|The Anxious Client Reconsidered - Page 4|
During the second session, we usually begin to practice diaphragmatic breathing and progressive muscle relaxation. I also give clients a tape recording of a 30-minute relaxation program. For homework, I instruct them to practice the breathing for five minutes, three times each day, and to listen to the tape daily. We take considerable time during our sessions practicing these techniques, but the clients need to practice at home, too.
If by the third or fourth session a client is not practicing breathing and using the tape, therapy is unlikely to be successful. I have tried numerous times to explore other issues or confront resistance at this point. It rarely helps. Sometimes clients are simply not ready to do the work necessary to create change.
But clients who commit themselves to learning to breathe and to purposefully relaxing when confronted with anxiety-producing events progress quickly. They begin to believe they can regain control over their lives, and often, they do. In most situations, these clients are usually able to end this episode of therapy after eight or ten sessions.
Anxiety and Medication
One issue that often arises during these early sessions is whether a patient should take medication. I prefer that they do. Obviously, there is no absolute therapeutic consensus on this point. Some writers suggest that drugs may interfere with the impact of the cognitive-behavioral approach. They are concerned that clients may come to rely on medications for success in treatment. This is an interesting theoretical concern, but my experience is that clients who refuse medications often refuse to engage in diaphragmatic breathing, progressive muscle relaxation and self-talk. In a slight variation on this theme, some clients do not directly refuse medications, but take minuscule amounts at irregular intervals. These same clients are very likely to practice relaxation once a week, turning it into an empty ritual.
Dealing with anxiety "naturally" is a wonderful idea that I support wholeheartedly. But the refusal to take medications often indicates that a client is unwilling to confront his or her condition and to make other changes. (This is not always true, but it is very common.) For these clients, control is such a central issue that they refuse to give it up to a pill or to muscle relaxation. Ideally, clients who are established on appropriate medications can begin to gradually cut back on them, with their physician's supervision, as they master coping skills.