Monday, September 22, 2008

Ever Thought about Therapy by Phone?

photo by Leo Reynolds
Have you ever wanted to talk to someone but talking in person seems really uncomfortable? Have you ever considered doing it over the phone instead?

Today psychotherapist and educator Tim Desmond from Coherence Counseling shares an experience of what you can expect from phone counseling.

Here is a case history from a recent client.

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 to let me know when she was there. 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 finish itself without pre-thinking the ending. The sentence-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 "I refused to end up like my family, and I need my anxiety to keep that from happening."on an index card for her to read a few times a day.

I asked her to call if she needed another session. 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.

Thursday, September 18, 2008

Worrying is a Wasteful Use of Energy


It’s interesting how many times the anticipatory anxiety is worse then whatever event I am worrying about. Of course the baby blessing and family BBQ were just fine. The baby slept through the whole thing and was a delight afterward. The food was yummy and we had a great time. I was able to manage any little bits of anxiety that arose. The worst was beforehand when I couldn’t stop thinking about all the What ifs!


Do you consider yourself a worrywart? I know I am. If you are then you might be plagued by "The Worrier" as well. Any fears that we can write down that start with "What if..." is a horrible waste of our time and energy. However its probably what effects me the most. I am always worrying about things that haven't even happened yet. And how many times like the example above do I need to show myself that they are empty, worthless thoughts. They rarely come to pass and in the mean time all I have done is added a few more wrinkles and grey hairs.


Imagine all that you or I could accomplish if we could channel all the time and energy we use worrying into something positive. Easier said than done, but still an interesting thought.

Sunday, September 14, 2008

Why Must We Strive for Perfection?

Today is my daughter's baby blessing. I have been nervous about today for a long time, and this morning my anxiety level is really high. I haven't felt this anxious in a really long time. I finally felt things slipping out from my control and so I am forcing myself to write things out to help calm me down. So many things could go wrong today, granted they are all little and not a big deal but I have this huge desire for everything to be perfect. I am hoping things are somewhat organized but forgive me if I babble. Things that are bothering me:

What if we are late to church in the first place?
What if she cries through the whole blessing?
What if she poops all over her pretty dress before we even make it in the doors?
What if she doesn't eat enough before hand and is hungry and won't stop crying?
What if its not perfect?

I thought these thing through thinking, what if all of the above happened, whats the big deal? Why am I so worried? And then it hit me. Deep down inside I am telling myself that if any of these things happen, I am a bad Mother. And then I realized a whole new role had opened up in my life for people to judge me and me to worry about.

As if to prove a point that things weren't going to go right, when I woke up yesterday my Little One had scratched all across her nose with her fingernails leaving a long, first-thing-you-see-when-you-look-at-her, scratch mark. Luckily I am familiar enough with Photoshop to be able to remove it from pictures, but it still seemed like the mark represented a failure. "If I was better at keeping her nails short, this wouldn't have happened." "If only I was a better mother," is what I was telling myself. How mean I am to myself. I know I am not a bad mother, but subconsciously I am thinking this over and over again. I want so badly for everyone to think I have everything under control. So I had to tell myself over and over again that I am a good mother. Replacing the negative thoughts with a positive one seemed to help calm me down a little.

So here goes. Taking deep breaths. We have to leave in about an hour and a half. I haven't even grazed on the fact that all of the family is coming over to our house for a BBQ afterward and the anxiety that I will most likely feel there. I will update this afterward to let you know if and how I handle any panic attacks.
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