36,309 clients. 139,687 appointments. One Sydney private practice. Four shifts in fifteen years that align with what international datasets are also showing.
About this report. This is a longitudinal case study from one multi-location private practice in Sydney, Australia. It is not a population sample and it is not a global mental-health study. The Sydney data is presented alongside WHO, OECD, Eurostat, ABS and other public datasets so readers can see where the practice-level pattern aligns with - and where it diverges from - broader international evidence.
Across 36,309 clients seen between 2011 and 2025 in one Sydney private counselling practice, four shifts stand out. None of them is unique to Sydney. Each aligns with a pattern documented at population or workforce level by the World Health Organization, OECD, Eurostat, the UK Office for National Statistics, the UK Health and Safety Executive, the Australian Bureau of Statistics, and other public bodies. The role of this dataset is to document those shifts at the level of the consulting room: who is presenting, with what, and how that has changed.
Anxiety is now the leading presenting issue for female clients (25.8%), narrowly ahead of relationship issues (24.9%). Aligns with the WHO finding that global anxiety and depression prevalence rose 25% in the first year of the COVID-19 pandemic, with women more affected than men.
For the first time in this 15-year dataset, female clients (12.2%) cite work stress as a primary issue at a higher rate than male clients (8.6%). Aligns with Gallup's 2025 finding that women report consistently higher daily worry and stress than men globally.
In 2011, 6 of 982 clients (0.6%) presented for burnout. By 2025, 69 of 2,427 (2.8%) did - a roughly five-fold rise as a share of clients once practice growth is taken into account. Raw client count rose 11-fold over the same period. Aligns with WHO's 2019 inclusion of burn-out in ICD-11 as an occupational phenomenon, and with Gallup and McKinsey survey evidence that women experience burnout at substantially higher rates than men.
Men in this practice presented for help with suicidal ideation at almost the same rate as women (0.84% vs 0.82%) - yet die by suicide nationally at 3.2× the female rate. This 3.2× ratio matches the WHO global figure for high-income countries.
For the first time in fifteen years of intake data from this Sydney practice, anxiety has become the most common primary presenting issue for female clients, narrowly ahead of relationship issues. For male clients, relationship issues remain the top category. The Sydney shift maps onto a body of international evidence indicating that anxiety prevalence - particularly among women - has been on a structural upward path since 2020.
Anxiety now sits at the top of the list. Work stress is the fourth most common presenting issue for female clients. Source: ACPS internal client intake records, 2011–2025.
Female anxiety rate jumped from a 2011–19 average of 12.5% to a 2021 peak of 24.3%, settling at 17.8% in 2025 - well above any pre-pandemic year.
In 2025, anxiety (25.8%) is the leading primary issue for female clients, narrowly ahead of relationship issues (24.9%). For male clients (not shown), relationship issues remain #1 (27.4%) with anxiety #2 (18.1%).
The Sydney practice data captures, at clinical level, a shift that appears in larger international datasets. US clinician surveys are reporting the same caseload shift in aggregate, and the strongest direct parallels - large, peer-reviewed, national counselling-service datasets that have documented an "anxiety overtakes another presenting issue" pattern within the same 15-year window - come from Australia and the UK:
The Sydney practice's female anxiety rate (25.8% in 2025) sits within the range that international population-level surveys have been reporting for women's anxiety and depression in the post-2020 period. The shape of the change - anxiety displacing another long-standing top category as the leading reason for presentation - has already been documented in a peer-reviewed national-scale Australian counselling dataset (Rickwood 2023, n=58,233 at headspace), and in regional UK youth counselling data (Mind 2024). The Sydney case-study finding does not establish a global trend on its own; it documents one clinical-level view of a shift that population data, peer-reviewed counselling-service data, and large clinician surveys are all picking up.
Throughout the 2010s, men in this practice consistently presented with work stress at higher rates than women. In 2025, that pattern reversed: 12.2% of female clients cited work stress as their primary issue, against 8.6% of male clients. Aggregate work stress also reached its highest recorded level in the dataset, at 13.9%.
In 2025 female clients (12.2%) presented with work stress as a primary issue at a higher rate than male clients (8.6%). Source: ACPS internal client intake records.
Aggregate work stress has risen every year since 2015. The 2025 rate of 13.9% is the highest in the 15-year dataset.
