Working with Anxious Clients
There are a lot of ways that one can work with anxious people, but I have found over the years a very helpful process that I would like to share with you. With any process it’s best that you make it your own and use what is helpful to you, and discard what is not. Also, processes have a way of not always moving in a linear direction, so what I have to share with you may take a different starting point than I suggest, or you might notice one step forward and 3 steps back when it seems so simple and straightforward in print. So I offer my insight to you in hopes that it bears some fruit in your work with anxious people.
When a new client steps into my office and they are struggling with anxiety, I usually have a process laid out in my mind of how I would like to direct the sessions in order to help them work their way through anxiety. But as is the case with therapy, it’s helpful when a client comes to session with their own thoughts and ideas, and a desire to work on something they have been thinking about all week. In any case, here are some recommendations.
Six Steps in Helping Clients Work Through Anxiety
Normalize anxiety as part of the human experience.
I can’t say enough about this first step. By the time someone steps into your office to talk about their anxiety, they have more than likely been wrestling with a lot of internal negative messages from their anxiety, and probably a number of negative external messages from people around them. So the very fact they are sitting your office, across from you, is an act of courage in my opinion. And because of that courageous act I strongly believe it’s important to let them know that having anxiety is normal. Anxiety is part of the human experience. To be human is to experience anxiety. Welcome to humanity.
One of the reasons this is so important is because many of the people that I work with are coming from faith backgrounds, and a very common message when faced with anxiety is to be told to simply not be anxious. After all, the apostle Paul in Philippians 4:6 declares this message, so why are you anxious is often the question put back on the person with anxiety. On many occasions I will be working with a new Christian client and they will tell me that one of the reasons they ultimately decided to come see a therapist was because they didn’t feel emotionally safe in their faith community to talk about this issue. Many tried talking to a pastor, or small group leader, or friend, only to feel like something was wrong with them or their faith based on the comments and suggestions that were given to them. I tackled this topic in an earlier post in this series, and I highly recommend you read it.
And faith issue aside, many people just struggle to reach out for help, so when you can normalize anxiety for someone who is anxious, I believe you offer them a huge gift. And in the process, what you are communicating is that your therapy room, and working with you is going to be a safe experience where they can truly be themselves, free of judgment, regardless of how much anxiety they may bring with them.
Reframe anxiety as an opportunity for growth.
As I wrote in an earlier post, anxiety is information that gives us clues about what is going on inside and outside. It tells us about the state of our internal lives such as struggles we have with identity and personhood, as well as telling us about the state of our external struggles as we wrestle with safety and relationships. But none of this is accessible unless the person you are working with believes that the anxiety they suffer from can actually be used in a redeeming matter. Anxiety is either moving us towards health and growth, or it’s moving us towards unhealth and destruction. So how we cue into anxiety will often determine which direction we will be going.
When I tell clients that their anxiety can be used as an opportunity for growth, you should see their eyes light up. They respond with either a hopeful word because it’s the best news they have heard all day, or they respond with a too good to be true look…after all, anxiety brought them into therapy so how could it be good. But as the therapist, you have the opportunity to guide them on a journey to growth as you help them listen to their anxiety.
Identify the root feelings and emotions that drive the anxiety (Pain Cycle).
After you have normalized anxiety for a client, and then let them in on the good news that their anxiety can be used as a tool for transformational growth, then it’s time to begin to do the work of identifying the underlying roots of their anxiety. As I mentioned in another previous post in this series, anxiety is a response to an underlying root issue, and when that isn’t clear, the therapist and client end up constantly chasing down the symptom, and applying band aids to a wound that never heals because the root issue hasn’t been identified.
In my work in Restoration Therapy, I help a client identify the roots of their anxiety, and then show them how anxiety is a response to their underlying feeling. This work is known as the Pain Cycle and it has been transformative in not only my personal life and my anxiety, but in my therapy work with others.
Identify the truth and actions to help transform the anxiety (Peace Cycle).
Once you have helped a client (and probably in conjunction with it), it’s important to move to work on the Peace Cycle which helps a client identify an emotionally regulating truth that will give them direction in terms of a healthy action. This can often be a hard step in the therapeutic work, and it’s where I usually spend the most of my sessions with clients. Because anxiety is a response to an underlying feeling, it’s critical to find a truth that speaks into that underlying feeling, and allows the client to move in the direction of non-anxious behavior. Like the Pain Cycle, I often will use handouts with clients, as well as helping them locate their truth from God, self, or others.
