Complicated Clients Part II

Elizabeth Spencer

Complicated clients look to clinicians to help with their terrible suffering from anxiety or OCD, which is often combined with other problems. In Part I of this Blog, I suggested that cases that are complicated fall into two broad categories: severe disability due to anxiety, and anxiety combined with another serious health, mental health or economic problem. In this blog, I consider ways to broaden the help and support for your complicated clients.

Most of our clients with complicated anxiety and OCD will need medication management from a psychiatrist or primary care doctor. Sometimes you may be able to collaborate with this prescriber to develop a comprehensive treatment plan. For example, the prescriber can help a client with many health-related concerns by limiting referral for follow up tests that would only be done to appease the client’s anxiety. On the other side, clinicians can be important advocates for our clients when doctors are not listening to crucial medical information. I think of a client with severe panic disorder as well as diabetes who started a longer-acting medicine for her diabetes and began waking at night with what she thought were panic attacks. When she tested her blood sugar, however, she found her blood sugar level was way too low and she needed her doctor to know that information quickly so her dose could be adjusted, but the doctor initially thought she was calling about panic attacks and sent her to her psychiatrist. One of the difficulties with anxiety and health problems is some clients are seeking too much care and some clients are not taken seriously by prescribers because their symptoms are brushed aside as “just anxiety.” Since we see our clients more frequently than prescribers, we are often in a good position to help either way.

Support Groups or Activities
Clients with severe anxiety or OCD are often isolated and underemployed. Family members may be burned out or stretched thin supporting the client financially and unable to be companions or coaches. Consider helping your client find other people and activities. One socially anxious client who also wanted to lose a considerable amount of weight found joining a Weight Watcher’s group to be a double success – she learned how to eat better and she also had people to practice her new social skills with ( Meetup groups are often a great way to find people to do things with ( One client, a single mother who was severely limited with agoraphobia started a Meetup group in her area for other single moms and found tremendous support that allowed her to venture further from home than she had before. She was able to terminate treatment once she had that new support system, and she sent me an excited email several months later saying she and her son had made it with the group to an amusement park 2 hours from her home – further than she had been in years. For clients who are more limited in being able to get out of the home, consider on-line support groups, like those on or For clients who have signs of trouble with alcohol, of course Alcoholic Anonymous is a great place to find help. One client who I sent to AA recently told me she thinks I saved her life by encouraging her to attend meetings. She has been sober for 90 days this week.

Whenever possible, consider looking for other sources of support or help for your clients who have complicated problems to give them the best chance to get well and lead productive, satisfying lives not limited by anxiety or OCD.
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