CBT Works in Uncertain Times

My client, Mary, came to see me for her OCD, perfectionism, and the resulting procrastination that threatened to keep her from being self-supporting and autonomous. Have you had a client like this? Life was not easy for Mary. I worked with her for several years, including a period of time that she was so disabled by OCD and depression that she had to go to a day treatment program for a month before she was stable enough to begin weekly work with me. She was determined to live independently from her parents and made the jump when she was 29. Even though she had been in the same job for a year before she moved into her own apartment, having to get herself up and out in the morning was a tougher challenge than she had expected, and she missed a week of work because after she missed the first day she could not think of what to say to her boss. Mary overcame that obstacle like she had all the obstacles before that – by recognizing the way anxiety was bossing her around. Anxiety set the topic. Anxiety is mean and picked every topic Mary cared about most. Mary learned that is just the way anxiety works.

This week Mary came to see me for a regular monthly booster session. I always have a goal to work myself out of a job with my clients, but a client like Mary who has made such enormous progress after a lifetime struggle with anxiety will need support for a longer period of time than someone who is dealing with a more specific phobia or shorter duration of anxiety. When we scheduled our monthly session in last month, it did not occur to either of us that this appointment would be after the election. Yet here we were, meeting after this polarizing election when I knew she had been a long-time supporter of Hillary Clinton. I admit, I was a bit nervous to see how she was doing. Smaller things than this have overwhelmed her before, and in my practice in the Washington, DC area, this week many people with less severe anxiety have been struggling.

Mary came in on time, neatly dressed, and began our session as we normally do by setting up an agenda. She said she wanted to talk about three topics: the election results, a new obsessive thought about her parents that was bothering her, and to strategize about an interview she had been asked to have for a promotion at work. Writing this, I feel the emotion of that moment sweep me again. I am so enormously proud of her. This brave, resilient woman had been saddened and shaken by the loss of her political candidate, but she was moving on in her life. She said, “I have been through hard things in my life. I have learned to say to myself, ‘I don’t like how that worked out, but I am interested to see what happens next.’” Wow. We spent about 10 minutes reflecting on her sadness about the election results and with her able to give herself credit for her success managing that sadness. Then we moved on to the other important topics on her agenda, her OCD and her upcoming interview.

I have seen many times in my practice that people who really do the work of CBT as they struggle with anxiety or depression reap the reward when tough times come. In talking to other therapists nationally this week, we all have noticed the same thing. CBT works, the results are long lasting, and it can help people in moments very different from the ones they had practiced. Life is uncertain. It’s wonderful to know that with CBT we can give our clients a strategy that can help them cope and even thrive living in this changeable world.

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