Do You Feel the Pressure to Help Your Client Get Well Using CBT?

Kimberly Morrow

I am passionate about helping my clients live well with anxiety and I have a pretty good arsenal of CBT skills that really help them get well. However, I also find myself getting swept up into the belief that learning more, practicing more, climbing over every obstacle, and persevering is the best way to help clients.  Leave it to my clients to teach me.

Recently, I have been working with some adolescents who are really suffering with anxiety as well as complicated family systems. They have waited a long time to see me and I felt the pressure to get them well quickly. It didn’t take long for me to realize that using an evidenced-based, manualized approach was not making much of a difference. I felt ineffective. I sought supervision from colleagues, I googled, I read, but these kids were still suffering.

It was helpful to hear from my colleagues who are experts in the field that they had compassion for these kids and empathy for me, as their therapist. They thought I was “doing” all the right things. That sometimes we just don’t know why people continue to struggle. Some suggested I end therapy and refer to family therapy or more intensive treatment. These have all been helpful suggestions but I was seeking more.

Last week I went for a walk in the woods and decided to sit on a rock near the creek and meditate. I noticed the leaves falling off the trees and was struck by how innocent the leaf seemed. I focused on one particular burnt orange leaf as it seemed so helpless. I watched the wind blow it off the tree. I watched it fall into the creek and be carried downstream by the current. This leaf bumped up against a rock and got stuck. It eventually found its way to the water again and flowed downstream. I found myself changing my belief about this leaf. It no longer seemed helpless. It was just present in the experience it was having. It was allowing the stream to carry it. It stayed stuck for a little while and trusted that  it would find the stream again. It wasn’t trying to get back to the tree that had given it support and life . It was just flowing with whatever happened next. On its journey the energy was coming from the water, a new source.

Well I pondered this for a long time. I find myself wondering about the urgency I sometimes feel to help my clients using the CBT model. I wonder how they would be served just by my presence on their journey, observing their struggles, trusting that they too will get unstuck and be carried along in life by some source. Maybe this source won’t be their complicated family system. Maybe it’ll come from somewhere else.  I am now challenging myself to change my beliefs about these kids. Instead of seeing them as innocent and helpless, maybe I could see them as kids who are bravely facing this journey they are on toward self discovery and self love. It is quite a journey that is powered by many forces including our parents, our experiences, people who help along the way, friends, nature, spirit, as well as medicines and evidenced based treatments.  Suffering is a necessary part of this journey, as much as I wish it wasn’t.

Maybe, as therapists we can learn how to better be present when we feel so stuck; to be observers of the process; to help our clients allow and accept their experiences; to trust that their obstacles are an important part of their growth; and then to offer them some CBT skills that may become a part of guiding them to wellness.


If you are seeking support and guidance from colleagues on your difficult cases, you may find help through the Anxiety and Depression Association of America, clinical supervision with someone in your community, or Case Consultation  with




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