Combatting Anxiety, “Bird by Bird” By Donna C. Moss, MA, LCSW-R on 4/10/19 - 1:03 PM

It occurred to me the other day that I was laughing with a client because I completely and utterly understood where she was coming from. And then it hit me. No wonder I've been so busy helping my young adult clients overcome anxiety—wait for it—I “have it”, or should I say, “it has me” too!

Of course, I have known this for many decades, but that day I had a kind of breakthrough. I can laugh at the insanity of it all. I've been there and done that on almost every occasion. My client Elsa said she was afraid of driving over bridges. Hmm, I don’t have that one. But I do have the one where my husband is driving too fast and I think I’m going to fall into the Hudson River. Then there’s the one where I’m going on a job interview and I think to myself, “OMG, I have gained so much weight since I had kids!” Or my mind goes blank and I forget everything I ever accomplished. Then there was the time my puppy ran across the highway and I had a panic attack. The worst is ruminating. Although I teach clients all day about fight or flight or freeze, I forget that I myself need to take a break from overthinking. When my kids started driving, I gained a new and paralyzing dread that someone would run into them. Add to that health and money worries, and sirens passing by while I’m quietly doing paperwork at home—catastrophizing is my specialty.

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Self-care is our therapy buzz-word and it works wonders. My friend, a fellow therapist, said I need a spa day. “Do it!” My patient debated the whole day if she should take a “mental health day” from her demanding teaching schedule. “Do it!” Another patient wondered if she should take up journaling again. “Do it!” And the very process of pushing through your fears is instructive; it combats avoidance. My client was afraid to call her doctor for some results. “No problem, do it in my office.” My client was terrified to sleep over at his Dad’s new apartment. “Build up to it.” Once, many years ago, when my mother was dying of cancer, a kind and wonderful boss at Disney.com handed me a laptop and said, “I’ll see you when you’re ready.” Ask for help. Take a small step. All the clichés stacked up to the sky, or, as Annie Lamott says, “Bird by Bird.” The simple catchphrase, “Do it” flows so easily from my mouth—it just doesn’t quite make it to my ears and into my brain.

Clients often ask me, “How I can begin to trust my inner voice when all I know is worry.” And I tell them “For one thing, you have a choice. It’s your life. Own it. Take care of it.” It seems to me that people in other countries get more time off to recharge. Only here do we grind ourselves until there’s no more fuel.

And, let’s see if we are mislabeling anxiety as something else? If it’s not anxiety then what is it?

1. Anxiety from the past may be triggering a fear of abandonment. My client Mary wants to marry her boyfriend but thinks he might be cheating. She stalks him on Facebook, Instagram and Twitter on an hourly basis, based on her "hunch." She finds nothing but cannot stop her obsession. This is no longer a gut feeling, it's a bad habit, a self-destructive, relationship-bombing behavior that is sure to drive someone away. In this case, although there is no evidence whatsoever that he's a cheater, Mary continues to rely on her false "gut feeling" which only serves to create more anxiety and self-sabotage. Go back to where it’s coming from and try to counter the fear with a more realistic appraisal.

2. Anxiety masks as fear of the unknown. My client Joya wants to go out with a boy from her fraternity, but he is a “player.” When he finally asks her out, she says no based on what her friends have said. The information she has obtained is from the past, and unproven, especially since Joya really likes him. She continues to rely on second-hand information instead of living her own life. She is more afraid of the unknown than finding out the truth about him by using her own judgment. Unknown fears need to be faced, not avoided. Sometimes when I’m driving to a new place, I make it a habit to stop somewhere en route to pick up a treat or run an errand. This makes the unknown into a little adventure.

3. Anxiety is not the same as intuition. Jessica thinks her boyfriend is simultaneously dating someone else. Her so-called intuition is based on patterns and evidence that she has directly observed—he's always late, keeps his phone locked away and acts sneakily. Intuition tells her from observed experience that he is hiding something. Anxiety, fueled by insecurity misguides her into convincing herself that he is doing something wrong and that he will inevitably leave her, instead of leading her to confront him directly. As psychologist David Barlow warns us, “don’t believe everything you think.” “Ask him what's going on instead of making up stories in your head,” I suggest. Test the intuition with objective observation. Your anxiety may have something to tell you.

If this sounds tricky, it is.

Intuition can be considered a neutral and unemotional experience, whereas fear is highly emotionally charged. Reliable intuition feels right, it has a compassionate, affirming tone to it. It confirms that you are on target, without having an overly positive or negative feel to it. Fear is often anxious, dark or heavy.

Take a step back and breathe deeply for a moment. What's the worst that can happen? What part is objective and what part has no business in the present? If it belongs in the past look at what happened. It's over. You are safe now. The only way to separate from rumination is to pause. My last client of the evening recounted her fight with her ex-girlfriend over text. “Please Hannah,” I said, “unplug for just five minutes. Then assess how you feel. You are only feeding the attention-seeking behavior of your ex. Can you step back? What will happen if you just sit quietly?”

Can a therapist, this therapist, heal herself? The phone rings, the news blares, and real tragedy rings into our consciousness, implanting itself in vivid living color from a smart TV into our visual field whether we want it or not. I can help my clients not because I’m master of my anxiety and of my fate, but because I’m continuously right there with them. My friend calls and says “Let’s take a walk.” “Yes, I say. Let’s do it, everything else can wait.”  


File under: The Art of Psychotherapy, A Day in the Life of a Therapist