A Columbia University-trained psychotherapist with more than a decade of clinical experience, I’ve come to believe that what it means to help people in therapy is to help them create their lives and I relish in this challenging, playful activity.
Anxiety can mean a lot of different things–both in and out of therapy. When we reference anxiety, we’re often talking about a broad range of emotional and physical experiences. This can include–but is not limited to–stress, angst, trauma, hypervigilance, fear, nervousness, dread and even, a certain sort of enthusiasm or excitement.
Anxiety is also an ordinary and unavoidable part of everyday life. There are plenty of times when anxiety is present and even though we would prefer it go away, we wouldn’t necessarily define it as problematic. The feelings of being anxious before a big game, startled after a scary surprise or dreading a meeting with your boss, while not exactly fun, need to have a welcome place in daily life.
With these various forms of anxiety and its challenging definition (even the DSM uses the word anxiety itself in the criteria for Generalized Anxiety Disorder), there has to be an acknowledgement that when we talk about treating anxiety in therapy, we don’t mean getting rid of anxiety.
Building A Powerful Relationship With Anxiety Doesn’t Mean Eliminating It
Rather than eliminating anxiety all together, I find, in my NYC therapy practice, that it’s better to help people have a powerful relationship with anxiety. A powerful relationship with anxiety means not overreacting to anxiety, but developing a habit of responding to it as ordinary, making use of anxiety toward assertiveness (even, at times, aggressiveness), and developing cognitive and behavioral habits that can keep anxiety in check. You can plan in advance to do things in a way that reduces stress and worry, while also finding ways to include other people and relationships in challenging moments.
Some of this work is about reducing certain kinds of anxiety–some of which can become quite intense, unrelenting and disruptive. Anxiety can be literally crippling. In other instances, we may need to help someone tolerate anxiety that, while painful, is inevitable.
How Do You Develop A Powerful Relationship With Anxiety?
The first step is to develop in your capacity to identify the difference between problematic anxiety, inevitable anxiety, anxiety that is understandably present yet disruptive, and anxiety that seems to come out of nowhere. It’s important to accept that all anxiety can’t and shouldn’t be eliminated. But, just because anxiety might make sense doesn’t mean it also doesn’t need attention. Acceptance isn’t code for ignore.
It’s also essential to realize anxiety may show up at seemingly arbitrary moments, but in reality, anxiety is never arbitrary. Often a patient will report a sudden onset of intense anxiety about getting on the subway or another specific phobia. Other times people will tell me they’ve just always been anxious, citing that it runs in the family. The underlying assumption is that anxiety is similar to, say, certain kinds of cancer that just appear out of nowhere.
But I’ve literally never found that to be the case. Even if it doesn’t initially appear to, anxiety always comes from somewhere–typically a current or historical experience of significance. Understanding where anxiety comes from and talking about trauma helps us direct our attention to solving that problem or getting the right help to do so.
Creative Therapy For Anxiety
Anxiety can often be limiting of emotional creativity, but ironically, creativity is also necessary to construct a powerful relationship with anxiety. Involving others, like a therapist, in this process is huge–they can bring creativity and help you be more creative by virtue of not being in that anxiety themselves.
In my NYC therapy practice, I see creativity as curative, which comes from understanding humans systemically–progress or pain in one area produces a reaction in another area and so on. Our emotional, social, relational and physical lives are intertwined. Once we realize this, the idea of “treating anxiety” singularly doesn’t make much sense. Yes, that may be the primary complaint–and may be a quite problematic part of someone’s life–but it has a context.
What this has to do with creativity in therapy is that, when trying to affect a system, there are countless points of entry. Rather than just using CBT (Cognitive Behavioral Therapy), which has largely been the anxiety treatment period, we can invent our own strategies in the therapy room. Even if we’re using CBT, which I love using as an intervention and has done a brilliant job of saying, essentially, “This is what anxiety is, this is how we fix it and here are our results,” we can explore how to use it in a way that is the most helpful for the patient. We can distort it or abbreviate it. Whatever the intervention, we have to see anxiety in context and work to be creative together.