How your therapy might be making your anxiety worse…
I distinctly remember when I first discovered exposure work. At the time I was working at a community mental health center…burnout and actually thinking of switching professions altogether. Most of us in the helping profession get into this field because we want to help, but it is all too common of a storyline that a therapist or social worker feels like they are running in a circle with their clients, not completely sure if they actually are helping or seeing their clients change.
It was actually just a few days before covid hit where I got a call from a contracting company inquiring about a therapist position. This company focused predominately on the treatment of OCD. The recruiter on the call described to me, briefly, the concept of exposure work and I was immediately intrigued. If I was being honest with myself, my therapy style wasn’t, and still isn’t, the “oh that sounds so hard," type of therapist. I would describe myself as a pretty direct person. I actually wanted to be a judge or a lawyer for the longest time before I last minute switched to mental health before grad school. Of course empathy is something I give, but I never thought that validation, empathy and paraphrasing was enough, but I followed along the therapy model so many of us are taught “hold space for your client, let them talk.” This company interested me because of their specialty. You see, in the therapy world once you become licensed you can “technically” treat any disorder. If you think about that, that is sort of wild. No way someone is a specialist in all the disorders in the DSM (the diagnostic manual for us clinicians). So, when I was working in community mental health, one hour I was seeing someone with a psychotic disorder and the next I had someone with PTSD sitting across from me followed by 3 other disorders or issues. I was treating dozens of different conditions, probably not effectively, so switching to a specialty in OCD and anxiety realted disorders was new, but eye opening.
Once I started with this company I quickly fell in love with the style. Exposure work requires a therapist to be direct, convincing and empathetic. This all fell perfectly with my personality. I immediately learned that this type of therapy ACTUALLY works. I was seeing real time, in session and outside of session, people get better. I immersed myself in learning about this therapy because I was stunned at the results I was seeing. It was so heart warming to witness people who have been struggling for years and years finally get relief and to be honest, I was finally getting relief and felt my burnout dissipate. For once, I felt I was actually being helpful.
I think so many clients need the structure and directness that exposure work provides.
Exposure work falls under the premise of “leaning into discomfort and uncertainty, versus trying to avoid it or prevent it from happening. Exposure work focuses on helping a person change their behaviors versus trying to change or understand their feelings. You see, when someone has an anxiety disorder they are doing things mentally and physically to make themselves FEEL like they are going to prevent a fear from happening. I capitalize the word FEEL because feeling is not fact and just because you feel like you’re problem solving, it does not mean you actually are. In fact, so much of traditional therapy encourages the client to explore questions like “why do you think you feel that way?” Im not saying these questions should never be asked, but they certainly should be asked sparingly with an individual who has anxiety. Someone who has anxiety already has spent countless hours trying to “figure out” damn near everything, and the truth of the matter is SOMETIMES THINGS DONT HAVE TO HAVE MEANING. Additionally, let’s be real, it really doesn’t take a rocket scientist to figure out why most of us are the way we are. This right here is often times why traditional therapy can worsen anxiety symptoms. Traditional therapy encourages people to “figure things out” and to apply “meaning” to things. AKA traditional therapy can oftentimes encourage rumination, which is a habit a person with anxiety desperately needs to break.
Instead…
A person with anxiety needs help practicing DOING. Let me share an example:
Client A comes in with a fear of driving. Instead of dissecting why they have the fear, take a few sessions to understand and empathize, but from there drive IN SESSION with the client as much as possible, maybe start with a drive around the block or even just sitting in the car, work your way up to high ways and then eventually a road trip. Integrate clips of car accidents and statements like “I could get into a car accident.”
Why drive in session? The place in the brain where fear lives doesn’t understand language, so you cannot convince someone that they can drive, but you can SHOW them.
What’s up with the statement “I could get into a car accident.” I know, I know, sounds wild, but stay with me. The reason you would suggest a person with anxiety say this is because the best skill you can teach an anxious person is how to stop trying to figure out everything. If we are all being real, ANYTHING is possible and saying something doesn’t now mean it’ll happen. But, when a person with anxiety acknowledges that they don’t have the ability to control the future (by saying this phrase) you are giving them gift of relief. You are teaching them that yes, anything can happen, but we have the choice as to weather or not we consume our lives with trying to predict the future.
Why the clips of car accidents? People with anxiety often have what we call thought action fusion, meaning they think if they feel, think, see or say something that means it is going to happen. Now, most people with anxiety understand that is not really how the world works, but they feel like it (there’s that feeling word again). Remember, anxiety and fear doesn’t understand language so telling a person with anxiety “that isn’t how it works,” wont do much help, again you must SHOW them that isn’t how the world works, so let’s test it out… let’s watch a car accident clip and let’s see, do you now all of a sudden get into a car accident?
There will be much more where this came from, but if this resonated with you, please follow along for more…
