Four Systemic Steps for Addressing Anxiety with Therapy Clients
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.
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