One of the things I mentioned in a previous post is that this can often be a difficult step with Christian clients. As a Christian myself, I know that it’s quite tempting to give the Sunday school answer to the questions, “What is the truth about you from God’s eyes?” or, “What does God want you to know and believe about yourself?” Clients don’t hesitate and often respond with things like, God wants me to know that “I am loved”, or “Have value”, or am “His son or daughter.” And it’s not that these truths, aren’t true. It’s just that they are often intellectual beliefs that are stuck in their head, but they haven’t made the journey to the heart where transformation takes place. So it’s important to push back in some gracious and healthy ways with Christian clients so that they can move from the automatic Sunday school answer to one that is more life changing for them because it’s something the know deep down and have experienced.
The apostle Paul writes in the book of Romans, in verses 12:2:
“Do not conform to the pattern of this world, but be transformed by the renewing of your mind. Then you will be able to test and approve what God’s will is—his good, pleasing and perfect will.”
I often cite this verse with clients to let them know, that sometimes the way that truth works it way through us, especially from an easy, cliched Sunday school answer to one of real depth that creates change, is that it begins with the renewing of our mind. We can start to think right thoughts, and as we do that it makes it journey to our hearts where that truth becomes belief.
Provide tools and resources to help manage the anxiety.
I believe that for anxiety to be reduced and managed, and ultimately worked through, clients need some tools and resources to engage them in the process of practicing and working on their anxiety. The good news is that today there are more than ever more tools to help with anxiety, and with all the great technology available to us, there are lots of accessible tools for people to use.
I wrote an earlier post in this series exploring a variety of tools that are available not only to therapist to give to clients, but for clients to access on their own. When it comes to tools, I continue to use the 4 steps of the Pain and Peace Cycles in the Restoration Therapy model as my foundation tool, and from there I employ a variety of peripheral tools that clients can use to gain insight from, as well as to practice.
I don’t think it’s enough that we just do talk therapy with clients, or that we simply try and help them gain insight about their anxiety. In this day and age especially, it’s important for therapists to encourage the use of tools that a client can engage in using. Because it’s that engagement of the tools that make up the practice component of therapy that I consider really vital to change.
In an earlier post I wrote that my formula when working with people is typically something like this: Insight + Deliberate Practice = Transformational Change. I believe that for many people struggling with anxiety, practice is the missing component. A therapist can spend countless hours helping a client gain insight into their anxiety, but that is often all for not if the client can’t create change from the insight.
I often tell clients that I think we therapists have often been doing a disservice to them by not laying out a framework for counseling that includes a large portion of practice in it. Without this clear pathway with practice as a core component, clients can often get lost in a black hold of therapy that is untethered from a roadmap to success.
I’ve heard lots of stories about the countless hours that Michael Jordan put into deliberately practicing varying components of his game. He was meticulous about it. And that deliberate practice paid off in his game play in what many would consider flow. I’ve also heard lots of stories about Michael Phelps and how his coach would encourage him to “Put in the videotape” as he would play through every detail of his perfect race. That deliberate practice came out in many gold medal performances in the form of flow. This is what practice looks like. Individuals and couples with anxiety may not be practicing for an NBA Championship or Olympic Gold Medal, but when they do deliberately practice, their working through issues and conflict is often experienced as flow.
I have suggested in this post a framework for working with client who struggle with anxiety, because I believe it’s a helpful framework that has helped keep me grounded in my work with clients. Anxiety has a way of ungrounding someone, especially someone like me who has a history of struggling through anxiety. So I appreciate having a roadmap for success when working with anxious clients. But it’s also a roadmap that can be flexible and you can make it to your own liking. After all, to be a good therapist, especially with an anxious client we have to be able to read a situation and act accordingly.
I hope you have found this information helpful, and if you do nothing but one thing, I implore you to let them know that their anxiety is an opportunity for growth and it can be used for their good. That alone can transform anxiety.
Rhett Smith is a Licensed Marriage and Family Therapist in private practice in Plano, TX. He specializes in helping people struggling with anxiety find new opportunities for growth, as well as spending a majority of his week with couples as they navigate relational issues. He is the author of The Anxious Christian: Can God Use Your Anxiety for Good? and What It Means to Be a Man: God’s Design for Us in a World Full of Extremes. Rhett lives in McKinney, TX with his wife Heather and their two children. You can discover more about Rhett’s work through his writing and podcast at rhettsmith.com