Every time a new client with anxiety sits in my office with their brain’s twisted version of danger signals, I find myself wondering, “What if I can’t help this person who is suffering and so desperate to feel better?” Anxiety is a powerful force and it can sweep us away with it. I like to think that my own anxiety is often just looking for a friend to be bullies with and is happy to join forces with my client’s fears. After several minutes of this, my own fears begin to quiet down as I listen to the stories that are so typical from our clients and yet feel so real to them. One of my favorite parts of being a therapist is developing a relationship with my clients. As I focus on this, helping them to feel safe while they are vulnerable and leaning in because each person is so interesting and anxiety is so endlessly fascinating, I remember that this is the most basic and yet most important part of therapy. If you haven’t developed a safe, caring and compassionate relationship with your client, nothing else we teach you will really matter. Learning evidenced based treatment for anxiety and OCD has helped me as a clinician.
Oftentimes our clients fear they are going crazy. I have consulted with many clinician’s who wonder how to discern whether their client is experiencing an anxiety disorder, Obsessive Compulsive Disorder (OCD), or a psychotic disorder. My response is to tell them to listen. In that first session, while you are developing that relationship, listen to how your client describes their struggles. If their symptoms are egodystonic (thoughts and goals that are in conflict with who they believe they are), then they are suffering from anxiety. This often sounds something like, “I know this sounds crazy and I don’t think I would ever do that, but I can’t stop thinking of…..”. Being clear and confident that your client is suffering from an anxiety disorder or Obsessive Compulsive Disorder is key to developing your evidenced based treatment plan.
Now that you have developed a relationship with your clients where it is safe for them to be vulnerable and share their fears and you are clear about their diagnosis, you can move forward with the next thing that matters. There are two important concepts to teach your client that are key to helping a person who is suffering with anxiety or OCD and those are uncertainty and distress. Anxiety bullies our clients into believing if they just avoid, get clarity, know for sure, get reassurance, check one more time, talk it over several more times, …. they will feel better. However, the key to feeling better is choosing to not know, to live in the doubt and accept the uncertainty. This feels almost impossible to our clients so it is part of our journey with them to help them to tolerate “maybe” and “I don’t know”. The other way anxiety messes with people is by making them feel physically and mentally awful! It is their instinct to get away from pain and suffering so we need to teach them how to embrace it.
This therapy isn’t for the weak at heart and it takes a strong therapeutic alliance to help your clients into these uncomfortable places. However, if you take small steps with your clients, encourage them, believe in them, and celebrate with them, you will also begin to see your own fears dissipate with the knowledge that you understand what matters when treating your clients with anxiety and OCD.