From a systems theory perspective, we, as individuals, exist within a network of relationships and relational interactions. It is within these relationships that problems occur and reside; it is also within these relationships that solutions are generated and maintained (Becvar, 1998).

A systemic approach for guiding clients through addressing, managing, and living well with anxiety takes into consideration not only clients’ relationships with themselves and significant others, but also their relationship with anxiety.

The following steps center on the belief that clients’ awareness of their experience of anxiety, and their awareness of their relationship to it, can help them live differently.

1 | Acceptance

The difference between a systemic approach to anxiety and a behavioral approach, is that a behavioral approach offers new behaviors as responses to anxious moments and experiences, while a systemic approach addresses experiences and reactions as a pattern of relating. Both (along with other approaches) have a place in anxiety treatment.

In order to help clients systemically, we can assist them in learning how to feel anxiety, recognize it--its messages, influences, and physical effects--, and still make their best choice--one that is not based on anxiety. This requires helping clients cultivate trust and listening--trust in themselves as a belief that they can get through anxious moments, and the ability to listen to a variety of voices, including their own (anxiety being just one of those many voices) (Bakhtin, 1984).

2 | Curiosity

Anxiety communicates many messages, such as warnings, alarms, suggestions, panic; some are screams and some are whispers. In order for clients to intimately know anxiety, they must become curious about anxiety within their anxious moments. Through curiosity, they can learn to differentiate between screams and whispers, alarms and suggestions.

One tip for nurturing curiosity with clients is exploring ways in which they can begin to listen differently, so that they can make a distinction between their voice and anxiety's voice. For example, they can ask themselves, "What fear is anxiety bringing up? And then, counter it with, "What do I know to be true that directly counters that fear?” They can also talk to anxiety directly, in the first person, in order to help externalize their experience of anxiety and gain a sense of empowerment and choice (White, 1990).

3 | Presence

There is great benefit in taking up a challenging physical or creative pursuit, because it quiets the mind. Great examples include running, yoga, pottery, playing a musical instrument, etc. Time spent in the creative activity, over time, teaches clients (and anyone) that they are capable of reaching new goals; this allows them to gain trust in their strengths and abilities.

"The whole culture is telling you to hurry, while the art tells you to take your time. Always listen to the art."

This quote is from an image I saw on Instagram recently, and it applies to the connection between creation, presence, and felt pace. Anxiety is often experienced as fast paced; it wants answers now, and it is relentless. Creative activities require attention and acceptance of what is transpiring now. For this reason, they foster mindfulness and focus. As a byproduct of the focus required during creative pursuits, clients learn that anxiety isn't always in control, present, loud, or important.

If clients already participate in an activity that cultivates presence, ask them what they notice about anxiety when they are practicing the activity, and what they notice about the activity's ability to quiet anxiety? If they don't already have a creative or physical pursuit, discuss small steps for incorporating presence through engagement that are welcome by the client.

4 | Changing Dynamics

The dynamic of the client-anxiety relationship can be assessed and examined collaboratively with the client. For example, is it a relationship of hatred, avoidance, fear, curiosity? Take some time to define, with clients, their current relationship as well as how it promotes and prohibits the development of the kind of relationship they'd prefer. Generate options for how they can change their stance in the relationship, based on what it is currently and what they'd like it to be. For example, if it is now a relationship of avoidance, brainstorm ways clients can begin to acknowledge anxiety regularly. If it is currently a relationship of hatred, how can they begin developing a relationship of acceptance (Flemons, 2001)?

As clients recognize their responses to anxiety, they are able to imagine and create options for engagement that are not presently available to them.

Summary

A systemic approach to anxiety that incorporates acceptance, curiosity, presence, and interactional dynamics allows clients to make room for more expansive and hopeful ways of living with anxiety.

Disclaimer: For many people living with anxiety, a combination of approaches works best, including behavioral and cognitive-behavioral therapy, psychiatric consultation and medication, family therapy, trauma treatment (if applicable), in conjunction with this systemic approach. I am not suggesting that these four steps are the only way to address clients' anxiety, but I am offering that systemic, relational approaches create options for recognizing the relational aspects of a client's experience of and reactions to their symptoms.

Several ideas from this post were originally published on the Quiet Mind Collective blog.

