Therapy for overthinking and rumination in Seattle

If you track when someone's overthinking gets worse over a few months of weekly sessions, a pattern shows up that I didn't learn from any textbook.

The worst weeks usually aren't the hardest ones. A brutal deadline week is busy, but you're mostly doing things. The loops come in the gaps: the days after a final-round interview, waiting on a test result, the week after sending your manager an email that still hasn't been answered.

Overthinking tracked uncertainty far more closely than it tracked difficulty. Give most people a hard task with a clear next step and their minds settle down to work. Give them an outcome they can't affect yet and the rehearsing starts.

I still use this. When someone tells me their overthinking has gotten worse lately, one of my first questions is what they're waiting on. Often they hadn't connected the two.

Two features separate rumination from useful reflection.

It's abstract. Rumination asks why am I like this, what does it mean about me, why does this always happen. Those questions have no answers, which is why the loop never ends. Concrete thinking asks what specifically happened and what the next step is, and those questions run out.

And it's about control. Underneath the loop is usually a bet: if I can anticipate every way this could go wrong, I can prevent it. That bet turns a worry into a rehearsal of the worst version, and it explains why the loops cluster around waiting. You can't argue a control strategy out of a nervous system that believes the strategy is keeping you safe, which is why "just stop thinking about it" has never helped anyone.

A related distinction: rumination mostly faces backward. It circles what already happened and what it says about you. Worry faces forward, toward what could go wrong next week. Most overthinkers do both, often within the same hour, and in therapy the work on each looks much the same.

Addiction treatment, where I was a clinical lead before private practice, makes one kind of rumination very easy to see: the loop that starts after a slip. In my experience it rarely produced insight. It produced shame, and shame tends to make the next slip more likely, not less.

Most of the people I see now aren't in recovery. The post-mistake loop has the same shape anyway. You sent the email with the wrong attachment, or you snapped at your kid, and the next six hours belong to a prosecutor in your head. It feels like taking responsibility. It works more like punishment, and it leaves you less able to repair anything.

So when the loop is about something you did, I'm interested in a smaller, more specific kind of reflection. What happened, what you'd do differently, who needs to hear from you. Then it's allowed to be over.

Night removes every distraction and every possible action and leaves you alone with the material. Falling asleep requires your nervous system to accept that nothing needs guarding. Rumination is the argument that something does.

The bedtime loop and the 3am loop are different problems. At bedtime the day usually had nowhere to land, so it helps to give the open items somewhere to go an hour or two earlier, written down with one concrete next step each. At 3am the activation has a head start: you wake with your heart already going and the thoughts arrive to explain it. I'd treat it as something happening in your body first. Breathe slowly, keep the lights low, and if you're still wide awake after a while, get up and sit somewhere dim instead of lying there negotiating.

Honestly, these are tools for the moment and nothing more. If the underlying vigilance never comes down, you'll be doing the technique every night forever. The rest of this page is about bringing it down.

Yes. It's one of the things therapy does best, and with me it usually covers four things.

Catching the loop earlier. Most people notice they're spiraling twenty minutes in. Getting that down to two minutes is most of the practical work, and it's a learnable skill.

Changing the question. People sometimes expect a psychodynamic therapist to keep asking why. Early on I mostly ask when and where, because "why am I like this?" is the loop's favorite question. Swapping it for "what's in front of me right now?" trades a question with no answer for one that has an answer.

Working with the body. By the time you're spiraling, your body is already activated, and you can't reason with an activated body.

Finding out what the loop is protecting. This is what produces lasting change. For many of the people I see, rumination is standing guard against something specific: an old humiliation, or a fear of getting it wrong in front of someone who mattered. That's the attachment-based part of my work, and it's why this doesn't have to be a lifelong management project.

Some loops loosen more easily on the move. When the weather allows, I offer walk-and-talk sessions along the Edmonds waterfront, which I wrote about in sometimes the best therapy begins with a walk outside.