- Falling Out With Friends — when the closeness ended and no one named it.The group chat that thinned to logistics, then to nothing.
- Jealousy Issues — the alarm bell that’s rarely about the other person.Their colleague’s name in a story you weren’t part of.
- Power Struggles — the fight that’s actually about being seen.Twenty minutes of who’s-right that started as a parking question.
- Separation or Divorce — the dismantling that’s also a making.The mattress that has to be split four ways.
the good-child trap
Family Boundaries
Read the full page on family boundaries therapy.
- Childcare Issues — when the village isn’t there and the expectation is.The school pickup you can’t afford to miss and can’t make either.
- Conflicts With Family — the holidays that drained you again.The Sunday dinner you left feeling smaller than when you arrived.
- Domestic Responsibilities — the unequal load that no one named out loud.The mental list — groceries, vet, laundry, birthday — and the partner who didn’t know it existed.
- Elder Care Challenges — the role-reversal that surprised you.The Tuesday afternoon you became the parent.
- Family Caregiving Burdens — the love that has weight you didn’t expect.The hospital parking lot you know better than your own block.
- Family Disputes — the inheritance fight that’s about something older.The lawyer’s office in October, and the dinner table in 1997.
- Family Estrangement — the distance you chose and the grief inside it.The relief that didn’t make the missing smaller.
- Family Illness — when the family system reorganises around the diagnosis.The new vocabulary that became the only vocabulary.
- Lack of Parental Support — the absence that shapes how you ask for help now.The text you draft to your parent, delete, and send to a friend instead.
- Parenting Challenges — the version of you that becomes a parent meets the version of you that was parented.The tone of voice that came out of your mouth before you could stop it.
- Unstable Home Environment — the childhood that didn’t stay still.Three schools in five years, and the friendships that didn’t survive any of them.
the exhausting yes
People-Pleasing
Read the full page on people-pleasing therapy.
- Conflicts with Friends — when honesty would cost you the friendship and silence is costing you yourself.The text reply you’ve drafted six times this week.
- Feeling Unappreciated — the resentment that’s asking to be heard.Two hours of cooking, twenty minutes of dishes, and a thank-you that wasn’t for either.
- Feeling Unheard — when speaking up feels like work the other person should have done.Saying the same thing three times in three different ways.
- Friendship Struggles — the friendship maintenance that became a part-time job.Your phone reminders for other people’s life events.
- Harsh Criticism — feedback that landed harder than it should have. Often early-attachment activation.The Slack message you re-read eleven times in twenty minutes.
- Peer Pressure — the social shaping that doesn’t end at 25.The drink you ordered because everyone else did.
- Pressure to Conform — fitting in as a survival strategy.The opinion you swallow before you’ve fully thought it.
- Pressure to Fit In — adult code-switching that hasn’t got a name yet.The version of you at work that doesn’t make it home for dinner.
- Social Obligations — the events you said yes to from a tired self.Saturday’s RSVP, made on Tuesday, regretted by Friday.
- Social Pressures — the unspoken rules that exhaust you to keep tracking.Who texted who first, and how soon you can reply without seeming too eager.
the doubts that loop
OCD & Intrusive Thoughts
Read the full page on ocd & intrusive thoughts therapy.
- Ethical Dilemmas — when moral certainty becomes scrupulosity.Replaying a comment from yesterday for evidence you’re a bad person.
- Performance Issues — perfectionism that’s actually compulsion.The presentation rehearsed eighteen times the night before.
- Pure-O patterns — intrusive thoughts without visible rituals.The same intrusive thought, eight hours of mental review, no one watching.
- ROCD — the relationship doubts that loop.The night you spent on Reddit researching whether love is supposed to feel like this.
- Harm OCD — the thoughts that scare you and don’t mean what they seem to mean.The thought that scared you, and the four hours of mental review that followed.
- Scrupulosity — religious or moral compulsion.Apologizing for the same prayer three times in case the first two didn’t count.
the food math
Disordered Eating
Read the full page on disordered eating therapy.
- Lack of Exercise — when not moving has become a sign of something.The walking shoes by the door, untouched for a month.
- Lack of Outdoor Time — the nervous system that needs what the day used to give it.The afternoon that disappeared without sky.
- Poor Diet & Nutrition — when food has become rules instead of fuel.The mental scoreboard you’ve been keeping since Monday.
- Body-image patterns — the mirror conversations you can’t stop having.The three outfits on the bedroom floor before a coffee date.
- Exercise-as-earning patterns — when movement has become punishment.The Saturday morning workout to undo Friday night’s dinner.
the tank you can’t refill
Burnout & Work Stress
Read the full page on burnout & work stress therapy.
- Academic Pressure — the GPA that became identity.The 3.94 that felt like a failure because it wasn’t a 4.0.
- Balancing School & Work — the impossible math of being 22.Closing the laptop at 11 p.m. and opening the textbook at 11:01.
- Boring Meetings — disengagement masquerading as routine.The fourth recurring meeting this week that could have been an email.
