Finding Strength in the Symptom

Breaking Free from the Limits of Our Medical Treatment Model

Courtney Armstrong3 Comments

As therapists, we’re taught to be master detectives, methodically investigating our clients’ symptoms in search of a culprit—the source of their pain. But if we spend too much time preoccupied with our clients’ symptoms, we’re likely to miss important clues to their hidden strengths. Over the years, I’ve learned that turning a symptom into a client’s ally, rather than a nemesis, can transform the whole experience of psychotherapy for both the therapist and client.

I didn’t always see symptoms as allies. In fact, my early training in hospital settings taught me to view symptoms as pure pathology, and evidence of impairment. Unfortunately, seeing patients as impaired made exploring their innate strengths and how their symptoms might be resources seem irrelevant to the main task of therapy: medicating, controlling, and managing pesky emotional and physiological problems. To make matters worse, clients’ belief that symptoms were their enemy validated their fear that something was terribly wrong with them. Too often I saw therapy bog down, as patients became even more helpless, stuck, and despairing, rather than moving on with their lives.

Frustrated with the limited effectiveness of the medical model of treatment, I searched for more positive approaches to psychotherapy as soon as I obtained my professional counselor’s license in 1999. I began studying the neurobiology of emotion to deepen my understanding of how our brains and bodies produce emotional responses. Charles Darwin first postulated that all emotions are goal-directed, physiological responses, which mobilize the body to take an action: their function isn’t to make us feel bad, but to spur us to do something useful for our survival. For example, fear accelerates the cardiovascular system to strengthen your legs so you can run faster from a perceived threat. People want to get rid of fear, as though fear itself is the dreaded villain, but in fact, it’s nature’s way of giving us extra strength.

Understanding the functional value of apparent symptoms can make a huge difference in a client’s response to them. When people learned to view the physiological response of fear as a helpful ally, their emotions shifted from negative to positive.

Turning Panic into Power

My client Monique was a deeply traumatized 18-year-old college freshman. She’d been brutally raped and tortured for two days after a man had drugged her at a fraternity party and held her hostage in his apartment. Before the assault, she’d been a competitive track star and a straight-A student, but her post-traumatic stress reactions had forced her to drop out of school.

Monique’s attacker had been arrested, but constant reminders of the sadistic event haunted her in her Indiana hometown where she’d attended school.

When I greeted Monique in the waiting room for our first session, she was fanning her flushed face with one hand and wrapping her braided hair on top of her head with the other. She paced back and forth in worn blue Saucony running shoes. Thinking she might be reacting to the South’s steamy weather, I asked, “Is it too warm in here? I can adjust the AC.”

Monique shook her head as she wiped the sweat off her face. “No!” she cried. “I’m having a panic attack!”

I nodded. “Oh goodness, that must feel incredibly scary and uncomfortable,” I said. “If you want, I can show you some ways to get it under control.”

Monique looked at me tearfully. “I hope so. I feel like a total freak.” In my office, Monique sat down for a moment and then popped back up. “I’m sorry, I have to keep moving,” she said. “I can’t sit still when I’m like this.”

I replied, “That’s because your body is giving you extra adrenaline to strengthen you to overcome a challenge. It’s called the fight-or-flight response. When our bodies are in this state, they want to run or move in some way.” I noticed that Monique was paying full attention. “We have a private walking trail behind my office,” I said. “Would you like to go out there? Your body obviously wants to move right now, so walking might help you feel better.” She nodded.

Although I was taught to lead clients into calming breathing exercises when they’re panicking, I’ve found that moving the body can bring a panic attack down faster. As Monique and I walked together on the shady, wooded trail, I asked what she was noticing within her body. “A little more settled,” she said. Because she’d been on the track team and enjoyed running, I suggested that she might get additional relief by jogging for a few minutes. Without a word, Monique began trotting around the circular trail as I monitored her from the sidelines. After the first lap, she reported that jogging did seem to help calm her nerves, and she continued around the trail a few more times. When she finished, she flashed me a half-smile and observed, “Wow, you were right. When I started running, my heart rate didn’t get faster or seem that scary. It just felt like it was supposed to feel when I’m running.” We spent the rest of the session walking and talking. Rather than dive into Monique’s trauma story, I continued to buoy her sense of strength and competence by asking her to tell me how she’d become a track star. As she recounted tales of winning state championships, I noticed that she stood a little taller and her voice became livelier. Her stride was longer and more confident.

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I asked, “Were you ever nervous before those track events?”

She furrowed her brow, thinking. “Yeah, every single time.”

“Well,” I asked, “did you ever notice that the nervousness helped you run faster or perform better?”

“Yeah, we called it ‘getting pumped,’” she said, grinning this time. “You take all that nervous energy, put on some hip-hop music as you warm up, and visualize using that adrenaline to your advantage.”

“You know, panic attacks are the same thing,” I told her. “It’s your body’s way of getting you pumped to overcome a challenge.”

