How does your t approach your anxiety in sessions?

[barefoot]

My anxiety is very high at the moment.

I had my first therapy session following Christmas break yesterday. I think I had a belief - that perhaps, on reflection, was just a naive hope - that my therapist would be able to help me calm down. I was keen to go to the session because I felt certain that I would come out feeling less anxious than when I went in. The opposite happened - I felt much worse, much more anxious when I left, to the point where I took Valium on the train home.

I told her what was going on and how anxious I felt...told her that aspects of the anxiety were worse than they have been for ages...kept saying how I needed to calm down but I couldn’t seem to manage to do that.

And she just kept nodding a lot and saying it was understandable that I was feeling anxious and encouraging me not to label my anxiety response as “stupid” because it isn’t... I think she was perhaps trying to normalise some things and to encourage me to be more self-compassionate and to accept the anxiety as opposed to trying to fight it or make it wrong.

But the past week has been pretty much a write off because I’ve been so immobilised by the anxiety. In other words, this isn’t my pretty normal experience of having some anxiety. It feels off the scale, out of control and I’m just not managing it effectively to be able to get on with day-to-day things. It feels all-consuming.

I don’t know what I actually wanted my therapist to do instead. I just had this hope/belief that she would be able to do something there and then to reduce the anxiety even a little bit.

I feel disappointed that that didn’t happen. But I don’t know if I am having unreasonable expectations about what a therapist can achieve in a session when working with a highly anxious client. Was I really just doing the equivalent of wanting my therapist to be able to wave a magic wand and make it all stop? Which, obviously, she can’t.

So, my question is, how does your therapist handle it when you are in an unusually highly anxious state in sessions?

Are they ever able to say/do anything to calm you? And, if so, what do they say/do?

Thanks.

 

[UnicornSightings]

My anxiety is very high at the moment.

I had my first therapy session following Christmas break yeste...

I’m so sorry you’re experiencing such high anxiety! I know how that feels. And if you’re experiencing it to such a new high level then you need a solution. Something to make it manageable. Did you ask your therapist for help? In my experience, they won’t just freely give it. “Hey. So my anxiety is sky high right now and it’s not only affecting me here but when I leave as well. Can we work on some things to lessen this?”

You can do breathing exercises and grounding things. My old t actually gave me a lot of things to work on. But that was for “normal level” anxiety. With my new therapist my anxiety is VERY high where I find it difficult to speak at times. I occasionally take big gasps of air. What personally works for me is accepting it. This is anxiety and just welcome it to stay. There’s nothing wrong with it. So I will take big gulps of air and he will ask “how’s it going over there?” and we will laugh. I know he feels bad I’m so anxious but I’m really not looking for a way out of it. For me, the way out is through. So accepting that it’s there. I just told my new t that what I need from him is just to be ok with it. And we do our best then with it being present. If you judge it, you will anger it. Lol. So be accepting. It’s ok to feel it. When you allow your experience it creates a tiny space. That space becomes your salvation. So my advice is allow your anxiety. Breathe through it. And if you just can’t function, ask your t for help. If she doesn’t help you, she sucks. Find a new one. They all should know how to help with anxiety that’s like the number one reason people go to therapy.

 

[MyWillow]

I’ve walked in and we’ve spent 80% the session on breath and safer place work. Not so much the latter anymore as I realised I was actually dissociating....hearing going was my first clue. So we do more of being aware of tension in my body, visualising what colour it is, what message my body is giving me (“RUN!!!”) and then taking in warm white light to change the colour. Saved my @r$e a few times.

 

[EveHarrington]

I think it’s important to be direct when we need something. Are you able to ask for help when you need help? If your therapist tries to be a mind reader or only asks you if you need XYZ, she is in effect doing the hard work for you. I know it’s sucks in those moments, but it’s very important that we are able to ask for what we need and not expect others to read our minds and just give it to us. Hugs.

 

[MyWillow]

Yes I really struggle to know what I need but my T reads me like a book. Sometimes great, sometimes bloody annoying lol

 

[ButterflyBean]

Hi @barefoot, first and foremost, I wanted to simply empathize. As you probably know, anxiety is often a symptom of an underlying emotion. Therefore, my first question is, are you able to verbalize what you need when you feel a certain way in session? Ex: “I need to hold my teddy bear when I’m scared, or wrap myself in a blanket etc. In the same way, I’m feeling really anxious, so I need your help, and I need you to XYZ”. If not, it’s OK, I’m just wondering.