Several international workplace data sources are now showing the same gendered pattern that the Sydney clinical data is picking up - though the surveys vary in methodology and definitions. US workforce surveys are reporting the same female-skewed pattern, alongside UK and global data:
The Sydney finding - that female clients have for the first time overtaken male clients on work stress as a primary presenting issue - is consistent with what large international workplace surveys are now reporting for women's daily stress and burnout. Whether the Sydney clinical signal is leading or trailing those surveys is not a claim this dataset can support.
Burnout was barely a presenting category in this practice in 2011, when 6 of 982 unique clients (0.6%) cited it at intake. By 2025, 69 of 2,427 unique clients (2.8%) did - a roughly five-fold rise as a share of presentations after accounting for the practice's own growth, or an 11-fold rise in raw case count. The growth is most pronounced among female clients aged 25–44, and the steepest single-year jump is from 2020 to 2021.
Burnout grew from 0.6% of unique clients (6 of 982) in 2011 to 2.8% (69 of 2,427) in 2025 - a roughly five-fold rise as a share of clients. Plotted as percentage of unique clients per year to control for the practice growing from ~1,000 clients per year in 2011 to ~2,500 per year by 2025. Raw case count rose 11-fold (6 → 69) over the same period; both figures are accurate, but the rate-based figure is the one that controls for practice size. Growth is most pronounced among female clients aged 25–44. Source: ACPS internal client intake records.
Two structural factors plausibly contribute to the rate at which burnout now appears in the Sydney intake data: WHO's 2019 formal recognition of burn-out (which made it a category clinicians and clients alike could use), and the post-2020 elevation in workforce exhaustion documented by McKinsey, Gallup and others. The Sydney rise - 0.6% to 2.8% as a share of clients, or 6 to 69 in raw count - is consistent with both of these structural shifts. It is not, on its own, evidence of either.
The most internationally portable finding in this dataset concerns the male suicide help-seeking gap. The pattern - men dying by suicide at multiples of the female rate, while seeking professional help at similar or lower rates than women - is documented globally. The Sydney data offers a clinical-level view of that gap: across fifteen years of intake records, men and women in this practice presented for help with suicidal ideation at almost identical rates, while national mortality data shows men dying by suicide at 3.2× the female rate.
Suicidal-ideation presentations are near-equal across the 15-year window (90 male, 84 female). Self-harm skews female. These figures likely under-capture ideation: many clients present primarily with depression, anxiety or relationship issues and disclose ideation later. Source: ACPS internal client intake records, 2011–2025.
Source: Australian Bureau of Statistics, Causes of Death, Australia 2024 (preliminary). Men in Australia die by suicide at 3.2× the female rate. The highest-rate demographic is men aged 55–64 at 30.9 per 100,000.
The 3.2× male:female national mortality ratio observed in Australia in 2024 is the same ratio that WHO reports for high-income countries as a group, and it is consistent with the 3.0–3.7× range observed in the UK home nations. This is the structural pattern the Sydney data is documenting from the consulting-room side: men in this practice present for suicidal-ideation help at the same rate as women, while national mortality data shows them dying at three times the rate.
The composition of why people in this practice seek counselling has changed substantially over fifteen years. The most visible inflection point is COVID, which produced a clear step-change in anxiety. Work stress and burnout show structural upward trends that pre-date COVID and have continued past it.
All four series are plotted as a share of unique clients seen each year, so they can be compared like-for-like and the practice-growth confound is controlled. Anxiety shows a clear COVID-era step-change. Work stress shows a gradual structural rise across the 2010s, accelerating from 2020 onwards. Burnout was negligible in 2011 (0.6%) and rose to 2.8% by 2025 - a roughly five-fold rate increase. Suicidal-ideation presentations remained low and roughly stable across the period. Source: ACPS internal client intake records, 2011–2025.
2011–19 average rate 12.5%. Jumped to 21.1% in 2020, peaked at 24.3% in 2021. The 2025 rate of 17.8% remains well above any pre-pandemic year.
Aggregate work stress has risen every year since 2015. The 2025 rate is the highest in the dataset, and (as Section 03 sets out) now affects female clients at a higher rate than male clients.
