Finding the Courage to Stay in the Moment
by: Reid Wilson
As I tell this story, you can ask yourself, "What's this have to do with the practice of therapy?" I'll answer, I promise--after the story.
It's Monday morning, and I've set aside several hours to work on this article before my next client comes. I've cleared my desk at my home office, turned off my e-mail, put a sign at the top of the stairs--"Serious Writing in Progress!"--and settled in for the duration. At my first break, I visit the bathroom to discover the toilet is plugged up. I flush to clear it and then . . . filthy brown toilet water is suddenly spilling over onto my white Berber carpet! I rush to turn off the intake faucet and it doesn't help! The water is literally pouring over the side onto my white Berber carpet! I reach for the plunger. Finally, after more mess splashes onto the rug, I get results. But now I'm faced with a monumental clean-up that'll take hours. No more writing! I'm angry, disgusted, anxious, frustrated, and feel somehow betrayed by fate--it's all so unfair! "Why now? Why me?" I grumble. "This is the last thing I need right now!"
But instead of letting myself stew in my own whine, this time, I take a step back and say quietly to myself something that's become my guiding maxim for such situations: "This is exactly what I need right now." Suddenly, all sound quiets in my mind. I'm calm and clear. I continue cleaning up efficiently, but without the mental suffering caused by all the background noise.
This is a trick I now draw on frequently. For all the riches of my life--family and friends who love me, health, satisfying work, a steady income--it never seems like enough. I tend to complain constantly and resist what's happening all the time. At any given moment, I'm complaining that this or that isn't as good, fast, satisfying, exciting, beautiful, or enlightening as it should be. Something is too cold, warm, salty, bright, dark, cheap, or old. I'm not strong, clever, wise, nice, diligent, or happy enough. In short, things are happening to me and feelings are rising in me that I don't want.
The toilet episode says it all. Stuff happens (to bowdlerize the more apposite expression)-- life happens. Instead of fighting it, whatever it is, now I try to welcome it. I don't have to figure out why a stopped-up toilet was "exactly what I needed," I just have to get into that perspective and, once there, it instantly lifts me from my suffering. It doesn't mean I don't recognize how inconvenient, painful, and unpleasant some situations are, but I can acknowledge those experiences and let go of the need to figure them out or fix them. I can embrace the struggle, wrap both arms around the doubts and uncertainties in my life, and shift from being worried to being curious. If I can catch myself saying "I don't like this, I don't want that, I'm unhappy with this outcome, I'm anxious about that, I'm threatened by this," by shifting into a welcoming mode--"This is exactly what I want right now"--I find myself in a much better place psychologically. Then I can peacefully concentrate on cleaning up that rug.
Of course, I don't exactly want my toilet spilling all over my rug. When I tell myself, "This is exactly what I want right now," I'm disciplining myself to stay in the present moment--not to wish for other moments or to wish that my life was different at the moment, but to accept that this moment is all I have at the moment. The only power possible in the moment is to face whatever it demands. When we stop filtering every event through our judgments of what it should or could be like, what we really want, we become alert to our surroundings and curious about how we can interact with them. This is much more fun than complaining that the world isn't following the rules that our little egos generate.
How have these concepts altered my therapeutic practice? As a therapist and as just a person, I'm beginning to learn how important it is for me to embrace bad feelings and discomfort--all those emotions we spend so much of our lives trying to avoid--and then go on right through them to the other side. I'm learning that each time I'm tempted to resist a moment of distress, anxiety, or painful reflection about the past, I invite greater suffering. When I don't accept the present moment, everything bogs down from there. I generate a complaint, I declare there's something wrong, and I try to squirm my way out. At that point, I'm stuck in avoidance and can't move forward to actually solve the problem. But if I can open myself to the painful reality of the moment, I actually suffer less.
I remember the experience of taking my first group therapy course in graduate school, 27 years ago. I still see the syllabus in my mind's eye, listing the dates when each of us would lead a simulated therapy group in class. We all dreaded it--dreaded messing up and looking stupid and incompetent in front of our peers. Perhaps I dreaded it more than most, because I was possessed of the rock-ribbed certainty that it was always my job to fix people, solve problems, do it right and do it fast, with no mistakes allowed. Not surprisingly, on the day when we began (I was in the first round of guinea pigs), I was in a cold sweat, almost panting with anxiety. Now I was faced with a situation that not only could spiral out of my control, but could make me look like a bumbler. What a catastrophe!
Then, as we got ourselves situated in our circle of chairs, our professor, John Gladfelter, introduced the task. "Here's the assignment. I want you to be the worst group therapist you can be. Just be as bad, as incompetent, as you can possibly manage." What?! I was stunned for a minute. When I realized he meant it, I felt my tension draining away like dirty water from a sink as I thought, "I can do that!"
How did it turn out? No one actually tried to be a buffoon. But with the pressure off, and with no need to strictly adhere to vague and ill-defined rules we still hadn't grasped entirely, we all witnessed moments of creativity and intuitive wisdom shining through. More than anything, we relaxed. Even I relaxed, as if given a reprieve from having to do everything perfectly. In relaxing, we could actually meet people on their own terms, see and hear them as they really were, let ourselves connect with them rather than funneling all our energy and attention into squelching or hiding our own fears. We got a taste of the healing power of human contact. And we experienced the freedom of spontaneity--of not being under the gun to predict and control everything that happened in our tiny little worlds. Gladfelter had brought our fears of what might happen into the present, by making it the assignment. In the present, the group had new liberty and power.
Now, as a therapist, I want to help clients discover this same kind of freedom--freedom from the anxieties that imprison them. And I now think that, rather than trying to suppress the symptoms of their anxiety, clients can better free themselves by engaging with their symptoms in a spirit of welcome and open-minded curiosity: "Hello, symptoms. Who are you and what are you trying to tell me?"
What this does is help clients begin to change their own frame of reference about their symptoms, and shift the perspective from which they observe what they're feeling. This shift from "symptoms=bad" to "symptoms=interesting" can utterly transform the way they view themselves and the world. By accepting what the present moment offers, by not resisting, they widen their present possibilities.
Renee looked visibly frightened as she sat down for our first session together.
"Hi, are you nervous?" I asked brightly, realizing perfectly well that she was scared to death.
"I'm extremely nervous," she responded in a quavering voice. I asked her how nervous, on a scale of 0 to 10, and she rated her nervousness as about 8.5.
"Impressive!" I said jovially, "I like people to come in with high anxiety, because it means we have something to work with."
She continued, "I'm really afraid that my symptoms will get so bad--my heart will start pounding so hard and I'll be shaking so much--I won't be able to control them and they'll just overwhelm me."
"Well, you're not in control of them now, are you?" I asked.
"Not really," she responded, "but just talking to you, I'm not thinking about my heart pounding so much."
I leaned back, smiled broadly and said, "Ah. Then, maybe we should get your attention back on your heart again." We both laughed--I heartily, she uneasily, giving me an odd look, as if she were beginning to wonder what she was doing in my office.
A minute or two later, I asked her when the last time was that she'd felt she couldn't even move because her anxiety was so great. "A few years ago," she responded.
I said, almost gleefully, "A few years ago? So you're due for another episode any time now, aren't you?" Now she was looking at me with something approaching alarm, as though wondering, What's this character up to anyhow?
What I was up to doesn't look or sound like the standard, empathic, rapport-building opening moves of a senior therapist. In fact, to Renee, I must have seemed careless, provocative, insensitive, maybe even clueless. She'd entered my consulting room in a state of nearly full panic and I'd said I was pleased. She feared losing control, and I'd reminded her she's wasn't really in control at the moment. She was avoiding panic by not attending to her heart, and I'd suggested we should pay attention to her heart. She hadn't had a full panic attack in a few years, and I'd suggested she was due for one. What kind of therapy is this? What was I doing?
Now, in therapy, I dedicate myself to helping people learn to accept, even welcome, their symptoms. I try to teach them to run toward rather than from what they fear and hate most about their disorders. I insist that instead of trying to evade, stifle, override, or distract themselves from these symptoms, they work as hard as they can to make the symptoms worse. I do all this as a therapist dedicated to helping them genuinely recover from the suffering caused not only by their anxiety but, more to the point, by the endless and often counterproductive tactics they use to escape it. I invite clients--as I invited Renee--to join me in looking directly at their problem with curiosity, humor, and compassion.
My therapeutic premise is that people's worries can be signals warning them about something they need to attend to. But the repetitious, unproductive, obsessive thoughts that accompany anxiety disorders are simply distressing noise. If clients can change the frame of reference from "my obsessive thoughts are in response to a real and dangerous threat" to "my obsessive thoughts are pointless noise unrelated to a real threat," they have a steady platform from which to change their entire world view (and, incidentally, make the symptom go away).
Camille, who was diagnosed with obsessive-compulsive disorder (OCD), had become consumed with worries after her father informed her that he was buying a gun. She thought continually about the possibility of finding the gun and accidentally harming her parents with it. To avoid and neutralize these fears, she compulsively analyzed ways to avoid the danger--she imagined never coming into their house, or searching for the gun and then avoiding the hiding place, or asking her father to get rid of it.
Together, we established that her worry about accidentally shooting her own parents wasn't a reality-based signal or genuine alarm, but a false threat created by her OCD. Thus, her constant analysis of how she should avoid this danger was a chimera built on a falsehood. She experimented with this new frame of reference. She decided to treat her fears about the gun neither as a realistic response to a genuine danger nor as awful symptoms to suppress, but as tiresome noise--those fears were just there, like a mosquito droning in her ear.
The question then became: How best to respond to this pointless background noise? The answer: Camille would purposely try to accept it, even ratchet it up, rather than fight it--feel it, go through it, make it as bad as possible rather than evade it. Once she allowed herself to get into her distress as much as possible, she'd simply tell herself to drop it. In effect, she now had a readymade protocol: "I want to feel uncertain and uncomfortable and worried about the gun. I want to have these fears. That's how I'll get better. So I'm going to fully acknowledge that the worry is here, and then drop the topic as soon as it starts." When the worry popped up, she noticed it, accepted it, and then said quietly to herself, "Drop it!" No thinking, no analysis; she'd just follow the edict. When the topic arises, acknowledge it and then, "Drop it!"
Was this easy for Camille to do? Not at all. Analyzing the problem was her compulsion; it made her feel safe. When she dropped the analysis, she was faced with the dreadful question, "Will I harm my parents?" and had no answer. So she had to hang out with her fear and worry, which put her in considerable doubt and distress. But she was bolstered by her belief in this therapy, by my confident support, and by the success of previous experiments of this kind in the past. Then this experiment worked well, too. She learned that if she let herself feel the worry, while telling herself to drop the compulsive analyzing (which is a kind of tranquilizer), the worry itself gradually faded away--but only if she stayed with her doubt and discomfort. Finally, the entire issue disappeared from her radar screen.
Basically, what I was helping Camille do was to step away from the content of her thoughts, get some distance, and learn to regard it as a kind of game. She looked at her compulsive analyzing and problem-solving and said, "Here I am again, labeling something as dangerous and trying to avoid it." Then she embraced what she'd just been rejecting, "I'm going to act as though this is exactly what needs to be happening."
Ideally, if anxious clients can respond by saying "yes" to the encounter--to accept exactly what they're experiencing in that moment--then they'll be back in control. They can learn to do this if they can endure discomfort. But for many, anxiety has become so dominant that they can't make such a shift directly. To stay on course, they need some sense of safety and a strong faith. In the past, I'd have asked them to be anchored by the skills I taught them. But now, their relationship to me is playing a larger role. I have always felt compassion for their suffering. Now I'm better able to appeal to their courage, knowing the direct benefits that accrue from opening their arms to what they most fear.
In the early stages, when their courage and confidence is still at low ebb, I don't suggest they have to commit to actually trying to change--I only propose that they may want to try experimenting a little. As I suggest homework, I use expressions like, "How about playing with this move?" and "Perhaps you can fool around with these responses." I imply that these strategies are malleable and temporary: "What do you think about trying this move a few times just to see what happens? We can talk about it next time." It's easier for clients to set aside defenses and endure distress if they think the "trial" will only be for a few moments.
The key is helping them alter their frame of reference, which is the entrenched belief that they can't tolerate discomfort and insecurity, even for a moment. To gently challenge them, I turn their struggle with anxiety into a mental game. Anxiety pitches you uncomfortable physical symptoms and uncertainty about the future; it wins if it can get you to avoid threatening activities, fight the symptoms, and hope they go away. But somehow, if you can purposely encourage symptoms, act as if you want them rather than dread them, you trick anxiety and hoist it by its own petard, so to speak. This new frame of reference--treating anxiety as a kind of game--seems to refocus clients' attention away from a pointless fight with their symptoms. Just trying to rev up symptoms makes symptoms seem weaker, more under your control. Clients soon find, in fact, that as they stop resisting symptoms, the symptoms begin to fade and then disappear.
How does this work in practice? Social anxiety disorder gives us shaky hands, a quaking voice, and worry about the critical judgments of others. The anxiety "expects" us to try to avoid it--perhaps by never going to parties or giving a talk in public. So, in this new game, we flip things around. Imagine when feeling anxious before a performance that you ask anxiety to make your hands shake, your voice quake, and the fear worsen. Do your best to get those feelings to last as long as possible. Plead with anxiety to make your hands even shakier, your heart pound even more, your voice become even tighter! That is, refuse to play the game that the anxiety disorder expects. Take charge.
I encourage my clients to push the old game board away and pull up their own game board of seeking out doubt and distress when anxiety wants them to defend against it or run. They then see that the symptom isn't nearly as powerful when they're in charge of it.
Breaking Through to the Present
Let's return now to Renee, the client with panic disorder who was beginning to think she'd ended up with one strange therapist. Halfway through that first session, she was explaining that the lump in her throat was currently causing her the most anxiety. I suggested she ask her anxiety, "Would you please make my lump get stronger?"
Her eyes bulged. She exclaimed, "It sounds scary!"
I asked what she thought would happen.
She said, "I'll either stay the same or get worse. I can hardly imagine getting better by telling it to get worse." After some teasing and persuading, she agreed to try it anyway. What courage! Her first attempt being exceedingly feeble, so I modeled for her: "Anxiety, I beg you to make this knot stronger. I want it to be so large; I want it to be as big as a marble. I want it to be--how about a golf ball? Could you make it a golf ball? I'd like it to be so large that people start to see my neck protrude with this big ball in there. I want to make it so big that to swallow, my saliva has to go all the way around this lump and then down my throat. If you'd do that, it would make me sooo happy. It's so important. All these years I've done so much for you! I'm asking you one simple thing: to make my lump larger, my knot bigger. Please do this one thing for me."
I asked her to try her own version, "as if you're auditioning for a role, and this is your job, and if you don't do this persuasively you don't get the part. Are you willing to try this again?"
Renee nodded and addressed her anxiety in the beseeching voice of a lovelorn swain: "Anxiety, I beg you to make that knot much, much bigger." She laughed, "This just seems so unreal." She laughed again and said with more conviction, "Anxiety, make this knot as big as you possibley can!" Then she paused, looking surprised, and said, "It's not there, anymore."
"Excuse me, Renee?" I said in mock astonishment. "Try harder. Make it as big as you can."
She concentrated for a minute and then looked at me. "It's just not there."
"What do you mean, it's not there?" I asked severely.
"It's just gone," she giggled.
And there it is: Renee accepted her present discomfort and embraced her uncertainty. She set aside her worries about future discomfort and challenged her nemesis. In her anxiety, she wanted to hold back out of fear of her symptoms. Instead, she played her own game of pleading with anxiety to make her more uncomfortable, and the symptoms disappeared. We continued the session in this same provoking style, hyperventilating together until her legs were shaking and hands were tingling and I was sweating and seeing stars. Then she demanded the symptoms worsen and watched as they slowly dissipated.
What's happening here? Instead of experiencing the symptom as interrupting and disturbing the present moment, we invite the symptom into the present moment--at which point, we're in charge, and the symptom is working for us. We prove that we have the ability to achieve a present consciousness that's larger than the symptom.
Then we can move forward with comparatively little resistance, and perhaps some curiosity and interest. When all I have to do is be the worst group therapist in the room, I'm ready to go. When anxious people take on the "challenge" of shaking even more, racing their heart even harder, making the lump in the throat even bigger, they believe they have the skills to meet the challenge. And that changes everything, paradoxically making the heart slow, calming the shakes, and eliminating the lump.
The problems we suffer with anxiety often continue not because we have symptoms, but because we resist the fact that we're experiencing symptoms--doing our utmost to block out the symptoms, rather than getting to know them a little bit. Most of our clients come to us trying to end something unpleasant, seeking both comfort and predictability in their lives. The desire for a life without stress or doubt is perfectly natural. And yet, we compound our clients' problems when we collude in their goal of simply making the unpleasantness go away. Our objective should not simply be to block their discomfort and allay their doubts, but to help reduce their suffering--ultimately, a completely different task.
Discomfort is an inevitable byproduct of interacting with the world and learning what life's rules entail. Doubt arrives as we challenge the status quo and muster the courage to explore our own potential for creativity. Suffering, in contrast, arrives when we insist on playing life's game according to our own private rules, without doubt or discomfort. Not only is this enterprise doomed to fail, when we try to avoid the symptoms of our existential anxiety, we foreclose the possibility of living fully and exuberantly in the present. Instead of saying when adversity strikes, "I want to push this away so as not to experience it," I'm finding that accepting it as it unfolds in the present is the most efficient way around it.
Present tense is what it's all about--even if the present tense isn't always so wonderful. If I can be present, I become powerful--I'll have tossed aside the dominance of my doubts and desires. My mind and body can focus on the task immediately in front of me. I want to engage in the present, not push it away. That'll guide me to my future. I don't want to be experiencing this and wanting that. When I stay with "this" without resistance, whether it's my disappointment, anger, or pain, I have a platform from which I can move forward to something better.
How do we make this shift in consciousness? In the midst of a conflict, to tell yourself, "I'm okay with this experience" places you with the problem in the present. You let go of your rigid goals of how this moment should be and settle into what the moment is, not knowing how it'll turn out or should turn out, but more ready to face what comes.
Reid Wilson, Ph.D., is associate clinical professor of psychiatry at the University of North Carolina School of Medicine and coauthor of Stop Obsessing! How to Overcome Your Obsessions and Compulsions. His newest book is Facing Panic: Self-Help for People with Panic Attacks. Contact: firstname.lastname@example.org. Letters to the Editor about this article may be e-mailed to email@example.com.