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.
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.
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?"
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).
Breaking Through to the Present
Halfway through that first session, Renee 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'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 possibly 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.
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.
This blog is excerpted from "Facing Our Worst Fears" by Reid Wilson. The full version is available in the November/December 2006 issue, The Present Moment: How Can We Get There and How Can We Stay?
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