A roughly five-fold rise as a share of clients (6 of 982 in 2011, 69 of 2,427 in 2025; an 11-fold rise in raw client count). WHO's 2019 inclusion of burn-out in ICD-11 made the diagnosis category visible to clinicians; the post-2020 workforce-exhaustion shift documented by Gallup and McKinsey is the broader context.
Gender was inferred from client first names using the gender-guesser library (see Methodology). Of 36,309 clients in the dataset: 11,608 male (32%), 11,026 female (30%), 10,944 couple sessions (30%), with the remaining ~8% unable to be classified by name. The differences in presenting issues are clinically significant and are largely consistent with gender differences documented in international population-level data.
Anxiety is the leading primary issue for female clients (25.8%) and the second-ranking issue for male clients (18.1%, after relationship issues). The 7.7-percentage-point gender gap is consistent with Eurostat 2019 (8.7% women vs 5.5% men reporting chronic depression).
Female clients (12.2%) now present with work stress at a higher rate than male clients (8.6%) - a reversal from earlier years in the dataset. Aligns with Gallup 2025 finding that women report higher daily stress and burnout than men globally.
16.6% of male clients vs 5.5% of female clients present with anger management as a primary issue. One of the largest gender gaps in the dataset.
Combined addiction presentations (substance, behavioural, gambling, pornography) affect approximately 1 in 5 male clients versus 1 in 20 female clients - a 3.6× gap. Consistent with international epidemiological evidence of higher male prevalence across most addiction categories.
Source: ACPS internal client intake records, 2011–2025. All addiction types grouped into "All Addiction." Couples and unclassified clients excluded from this chart.
This is a longitudinal case study from one private practice. Read the methodology before lifting figures: every quantitative claim in this report carries a methodological caveat, and the case-study framing is what makes the findings defensible.
gender-guesser Python library. Couple sessions were classified as "Couple." Accuracy is approximately 85–90% for common English-language first names; lower for names common across multiple genders or for non-English-language names. Approximately 8% of clients could not be confidently classified and are excluded from gender-disaggregated figures.The full table below is provided as a research resource for journalists who want to cite issue-level rates that are not addressed in the four headline shifts. A client may have more than one presenting issue recorded at intake, so percentages do not sum to 100. Source: ACPS internal client intake records, n = 36,309 clients across 2011–2025.
| # | Presenting issue | % of all clients | Notes |
|---|---|---|---|
| 1 | Relationship issues | 26.4% | Top issue overall; #1 for male clients |
| 2 | Anxiety | 22.2% | #1 for female clients (25.8%); see Section 02 |
| 3 | Depression | 17.4% | Higher for female clients |
| 4 | Work stress | 13.9% | 2025 aggregate rate, all-time high; see Section 03 |
| 5 | Anger management | 11.5% | 3× more common in male clients (16.6% vs 5.5%) |
| 6 | Family conflict | 9.7% | |
| 7 | Grief / bereavement | 8.5% | |
| 8 | Trauma / PTSD | 7.8% | |
| 9 | Self-esteem / identity | 7.4% | |
| 10 | Parenting | 7.0% | |
| 11 | Stress (general, non-work) | 6.2% | |
| 12 | Communication issues | 5.9% | |
| 13 | Couples therapy (general) | 5.6% | |
| 14 | Sleep issues | 4.7% | |
| 15 | Workplace bullying / conflict | 4.2% | |
| 16 | Pornography use | 3.6% | 97%+ male clients |
| 17 | Substance use (alcohol, drugs) | 3.4% | Higher for male clients |
| 18 | Sexual issues | 3.2% | |
| 19 | Burnout | 2.9% | ~5-fold growth as a share of clients (0.6% to 2.8%); 11-fold in raw count. See Section 04. |
| 20 | OCD / obsessive thoughts | 2.5% | |
| 21 | Eating issues | 2.1% | Higher for female clients |
| 22 | Gambling | 1.7% | Higher for male clients |
| 23 | Phobias | 1.5% | |
| 24 | Suicidal ideation | 0.83% | Near-equal across genders; see Section 05 |
| 25 | Self-harm | 0.32% | Higher for female clients |
Categories with fewer than ~50 client presentations across the 15-year window are excluded from this summary. Underlying data and additional category breakdowns available on request via media@counsellingsydney.com.au.