And she just kept nodding a lot and saying it was understandable that I was feeling anxious and encouraging me not to label my anxiety response as “stupid” because it isn’t... I think she was perhaps trying to normalise some things and to encourage me to be more self-compassionate and to accept the anxiety as opposed to trying to fight it or make it wrong.

The above, exactly! She was being direct with you in a nonjudgmental way. Use that example, that modeling, and see if you can be direct with her. Something like, “it seems that you were trying to normalize the way I was feeling last session; however, I felt like you were dismissing my anxiety. I’m feeling really anxious, and I need your help to calm down in the moment, right now. It’s hard for me to be compassionate toward myself when I’m anxious, and the anxiety has paralyzed me since I saw you...”

You also said that you had this belief/idea that she would automatically help you calm down. I think it was actually a need. Can you see the difference? Does that make sense? Something else to think about: how do I want my therapist to handle my anxiety in session? What do I wish she would say or do (within reason, of course)?

For me, decreasing anxiety is about finding ways to ask for what I need. It’s also about permission to have my feelings just as they are. Not easy, but completely necessary! Please keep us posted, good luck! I believe in you!

 

[barefoot]

Thanks for the replies. There are some things for me to think about here.

You can do breathing exercises and grounding things. My old t actually gave me a lot of things to work on. But that was for “normal level” anxiety.

Yes, exactly...breathing exercises (which my T introduced to me early on our work) usually work well for me and I have some other grounding things that I do for “normal level” anxiety.
They’re just not cutting it with this current frenzy though. Hence I was hoping T might be able to help me in the session as the normal level anxiety I just manage by myself.

Did you ask your therapist for help?

I think it’s important to be direct when we need something. Are you able to ask for help when you need help?

are you able to verbalize what you need when you feel a certain way in session? Ex: “I need to hold my teddy bear when I’m scared, or wrap myself in a blanket etc. In the same way, I’m feeling really anxious, so I need your help, and I need you to XYZ”.

OK...so, looking back, no, I didn’t directly ask her for help. In that I didn’t explicitly say the words, “I need you to help me with this now”. But I said repeatedly how bad my anxiety was, how things about it were worse than they had been for ages, how I wasn’t managing it, how I needed to calm down but I didn’t know how to make myself calm down...

I kept telling her that I knew the things I was stressing about were irrational because, intellectually, I know they’re not going to happen but knowing those things didn’t seem to help how frightened and anxious I feel because it all feels frightening and dangerous. And her response was to keep telling me that it was understandable that I feel anxious because anyone would feel anxious about it and then telling me lots of rational things about why I didn’t need to stress too much about them. Which, in my highly anxious state, just agitated me more because I found it frustrating. Because I just wanted to say “I KNOW THIS! I know what you’re saying is true. I know nothing bad is going to happen. So I know I don’t need to be losing my shit about this. But, despite knowing this, I am still losing my shit about this. Big time! And my whole body feels like it’s going to explode! So, can you perhaps help me with that instead of just speaking to me calmly and reasonably, which isn’t helping?!”

Anyway...I didn’t say that!

I’m not very good at knowing what I need or, if I do know, expressing what I need. My T used to ask me quite regularly, “what do you need?” Or “what do you need from me” and I never used to know so I used to just get a bit eye rolly about the question and then say “nothing”.
She doesn’t ask me anymore.

Something else to think about: how do I want my therapist to handle my anxiety in session? What do I wish she would say or do

The problem is, I don’t really know what I want her to say and do. Because I don’t really know what she could say and do that would help?

