Most therapists assume that, just as any rational person with a broken arm would be an eager customer for medical care, surely a person suffering from severe anxiety or depression would be equally motivated to receive the healing we offer. But what if this isn’t the case? According to renowned anxiety expert David Burns, one of the original developers of cognitive therapy, the biggest barrier to treating anxiety successfully is a failure to recognize that many clients experience anxiety as a subconscious suit of armor.

Deep down, many clients believe that their anxiety shields them from uncontrollable urges, feelings, and desires that contradict their idealized notions of who they think they should be. So it’s no surprise that they resist the onerous process of transforming their anxiety, especially given that much anxiety treatment involves some form of exposure to the very thing that causes them so much discomfort. Thus, Burns suggests, the key to working with these clients should begin with understanding the client’s rationale for staying exactly the way they are and supporting their resistance to change.

In this video clip, David shares the story of a case in which he treated a handsome man whose shyness was keeping him from dating. This case pivoted dramatically on what David calls “paradoxical agenda-setting.” In short, this method involves the therapists directly addressing the perceived perils of change in the very first session and verbalizing all the reasons for the client not to change, waiting for the client to take the other side of the argument and insist on change.