Thursday, March 17, 2016

Case #175 - Anxiety, options, contact

Frank was nervous, so I invited him to ask me a question. I often prefer to take the focus off of the client, and put it onto myself. A good way to do this is to stop asking the client questions, and ask them to question me.
Frank wanted to know how I dealt with traveling so much - the changes in time zones etc, and still keep healthy.  I explained some of the factors - I enjoy travel, am flexible, meditate and have a good diet.
I also said, 'I like change and variety'.
Frank revealed that he did not cope well with change - he got anxious easily.
I shared how I dealt with my anxiety by risk taking - not thinking much about negative things that could happen.
Frank said that he managed his anxiety by preparing thoroughly. But that he couldnt switch off - he would constantly think about what was coming up, and how to prepare.
I asked him about the context for this in his family (ie a Field question). He explained that his mother was very meticulous in preparing for things - in other words, thats how she managed her anxiety. The day before a school excursion, she would instruct him to make detailed preparations for the next day.
In other words, she taught him to be anxious, and also taught him how to deal with that anxiety.
He said 'this is the only option I have to deal with my anxiety'.
In Gestalt we are interested in expanding options. I asked if he would like more ways than one to deal with it.
So I invited members of the group to share how they dealt - in a healthy way - with anxiety. People shared many things.
These were new ideas for Frank. He was moved to see how many people struggled with anxiety, and in the process, he gained new options.
I suggested he consider these as a menu, and when he felt anxious, he could choose one.
Such behavioural choices are often the way that therapists head. Whilst expanding options is useful, it very much depends on more fundamental factors, including a person's readiness to do so, their resistance, emotional anchors etc. So its something I would monitor in ongoing therapy, to see if its as 'simple' as simply hearing new options. It may be, and it may be that the support of the group could be something that Frank would take in, and integrate.
I did want to take a second step with him, and not just leave it at a list of possible 'solutions', as expanded as that may be.
So I suggested that we now address something of his interpersonal anxiety.
I asked him to look around the group and notice who he felt least anxious with, and most anxious. I then invited him to ask those people to take part in an experiment. The person he was least anxious with I got to sit next to him. The one he was most anxious with - Mark - I asked to sit opposite him.
I suggested Frank tell Mark what it was about Mark that made Frank feel anxious.
He said that Mark reminded him of his father - who would yell at him and hit his hands when he got something wrong.
I invited Mark to reply. Mark said that he was different - he never hit his kids, and was not the kind of person to yell.
I checked with Frank for his feelings - he felt calmer.
We repeated this process several times, with Frank telling Mark what he was anxious about, and Mark telling Frank more about himself.
Frank felt calmer and calmer.
We carry around ideas of who other people are, but these often have elements of projection - disowned aspects of self. This was the first step for Frank in getting a reality check about his anxieties - which were generally  based on his imagination. It also gave Frank the experience of how to deal with interpersonal anxieties - through open and authentic dialogue.
In Gestalt we talk about 'good contact'. This is an example. Being present with another person, sharing your fantasies, checking them out, getting feedback, hearing the reality of the other person. These are grounding experiences, seemingly simple, but rarely performed.

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