I guess I read this:

I’ve walked in and we’ve spent 80% the session on breath and safer place work. Not so much the latter anymore as I realised I was actually dissociating....hearing going was my first clue. So we do more of being aware of tension in my body, visualising what colour it is, what message my body is giving me (“RUN!!!”) and then taking in warm white light to change the colour.

and I think....oh...there’s a T explicitly trying to use a tool/do an exercise with their client to try to alleviate their anxiety. Something...tangible...? We don’t ever do things like that. My T actually lists guided meditation, breathing and visualisations as techniques she uses on her website but we never do anything like that. That said, I think I would feel too self-conscious to do those things with her anyway. T also talks a lot about not intellectualising and that trauma/anxiety lives in the body etc. We rarely “go to the body” in sessions. She did try a few times early on but I always dissociated. So maybe that is why she doesn’t suggest those things now. Actually, to be fair, she did do this the other day. I have a “throat thing”, which I’m really struggling with in this current wave of high anxiety - I made another post about that because I just can’t get that under control at all right now. I told her about it so she started asking how it felt. And then my anxiety just rocketed even more.

So, maybe the things I think I want to do or that I think we “should” be doing - eg, “let’s try this exercise” or “let’s get out of our heads and come at this from a physical angle” - instead of me just rattling through all the things I feel anxious about and her just nodding, saying it’s understandable and then speaking calmly to me, pointing out lots of rational things that I already know....maybe those are the sorts of things that I don’t manage very well as I have tended to feel too self-conscious and/or dissociate with them in the past.

What personally works for me is accepting it. This is anxiety and just welcome it to stay. There’s nothing wrong with it.

It’s also about permission to have my feelings just as they are.

Yes, T has consistently encouraged me to accept without judgement. And I have got better at that. I can now be kinder to myself and more accepting when, for instance, anxiety or shame shows up in session or when my voice gets hijacked and I can’t speak to her.

At the moment though, the anxiety is so high and constant that it’s really getting in the way of normal every day functioning. I’ve not been able to manage it at all for the best part of the last two weeks. I’ve cancelled stuff and just stayed home, feeling in a bad state. I don’t think I can - or want to - accept that :(

I feel angry with my therapist today. Which probably means I feel angry with myself really.

 

[MyWillow]

Oh I get angry with my T all the time. But it’s never about her at the end of the day (“f*ck her she’s a liar like the rest of the them”...”I don’t need anyone damn it least of all HER!”....etc etc...)

Last session I was really struggling to stay present as we were discussing my mum’s recent visit. I couldn’t handle much more so she switched to talking about self-care which led to TS yoga. I force myself to go and we were discussing why it’s so hard (aka shall I run, throw up or dissociate today). I can’t even coordinate breath and movement. Panic inducing. T noticed that even TALKING about breathing exercises increased my anxious feelings. So we agreed I would try to sit and notice without judgement twice a day for a few minutes when I feel I can. If my mind goes flat out then I try to notice that without judgement and bring it back gently. And when I can’t I sit at all I try to notice that without judgement. It’s a nice neutral place to start. I’m not sure if it’s a helpful one for you @barefoot

 

[joeylittle]

I’m not very good at knowing what I need or, if I do know, expressing what I need. My T used to ask me quite regularly, “what do you need?” Or “what do you need from me” and I never used to know so I used to just get a bit eye rolly about the question and then say “nothing”.
She doesn’t ask me anymore.

I've found that telling my therapist I'm willing to try something again, or that I actually miss certain kinds of questions, even though I used to respond one way, I think now it would be different, etc...telling him that stuff just helps him do his job better. It would really be OK for you to tell her that the prompt - "what do you need?" is something that you want to try and work with again.

So, maybe the things I think I want to do or that I think we “should” be doing - eg, “let’s try this exercise” or “let’s get out of our heads and come at this from a physical angle” - instead of me just rattling through all the things I feel anxious about and her just nodding, saying it’s understandable and then speaking calmly to me, pointing out lots of rational things that I already know....maybe those are the sorts of things that I don’t manage very well as I have tended to feel too self-conscious and/or dissociate with them in the past.

This is also useful stuff to tell her, and ask her for. Incorporating physical ways of managing symptoms in-session.

At the moment though, the anxiety is so high and constant that it’s really getting in the way of normal every day functioning. I’ve not been able to manage it at all for the best part of the last two weeks. I’ve cancelled stuff and just stayed home, feeling in a bad state. I don’t think I can - or want to - accept that :(

Being able to say that you don't want to accept the interference, that's a big deal. Good job with that. Sometimes all you (we) need is that little grain of, being ready to fight back. Hang in there. I know it doesn't feel this way, but you are doing good work, hashing these things out. Keep writing, too.