At our next session, Monique said she’d been walking or running for at least 20 minutes a day. She noticed that it reduced the intensity of her anxiety and was helping her reclaim some semblance of her outgoing, happy-go-lucky former self. She said, “I know I need to talk about what happened to me, but I can’t remember much of it because he had me drugged the whole time.”

I suggested to Monique that instead of slogging through the story from the beginning, she start by telling me the end when she became conscious and escaped the situation. I added, “To me, hearing how you survived such a harrowing event is the most significant part of the story.”

Monique hesitated, then plunged in. “I remember waking up naked in excruciating pain next to this guy I barely knew. When I sat up, the room was spinning and I felt like I was going to throw up. He was sleeping, and I decided that was my chance to get out of there.” She was breathing faster, and I wondered whether I was pushing her too far, too fast. I touched her shoulder to let her know I was there.

“But when I stumbled getting out of the bed, he woke up,” she went on, swallowing hard. “He grabbed my arm and tried to pull me back, and I puked all over him, right in his face! He yelled at me and went to the bathroom to wash it off. I spotted the front door and sprinted out of there as fast as I could, screaming. He tried to run after me, but I was too fast for him. Luckily, two of his neighbors were outside. They were big guys, and they tackled him and pinned him down until the police got there.”

“Wow, way to use your track and field skills!” I cheered.

Monique took a long breath, and then looked up at me. Her face was animated. “Yeah, that was the fastest I’d ever run!”

I didn’t want to interrupt her flow, but I thought this might be a good teaching moment. “Well, that’s the fight-or-flight response in action,” I said. “When there’s something to run from, it doesn’t feel like anxiety. It feels like a natural surge of energy right when you need it. Even the vomiting is part of it. Your body empties your stomach to redirect energy away from digestion and into your legs so you can run faster.”

In subsequent sessions, I continued to help Monique review this part of the story until she could fully embody the feelings of power and strength she used to escape her attacker. We reprocessed what she could remember of the event, little by little. As horrifying as the story was, I kept my focus on recognizing her extraordinary fortitude. We continued to incorporate walking, jogging, and other empowering physical activities into every session to keep her connected to her strength and agency.

By the end of the summer, she was feeling secure enough to return to Indiana and attend a different college. Five years later, she called me during a visit to Tennessee to tell me that she’d finished school, had married a great guy, and had just given birth to a beautiful baby girl. “I wanted to thank you because you were the first person that saw me as a strong person, not a helpless victim,” she said. “Getting me out on the trail to run that first day was like a huge awakening. It made me see I wasn’t broken and could get better. I began to trust my body and myself again.”

***

Reframing symptoms as allies can’t be approached as a mere technique or therapeutic trick. I always begin by conveying my compassion for my client’s struggle and making sure I have a full empathic grasp of his or her suffering. If I skip or compress these steps, I can easily lose my bond with a client. So I tread carefully before inviting the client to work together to transform a symptom, whose painfulness I always validate, into a quality that increases their sense of power, competence, and purpose.

It may be hard for us to recognize that clients’ symptoms can reveal the path to healing, but if we look and listen carefully, we may find that it doesn’t take a detective to uncover their greatest strengths. Often they’re hiding in plain sight.

***

Courtney Armstrong, LPC, trains mental health professionals in creative techniques for healing trauma and is the author of The Therapeutic “Aha!”: 10 Strategies for Getting Your Clients Unstuck and Transforming Traumatic Grief.

This blog is excerpted from "Hiding in Plain Sight," by Courtney Armstrong. The full version is available in the September/October 2016 issue, Courage in Everyday Life: An Interview with Brené Brown.

Illustration © Illustrationsource.com/Phil and Jim Bliss

Topic: Anxiety/Depression | Creativity

Tags: 2016 | Anxiety | anxiety and depression | anxiety attack | anxiety attacks | anxiety disorder | anxiety disorders | anxiety relief | clinical creativity | Courtney Armstrong | Courtney Armstrong LPC | creative | creative counseling | creative counseling techniques | creative therapy | creativity | creativity in counseling | overcoming anxiety | panic attack | panic attack symptoms | panic attack treatment | panic attacks | panic disorder | symptoms of anxiety | treating anxiety disorders | treatment for anxiety

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3 Comments

Saturday, February 2, 2019 5:25:27 PM | posted by Elaine Brown
Great article!

Saturday, February 2, 2019 6:36:37 PM | posted by Elllen Luborsky
This is a wonderful way to work. It is a gift to the patient to have ways to clue into the meaning of the symptom, and use it as an opportunity for a new view. My father wrote a book called The Symptom-Context Method (Luborsky, L., 1996) in which he shows how the symptom can be a portal to understanding core issues. Your work takes it one step further, by offering positive ways to transform it.

Monday, February 4, 2019 5:47:55 PM | posted by Dr Karen Shue
Yes! As a clinical neuropsychologist, my biggest message to clients is that your brain is always trying to do its best for you -- it responds to what it's asked to do. You've given great examples of this: the brain providing the extra energy to escape, to work off the now excess energy, the parallels between an "artificial" need to run (in a competitive way) and a natural "real" situation. Yes!