- Burnout — the exhaustion that sleep doesn’t touch.
- Career Stagnation — the ten years that look the same.The org chart that hasn’t changed since 2019, and the version of you that hasn’t either.
- Culture of Mediocrity — when the environment dampens what you want to give.The ideas you’ve stopped raising because no one ever picked one up.
- Heavy Workload — when output expectations outpace human capacity.Three deliverables due Friday, two of them quietly impossible.
- High Pressure Work — adrenaline as a default operating state.The 8 a.m. cortisol that arrives before the alarm.
- Inability to Save — financial anxiety that wears you in the body.The 28th of the month, and the math you avoid all evening.
- Inconsistent Schedule — the nervous system that can’t settle.The shift that starts at 6 a.m. on Monday and 4 p.m. on Tuesday.
- Insufficient Retirement Savings — future-self anxiety, current-self paralysis.The 401(k) statement you open and close in the same breath.
- Job Insecurity — the chronic threat that lives in the gut.Refreshing the company Slack on a Sunday for the layoff announcement.
- Not Getting Promoted — the grief inside professional rejection.The email that started with “we appreciate” and ended with “this round.”
- Overdue Assignments — the academic version of the email backlog.The reading from week three you haven’t done in week eleven.
- Performance Issues — the gap between what you can do and what you’re doing.The review that was kinder than it should have been, and the dread that came with it.
- Pointless Meetings — the disengagement that’s a symptom, not a stance.The Zoom you’ve muted to do email through.
- Poor Study Habits — usually a learning-style mismatch, not a moral failing.Three highlighter colors and still no idea what the chapter said.
- Poor Test Results — when the anxiety is louder than the knowledge.The question you knew on Sunday and couldn’t find on Monday at 9:15.
- Poor Work Habits — patterns that need pattern-level work, not productivity hacks.The seventh productivity app downloaded this year.
- Poor Work Quality — when the inner critic is louder than the actual feedback.The deck that’s “fine,” and the four hours you spent making it slightly less fine.
- Unclear Expectations — the chronic stress of moving goalposts.The Friday meeting where the brief from Monday was no longer the brief.
- Work Stress — the umbrella term for several specific patterns.The Sunday evening that arrives heavier than the week ahead.
- Working Long Hours — when the schedule has become an identity.The 9 p.m. desk lamp that has become the only light in the apartment.
the in-between
Life Transitions & Feeling Lost
Read the full page on life transitions & feeling lost therapy.
- Disengagement — the version of you that’s checked out without leaving the room.Showing up to your life the way you used to show up to a job you’d already quit in your head.
- Feeling Lost — the soft, persistent question: am I in the wrong life?
- Lack of Direction — when the map you were following ran out.The five-year plan that was someone else’s, and the year you finally noticed.
- Life Changes — the visible thresholds and the invisible ones.The Sunday after the move, when the new apartment hadn’t earned the word home yet.
- Life Satisfaction Issues — when nothing is wrong and nothing feels right.The list of things you’re grateful for, recited, and the flatness that didn’t lift.
- Life Transitions — the in-between that has its own grief.The friend who asked how you’ve been and waited longer than usual for the answer.
- Regret — the conversation with a past self that won’t resolve.The version of you that almost said yes in 2019.
- Spiritual or Existential Crisis — the questions that don’t have therapeutic answers but benefit from therapeutic space.The 3 a.m. question about what any of this is for.
- Cost of Living — financial precarity that destabilises identity.The rent that ate the raise, and the version of yourself that was waiting on the raise.
the friendships that thinned
Loneliness & Connection
Read the full page on loneliness & connection therapy.
- Difficulty Making Friends — adult friendship without the built-in scaffolding of school.The coffee invite you’ve been meaning to send for six weeks.
- Lack of Community Engagement — when the village has not been built and you don’t know how to start.The local bookstore you’ve been meaning to walk into for a year.
- Lack of Social Support — having people, technically, and not having anyone to call.The 1 a.m. when the news landed and your thumb scrolled past everyone in the favorites list.
- Loneliness — the gap between the closeness you have and the closeness you need.
- Social Fatigue — when extroversion is being asked of an introvert.The Sunday recovery from the Saturday brunch.
When we’re not the right fit
Some of what you might be looking for isn’t our specialty.
Therapy is most useful when the therapist has depth in what you’re bringing. The patterns below are real and worth working on — they’re just not where Align has trained the deepest. We’ve listed them here so you can find them faster somewhere else.
- Accidents & Injuries→consider trauma-focused care (EMDR or somatic specialist)
- Addiction→consider an addiction-specialised program or 12-step framework
- Digital Literacy→libraries, community colleges, and aging-services organisations
- Food Insecurity→211.org, local food banks
- Grief & Loss→we hold this in adjacent work, but consider a grief-specialist for primary care; a dedicated specialty page is on our roadmap
- Health Problems→primary care + medical specialist + integrative health therapist
- Literacy→adult literacy programs, local public library systems