Therapy in a Nutshell: For Anxiety

Presenting Issues

Akanksha* sought therapy to address feelings of anxiety, indecisiveness and procrastination, and a sense of overwhelm at work.

Background Information

She mentioned a history of chronic stress related to high-pressure deadlines and perfectionistic tendencies in her job overseas. She also recalled that she was always academically inclined, and has worked hard to exceed the expectations of her family and her sister in this regard. She also mentioned her very humble beginnings, and recalls going through all odds (including financial difficulties) to reach where she is right now.

Assessment

Akanksha* came in with signs of overwhelm, distractibility and seemed to space out often. With her therapist’s facilitation, she observed a need for better emotional regulation, particularly with respect to the emotions of anxiety, frustration and disappointment. She then mentioned that she wanted to work on a sense of clarity and decisiveness within therapy.

Treatment Plan

Goals

1. Understanding pre-existing patterns related to the barriers or ‘stuckness’ that stop the client from being clear and decisive (beginning with the client’s own problem statement).
2. Reframing the problem statement to understand the functionality of presenting symptoms (for instance, what is your anxiety response helping you with?) to see what’s maintaining the ‘stuckness’, and to logically work toward their goals of therapy.
3. Explore cognitive-behavioural strategies to build on coping skills for work-related stressors and life transitions.
4. Over time, help with the uncoupling of anxiety/fear from specific actions and situations by building a practice tuning into the body’s responses (and not just the mind’s) responses, allowing for it to act as an authentic, self-sufficient guide to navigating most stressors.

Intervention Strategies

1. Rational Emotive Behavioural Therapy to help identify concerns, add directiveness to the approach and to reframe as needed
2. Parts Work (Internal Family Systems-based) for identification of specific emotions and parts that were concerning to the client, and shifting their relationship to said parts.
3. Somatic Experiencing to identify a pace that’s comfortable (and is least likely to result in retraumatization), and to facilitate a sense of ‘discharge’ about the ‘stuckness’ and the overwhelm.
4. Presence-oriented techniques like Grounding, Orientation, Mindfulness and Breath-work are employed within and outside of Therapy.

Frequency and Duration

Weekly therapy sessions for 10 weeks; after which sessions were discontinued as initial therapeutic goals were achieved.

Results

1. Akanksha* is slowly transitioning from feeling overwhelmed about her indecision as she continues to explore various perspectives to her concerns in therapy. She finds the therapeutic space to be very different from other spaces – especially with regards to the curiosity her therapist invites to the concerns she is facing instead of the knee-jerk avoidance in her approach to emotions that she’s employed before.
2. In her exploration, she has gained more confidence in dealing with stressors with the help of tools and techniques she practices (albeit a bit irregularly) on recommendation by her therapist.
3. With every other session, she brings up the most current situations in her session work, thus deepening her own body- and self-awareness. Her ability to regulate her own emotions is enhancing over time as she works on expanding her ‘window of tolerance’.
4. She recognizes that her anxiety doesn’t mean to hurt her, but rather serves the vital purpose of alerting her to a sense of possible threat. She knows that it eventually contributes to a sense of safety and comfort.
5. With renewed clarity, her sense of anxiety largely regulated, and seeing her own decision-making processes becoming more streamlined at work, Akanksha chose to acknowledge the work she and her Therapist had done together, and to close the relationship for the time being.