 

[UnicornSightings]

Oh, I forgot this. My t also suggested last time that maybe we spend some time meditating. We’re both into meditation and that could be something that helps when I’m feeling super anxious. Maybe next time we will. I really gotta say, ask for help. All the hinting that you’re not ok at that time.... all they will do is validate that. That’s the therapist code: “when in doubt, validate”. No t is gonna assume you need help and help you. That takes away your power. “Oh, she’s struggling, I’m gonna help her”. No! You have to ask. Then you’re in your power again. It’s ok to ask for help and really is cool when you have someone so willing to offer suggestions of things to help. I’d tell your t all of what you said. How you want to do more “in your body” stuff and that you kinda want to try guided meditations but feel kinda silly. Maybe you can start with a short one. I did guided meditations with my last t. Felt like an idiot but after awhile they were nice. I wish you luck!

 

[Deleted member 37474]

I’ve walked in and we’ve spent 80% the session on breath and safer place work. Not so much the lat...

I really like this color concept. I think it will help me.

 

[barefoot]

I've found that telling my therapist I'm willing to try something again, or that I actually miss certain kinds of questions, even though I used to respond one way, I think now it would be different,

The thing is, I don’t actually think it would be different now. At the moment, I’m reflecting back on how I felt in my session a few days ago and talking it through with people here and some ideas are coming up. If she’d have asked me there and then what I needed, I don’t know that I’d have been able to come up with an answer, especially as I was feeling such a high level of anxiety. If anything, all I think I would have said is “I need to feel calm!” And, actually, I did say that - I repeatedly said that I need to calm down but that I didn’t know how because I’d been trying and nothing was working.

This is also useful stuff to tell her, and ask her for. Incorporating physical ways of managing symptoms in-session.

Not sure whether this is just in my head as something that sounds like a good idea but in reality I wouldn’t manage it and would dissociate. So it may mean I’d be asking for something that, previous experience suggests I’m not actually capable of. I suppose we could try again and see if anything is different.

She did go to the body the other day by focusing on my throat for a bit but that was the part of my body that felt most full of anxiety and that was involved in lots of intrusive thoughts. And it just made it a lot worse.

How you want to do more “in your body” stuff and that you kinda want to try guided meditations but feel kinda silly

I’m not sure how much I really want to do these things. They were just ideas from @MyWillow ’s post which looked like tangible tools/exercises rather than just me sitting babbling to my T about all the things I feel anxious about. I have tried guided meditations on my own - they have helped with normal level anxiety. And as I just said to @joeylittle the “in your body” stuff sounds like a good idea if trauma gets trapped in your body. And the talking it through rationally approach wasn’t working because I knew the rational things were true - it just wasn’t helping my body calm down at all. I just don’t hink I’ll be able to be in my body long enough to achieve anything beneficial as I always then dissociate. I guess I need “in the body” stuff that feels safe? But I don’t know what that would look like.

All the hinting that you’re not ok at that time.... all they will do is validate that. That’s the therapist code: “when in doubt, validate”. No t is gonna assume you need help and help you.

I do get what you’re saying but, although I didn’t specifically say “I need your help” I think I was going beyond hinting. We’ve worked together for three years. She knows me. We have a good relationship. She knows that that was not anywhere near my usual state. She knows that I generally manage pretty well on my own. So, if I’m turning up saying I feel horrendous, that my hand has been shaking uncontrollably for five days, that I need to calm down but I can’t manage to do that and I don’t know what to do, that my throat thing is the worst it’s been for a couple of years... I don’t really see how she couldn’t see that I was looking for some help from her. And if she really does need me to say the words “I need your help” perhaps she could ask the question. I don’t need anyone to swoop in and “save me” or tell me what to do in a way that undermines my own power. I do need someone who will work with me to help me to feel a bit better when things get particularly lairy. Maybe I will ask her next week if she was waiting for me to ask her for help.

ETA: I just don’t see how a therapist is really doing a great job in a session if they are just sitting watching a client get into more and more of a state. I don’t expect her to intervene by deciding what’s best for me and then doing that regardless of what I think. I do think checking in with “how you are doing?”, “what’s going on right now?”, “how do you want to use the rest of our time together today?”, “what do you need?” (even though I find that a hard one to answer!) are reasonable ways that a therapist can try to offer/encourage some kind of guidance when a client is really struggling.