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When to Involve Family in Therapy

How often do you involve family in therapy sessions when you are treating an anxious client? In my practice, I encourage my clients to invite anyone who may be involved in “helping” them with their anxiety. I can’t imagine not having family and friends in our sessions. These are the people who have been beat up by anxiety and OCD. They have been in the trenches with my client. They know anxiety patterns even better than my clients sometimes.

Not only are family and friends a rich resource for you to learn more about your client’s anxiety patterns, but they are key to helping your client get better. I always say that anxiety goes to the weakest link. Anyone who cares deeply for your client instinctually does whatever it takes to help them feel better. Unfortunately, this makes family and friends easy targets for anxiety.  In our sessions, we want to harness their care and compassion in a way that is actually helpful, which is not the way anxiety and OCD have trained them to respond.

I was congratulating a mother of an 8 y.o. girl with severe separation anxiety recently. She and her husband have worked long and hard to set appropriate boundaries with their daughter’s anxiety. During that day’s visit, the mom wanted to speak to me alone for 5 min. She told her daughter to wait in my group room while we spoke. Her daughter became triggered and started to tear up, clenching onto her mother’s pant leg. In the past, her mother would have agreed to have her stay and sit quietly. This time she looked at her daughter and clearly stated that she needed to go to the group room for 5 min and that she might feel bad about that but she believed she could handle it. Wow! This was such a different response than I had ever seen her have with this child. Once alone in my office, I gave her a high five and told her how proud I was of her. She said that her time in our sessions has been invaluable in regards to how she responds to her daughter’s anxiety.

Reassurance seeking and avoiding are two main coping strategies people with anxiety use to feel better. It only makes sense that we would need to teach family and friends how to refrain from reassuring by giving them other language to use. I tell my clients that their family and friends will have a more challenging time changing their language than my client will have in facing their fear. Family members also find themselves caught in the trap of taking care of things for their loved one with anxiety and OCD. Without proper training from you as a therapist, they may not know how to get unentangled from supporting avoidance strategies.

If you don’t consistently involve family members in anxiety therapy sessions, I hope you will reconsider. It could change the course of treatment in a wonderful way!

 

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