I've put together a cheat sheet of 20 questions that address these 4 steps for working with anxiety. It, along with a bunch of other resources for counselors, is found in the *free resource library**. Sign up for immediate access below:*

Let's Chat

What is your favorite relational approach to addressing anxiety? Let me know in the comments below.
Have a question about these steps? Send me an e-mail.

References

Bakhtin, M. (1984). Problems of Dostoevsky's poetics. Minneapolis, MN: University of Minnesota Press.

Becvar, D. S., & Becvar, R. J. (1999). Systems theory and family therapy: A primer. Latham, MD: University Press of America.

Flemons, F. (2001). Of one mind. New York, NY: W. W. Norton & Co.

White, M., & Epston, D. (1990). Narrative means to therapeutic ends. New York, NY: W. W. Norton & Co.

Discernment Counseling for "Mixed Agenda" Couples: An Introduction

In my group practice, I sometimes create trainings on relevant topics for my staff, especially when I see an increase in a specific presenting problem for our clients, and/or I recognize an opportunity to expand our services.

Recently, I offered a training on discernment counseling, a pre- couple therapy approach, developed by Bill Doherty and Steven Harris, for helping couples who are presenting with mixed agendas; that is, one partner wants to work on the relationship, or is “leaning in,” and one partner is not sure, or is “leaning out.”

Terry Real's Couple Experiential: Five Lessons For Therapists

Recently, I attended a Terry Real Couple Experiential. The Couple Experiential is a two-day couple therapeutic experience that involves five couples--each receiving therapy from Terry Real, in the presence of the other four couples, as well as therapist observers.

Terry works intensely, for at least one hour, with each couple throughout the two days. He also answers therapists’ questions two hours per day: during a lunch hour, and for one hour at the end of the couple therapy time.

Family Therapy Basics Research Roundup: Summer 2020

It’s time for another research roundup!

This Spring, I taught Research and Analysis for the first time, to graduate MFT students. And, as expected, I I enjoyed it. I realize, as a former student myself, that grad students come to Research with many misconceptions. So, I began the first class with Brené Brown’s The Power of Vulnerability.

Tips And Encouragement for Student Therapists

Students starting their first field course (i.e., seeing clients for the first time) typically experience nerves, confusion, and/or worry. Worry that they won’t be helpful to clients, or don't know enough to provide effective therapy, as well as general anxiety about managing their studies, sessions, and often, the necessary assertiveness required to complete their clinical hours.

An email subscriber in her first field experience emailed me recently to request an article on tips for first-time counselors. In this post, I cover tips that I’ve learned as a therapist and supervisor, as well as those offered to brand- new therapists, by members of the Get Refreshed Facebook Group.

How to Establish a Therapeutic Culture in Group Therapy

One of the main roles of a group therapist is establishing the group's culture. Group culture is influenced by the group's structure (i.e., a closed vs. an open group), meeting schedule, and explicit and implicit rules. Both group members and therapist contribute to the culture over time; however, the therapist plays the lead role in setting both the tone and structure of the group.

The Art and Science of Therapy as Craft, Part 2: Crafting Questions

For this week's video chat, Dr. AnnaLynn Schooley returns to discuss therapy questions as an intentional craft, and she covers four basic question types: single answer, open, closed, relational, and circular.

Therapist Self-Disclosure Simplified

Self-disclosure is a touchy subject among therapists. Some therapists never self-disclose, while others feel stifled by having a rigid boundary around self-disclosure. As I consider self-disclosure in therapy, I ask myself, “When is self-disclosure appropriate?” “How does self-disclosure deepen the therapist-client connection?"

The Art and Science of Therapy as Craft

Dr. Anna Lynn Schooley, professor and family therapist, joined me recently for a conversation about therapy as a craft. AnnaLynn is a professor, clinical supervisor, licensed therapist in mental health and marriage and family therapy. She identifies as a family therapist; as a result, our chat leans toward a systemic view of therapy and clients.

Recently, I have been hearing more and more that master therapists view therapy as a conversational craft. Bill Doherty mentioned it in a talk he gave in November of 2016, and Elliott Connie also emphasizes this point. I invited AnnaLynn to discuss this topic, because she is a master therapist and teacher.

Unique Characteristics of Cohabiters Seeking Therapy: A Synopsis

The January issue of the Journal of Marital and Family Therapy included an article by Shannon and Bartle-Herring, in which they present result from their study on the differences between cohabiting and married couples in therapy. The article's title is Unique Characteristics of Cohabiters Seeking Therapy, and in this post, I summarize the authors' conclusions and present implications for therapists.

