A Case Example of Anxiety Treatment in One Session

Anxiety is often based in feeling that world is not a safe place. However, this is not always so. For some people anxiety can be a powerful motivator to succeed, a way to feel connected to one's parents, or countless other possibilities. This example is of a woman who is very surprised to discover that the hidden purpose of her anxiety is to be different from her family.

Grace, a nurse living in Oakland, CA, began our first therapy session saying she wanted to feel less anxious. I asked her to tell me about a recent example of her anxiety, and she told me about the previous night. Her husband was watching a movie and asked if she wanted to join him. She did, but complained the entire time about how much work she was not getting done. She told me that whenever she tries to take a break from work, she constantly feels anxious and is unable to enjoy herself. It had gotten to the point that it was beginning to create problems in her marriage, and she and her husband had begun to fight about her need to relax.

Curious about how her anxiety made sense, I asked her to imagine herself in the scene from last night, and described to her what she had told me. After a few seconds, I asked her if she was feeling her anxiety. She told me that she was and I asked her to describe how it felt in her body. She said, "It's like a hot, burning sensation in my chest. I hate how it feels." I asked her to stay with that feeling for now, and really allow it to be present. Then I asked her to try something that might feel a little strange. I said, "Now ask that feeling -- that burning sensation in your chest -- what it's job is. Try saying something like 'What is your job?' or 'How do you help me?' and then just listen for an answer." She was willing to try and paused for a minute or so. She finally said, "All I'm getting is 'I keep you from slacking off.'"

At this point, I wondered how not "slacking off" was worth the price of feeling so anxious and uncomfortable. I told her that I would give her the beginning of a sentence and ask her to let it finsh itself without pre-thinking the ending. The setence-stem was, "It is so important not to slack off because..." and she quickly said "It is so important not to slack off because my whole f***ing family are a bunch of slack offs." We repeated this process a few more times as it became increasingly clear how important it was for her to be different than her family.

She told me about her family's history of drug and alcohol problems and how embarrassed she felt growing up with them. I now felt like I was starting to understand. I asked her to try saying, "My anxiety is what keeps me from ending up being a slack off like my family. That is more important than anything, including being able to enjoy myself." She repeated it back and said it felt true. We spent the rest of the session looking at this new discovery from different angles and phrasing it in different ways. We finally wrote dow
"I refused to end up like my family, and I need my anxiety to keep that from happening."

I asked her to call if she needed another session, and asked her to look at her sentence a few times each day. When she called a few months later wanting to do a couples session, she told me that she now felt entirely in control of her anxiety. It would still come up from time to time, but she would know what it was about. She said she would just recognize how different she is than her family and that would make her feel much better.