Welcome to the third edition of In therapy: Working through anxiety.
In this post, I would like to talk about how therapy can help work through anxiety. As mentioned before, I will write from the perspective of what I do in the counselling room, what feels congruent and most helpful to my clients.
In another post, I’ve described the focus and goals of each of the main approaches I use – psychodynamic, person-centred and cognitive-behavioural – and mentioned other techniques and modalities that I might use.
Let’s get right to it…
As we talked about in the first post in this mini-series, anxiety is a response to danger, which was essential for survival in the times of cavemen. These responses still remain in us as fellow human beings, but are now triggered by different situations – not imminent danger, but still perceived as such.
My aim in working through anxiety with a client is
to understand the problem and how it came about
to trust in my client’s inner strengths and resources to work through what brings them to therapy
to challenge the thoughts and feelings that are expressing themselves in the form of anxiety
A psychodynamic approach will focus on understanding the roots of the problem. These roots are usually unconscious and originated in the client’s past. These past situations might have happened in the client’s childhood, or due to a trauma.
In brief, the thoughts and feelings linked to the situation that caused distress in the past, are most likely hidden – or repressed – in the client’s unconscious mind. This means that these thoughts and feelings are outside of the client’s awareness, and would cause the same or greater distress as when originally experienced.
The Ego acts as the guardian of the person’s consciousness, and when the unconscious tries to bring up the repressed material, the Ego will make a sort of deal with it and say “you can’t come out like this, it will be too much for the client, come out like this instead”. And the alternative way is where symptoms come about – in this case, anxiety symptoms.
Maybe the individual didn’t have a chance to develop good affect regulation skills due to neglect or other parental deficiencies, including insecure attachments; maybe the client didn’t have good models on how to deal with different situations in life. Therapy is a way of re-learning some of the things that the client might have not developed growing up.
It might take time to get to the origin of the anxious symptoms, but once it is reached, the change that I see in my clients is organic, and long-lasting. It is by processing the unconscious causes of anxiety that therapy can restore or develop better ways of dealing with situations – past, present and future.
Therapy doesn’t give us amnesia, so what we experienced will still be present in our minds, but we will have built up our resilience, our coping mechanisms and our understanding of what we are experiencing in the present as anxiety. We will be able to work through anxiety and be better equipped to carry on with life much quicker than before therapy helped us understand and process our thoughts and feelings.
I work in a Person centred, in that I believe in the client’s ability to self-actualise and to build the resilience and skills needed to live a happy life, in spite of the situations that might be leaving them feeling stuck at present.
In regards to cognitive-behavioural techniques (CBT), I believe it’s important to challenge negative thoughts that the client might bring. CBT sees anxiety as an exte
rnal stimulus, and therefore works with the client’s environment which might be the cause of their symptoms.
I take from CBT the fact that the client might need to:
reframe the risk that they might be under – are they in any real danger or can we work on the perceived danger and what the real consequences of the anxiety-provoking situation might be;
be able to work through the situation as it is happening – through developing breathing techniques, self-soothing talk, talking themselves away to regroup, and others I have written as tips in the past two posts.
Challenging the client’s thoughts and behaviours regarding anxiety-provoking situations, together with understanding the origin of the problem, are an effective way of working through anxiety.
Finally, using prescription drugs such as anxiolitics and mood stabilisers is a good, temporary solution, but ONLY IF used as a way to help the client be more present and able to think about their issues in therapy. I don’t believe that drugs in themselves can solve the internal conflict that leads the client to anxiety. I believe they help but not long-term. And not on their own.
If you have any questions or comments about what you’ve read, you can leave them below or message me privately.
Next week look out for a new topic in the series In Therapy: Working Through…