Couples and Understanding: Cultivating Presence in Therapy

As a couples' therapist, I've seen many couples in therapy over the years. And, I've noticed that many of these couples have this in common: One or both members of the couple have negative beliefs about their partner, because they've interpreted some of their partner's personal characteristics as character flaws.

Solution Focused Brief Couples Therapy Tips, with Elliott Connie

Elliott Connie is a Solution Focused Brief Therapy (SFBT) practitioner, author, and speaker. He developed an approach to couples work that distills the essence of SFBT into guiding principles for working with couples.

As a therapist who loves working with couples, I am always interested in ways to enhance my couples therapy skills. For this reason, I invited Elliott to explain the reasons why SFBT is his choice for working with clients, as well as how it creates a contrasting experience for couples that have a history in therapy.

Four Systemic Steps for Addressing Anxiety with Therapy Clients

10 Therapist (and Child)-Approved Activities to Support Kids with Anxiety

If you’re a mental health professional working with children, you will probably agree that many of the calls you receive from parents have something to do with anxiety or stress. Child therapists have the amazingly important yet challenging task of educating and supporting kids in a therapeutic setting that is both productive and fun. When working with children as young as preschool age, it can be a very daunting task to keep things fresh and exciting week after week! So, how do we help children develop the coping skills they need while keeping them engaged (and not glancing at their watch)? Here are ten therapist (and child!)-approved, fun activities that address anxiety-based disorders and promote relaxation and stress reduction in children:

Family of Origin Exploration for the Therapist: How to Create Your Genogram

In article three of the Family of Origin for the Therapist series, you learned 3 simple steps for how to begin family of origin (FOO) exploration: 1) read Bowen’s chapter, 2) observe your FOO experience, and 3) reflect on what you learned. Hopefully, your curiosity has led to significant understanding.

Understanding is the foundation of Bowen Family Systems Theory (BFST). Bowen (1985) believed that if clients could understand themselves as members of their FOOs and as created by their histories, they could begin and continue significant change.

In today’s post, I offer the next step in developing understanding: Creating your genogram. I explain how to create a basic genogram that you can expand as you continue your exploration.

5 Tips for Keeping Up with Therapy Paperwork

In my interaction with therapists as a mentor and supervisor, I’ve learned that one of the main struggles therapists face is having too much work and not enough time. Many therapists find themselves overwhelmed by documentation responsibilities, in particular; this includes completing client notes, referrals, billing, treatment plans, etc.

In today’s post, I offer several strategies for keeping up with paperwork, so that you can stay on track and avoid the stress of falling behind.

Solution-Focused Brief Therapy Client Types, and Their Relevance To Every Session

In her 1989 article, Of Visitors, Complainants, and Customers, Insoo Kim Berg details three types of “client-therapist relationships” (p. 21). Her wording is significant, because she is not labeling clients; she is describing them in terms of their relationship to the therapist, the process of therapy, and the problem. These three relationships have undergirded Solution-Focused Brief Therapy theory and interventions over the years, although they are not consistently discussed in newer works. The client relationship types are widely applicable to therapy, regardless of theoretical orientation, making them one of the most useful concepts in marriage and family therapy.

In this post, I present a review of these client types, and I explain their relevance to and usefulness for all therapeutic sessions.

How to Ethically Offer Coaching as a Licensed Therapist: A Step-By-Step Guide

One of the most common professional goals for my clients is expanding their private practice to include life coaching services. As professionals with a depth of knowledge in personal development and goal achievement strategies, therapists are ideal candidates for the coaching profession. Despite this near perfect fit, there are some important ethical consideration for therapists when offering coaching services alongside therapy, or when choosing to become professional coaches. In this post, I focus on offering solutions for these complications, in an effort to help you ethically practice coaching.

5 Step Plan for De-escalating an In-Session couple Argument

Most of us, therapists, have been there: A simple disagreement turns into an all-out screaming match in the middle of a therapy session. This is, thankfully, not a common scenario for most therapists, but it’s also not rare--especially for therapists who specialize in couple therapy.

In this post, I cover steps for disrupting an argument occurring in a couple therapy session. Intervention on the part of the therapist is necessary during some conflicts, because the arguments can cause further damage in the couple relationship. And, if therapists allow arguments to continue for too long, they can affect the couple’s sense of safety when in therapy.

The main goals of intervention in this case are to: