The Anxious Therapist

Our time in the therapy room can unveil a lot of personal feelings in need of processing—and not just for our clients. When a therapist’s own anxiety regularly rises to the surface before, during, and after sessions, is it a sign that we should consider a career change?

Not at all! For many new therapists, first sessions can be unnerving in and of themselves. But even experienced therapists can struggle with anxiety, which is why I believe exploring our anxious reactions during a session is an important part of preparing ourselves to be therapists. After all, most therapists are highly interpersonally sensitive, and our anxiety can tell us a lot about our therapy interactions if we learn to listen with curiosity. In fact, I’ve found that how sensitive I am to my own anxiety often correlates with, and even determines, the level of depth I’m able to attain with clients. I’ve come to learn that feeling anxious tells us that something unknown is about to emerge, which makes us nervous. It’s not a symptom; it’s a message.

After over 30 years of practice, the question for me is no longer “How do I get rid of my anxiety?” but “How do I use my fears—and my client’s fears—to arrive at deeper realizations we didn’t know before?” Although major anxiety has been rare for me, I’ve learned to listen when it shows up. I’d like to tell you three therapy stories that show the evolution of my relationship with my own anxious moments as a therapist.

Flash back to the start of my career. As soon as I open the door to the office in my graduate school clinic and usher my first client in, I experience a roaring in my ears so loud I can barely hear myself think. I have the wherewithal to offer my client a chair and sit across from her with a smile, but my head remains so full of the roaring sound that I wonder if I’ll be able to hear again.

Years later, I’m rewatching The Godfather and I recognize the same dissonant roaring in the movie’s sound design. You hear it when Michael Corleone is sitting at the restaurant table with the bad guys he’s about to kill. His anxiety’s depicted by the screeching crescendo of a train braking as it comes into a station: a sound so loud it blocks out the words of everyone around him.

Why did this roaring sound flood me? It had nothing to do with my client, who hadn’t even opened her mouth yet, and everything to do with my impossibly high expectations of myself. This was purely my countertransference reaction, the projection of my personal issues into the therapy session. I believed I had to be excellent no matter what, even with no experience! Because I was denying to myself how nervous I was, my fear had to sneak through in a mystifying physical symptom.

Since then, I’ve come to understand that emotions are a form of energy. They’re messages sent through the body to help keep us safe. Before we have self-awareness, we experience anxiety physically, and are unaware of the psychological reasons behind it.

In that first session, my anxiety was warning me that I didn’t feel emotionally supported enough to be taking this big step. I couldn’t explore or even name my anxiety: I just wanted the uncomfortable feeling to go away. I literally refused to hear the message because I was determined to dive into the work in front of me.

Some years later, I was a psychology intern at a psychiatric hospital, acting as co-therapist with the unit psychiatrist in an inpatient group therapy session. I was sitting next to a large young woman who was picking scabs on her legs and describing how she liked to watch someone try to walk after she’d beaten them up. Suddenly, my body felt like a live wire and only the thought of losing all recommendations for post-graduate employment kept me from bolting toward the door on the other side of the room.

This time, instead of being caught off-guard by this unwanted physical instinct, I was in touch with my fear and what was causing it. I panicked, sure, but I knew my reaction was disproportionate. I wasn’t really in danger of losing my life. Some tiny area in my prefrontal cortex was still keeping tabs on my inner experience, and I was able to stay seated in my chair and think, This is what a panic attack is.

Since this young woman was doing her best to scare the group, this time I knew my anxiety was just trying to help by urging me to get away from her. I wasn’t yet able to use my awareness to respond therapeutically to her, but at least instead of blindly reacting, I fully felt my feelings and consciously processed them. I’d had enough training to know it was only a normal anxiety reaction to a difficult client, and although I didn’t yet know what to do, I realized I could do nothing and just sit with it. Later I realized my anxiety was unavoidable, a natural side-effect of my vivid imagination and emotional sensitivity. This was progress!

Navigating my own anxiety gave me empathy for how hard it can be for clients to contain and understand their most intense emotional reactions. I also learned that sometimes my countertransference anxiety was an echo of my client’s anxiety about something we were discussing. Their anxiety was talking with my anxiety!

You too may find yourself feeling by proxy what your client has never been free to feel consciously. Although your client’s emotion is not yours, in the therapy session it may become yours to process. It’s a master therapy skill to realize that sometimes what you’re feeling is more than just your reaction. You and your client may be unconsciously enacting an interpersonal story from their past, mutually arousing old emotions that can finally be heard and handled.

For example, as a more experienced therapist, I was doing depth work with an imposing, alpha-male client. One day, as he was talking, I suddenly felt my arms go cold and my palms start to sweat. Every atom in my body wanted to flee this situation, but by now I found it easy to experience this flight reaction while also sitting calmly in my chair. This time I was familiar with the signals of anxiety and almost welcomed the pounding of my heart because I knew from experience that this was the last stage before the panic dissipated and my physiology returned to normal. While all this was happening physically, another part of me wondered, Is there someone in his life that makes him feel panicky and trapped?

What a step forward! Now, instead of becoming almost deaf with anxiety, I was able to use my panic as a signal to wonder about possible deep anxiety lurking beneath my client’s impressive, hyper-competent façade. I speculated that my attuned, subconscious mind had picked up on his underlying anxiety, even though it seemed out of context to what we were discussing. Although I’m sure I had some countertransference issues here as well, it felt more interpersonal than that. Later, by considering my panic as a reaction to his possible anxiety, it prepared me to explore with him the fear, rage, and powerlessness he’d experienced his whole life in a close family relationship. If I hadn’t felt that panic and listened to its message, I’m not sure I could’ve truly appreciated how desperately overwhelmed he felt at times.

These days, I think of my anxiety flashes as my finely tuned emotion detector. My job as a therapist is to keep pointing that detector in directions where it can be useful: toward deeper curiosity about both my client and myself. Once we focus on anxiety as communicative energy revealing our oldest, most hidden fears, a therapeutic path opens up for us and our clients. Sometimes we may need supervision or therapy to work through our anxiety, but that’s good because it will make us kinder and more understanding of our clients as well. The alternative—pushing away our anxiety—means we’re more likely to foster an environment in sessions that’s inhospitable to our client’s fears.

Learning to decipher the language of anxiety helps you redirect it in ways that can benefit you and your client. When we trust our anxiety is meaningful, and our client’s is too, these unpleasant experiences can take us to the heart of our unfinished business.