Anxiety

Paul J. Hannig, Ph.D., MFCC

The following disorders are classified as anxiety disorders: Panic Disorder, Panic Disorder with Agoraphobia, Agoraphobia Without History of Panic Disorder, Specific Phobia, Social Phobia, Obsessive-Compulsive Disorder, Post-Traumatic Stress Disorder, Acute Stress Disorder, Generalized Anxiety Disorder, Anxiety Disorder Due to a General Medical Condition, Substance-Induced Anxiety Disorder, Anxiety Disorder Not Otherwise Specified, Separation Anxiety Disorder and Sexual Aversion Disorder.

Anxiety is an inhibitory, restricting avoidant type of reaction to a perceived, conscious or unconscious, threatening stimulus. The threat can be real, imaginary or symbolic. The person who consistently reacts to a fear producing stimulus usually develops an elaborate idiosyncratic, rational or irrational explanation for the anxiety reaction.

Anxiety is not a true feeling. It is a defensive reaction against discovering a threatening feeling. Because the sufferer wishes to avoid arousing unpleasant or repressed emotions, anxiety functions as a resistant defense against buried injury and trauma. An anxious person would rather maintain the status quo of cerebral defensive, verbal strongholds than feel the real and true pangs of stored and compartmentalized emotional shock. By holding onto the defense the person effectively keeps the true source of anxiety out of consciousness. When anxiety eventually breaks through into consciousness, the individual needs to attach the anxiety to an external substituted source, such as a spouse, the therapist, a dog, bridge or some other displaced substitute.

A woman may project her anxiety onto the therapist's door in order to avoid going into the therapy room and facing the true origins of her fear. A woman might devalue a therapy method that threatens to breach her defenses and expose her deep emotional pain with her father. Another woman may accuse her husband of wanting to divorce her instead of fully feeling the abandonment of her father. A female may accuse someone of trying to kill her in order to avoid a near death experience at birth. A drug addict may get stoned every day in order to avoid feeling the loss of mother's love. These are just some of the scenarios.

Anxiety and terror are the last bastions of resistance to feeling one's own reservoir of hurt, pain, unmet need, desertion, etc. Anxious people walk tentatively and tend to postpone getting to their true self. They are more concerned with fixing others and controlling people in order to neutralize all symbolic, substituted threats. Inordinate fear creates a need for an inordinate amount of safety. But when you are dealing with inner demons there is no escape except to the temporary realm of a mind that is disassociated from feeling.

Treating the Anxious Couple

When anxiety disorders begin to ruin a couple's happiness, there are specific structures that I have found for the successful conducting of therapy. Structures are planned ahead of time, given what is already known about the case. You can assume that certain needs are not being met and communication is a problem in the relationship.

• Step 1: Assess what needs are not being met and the level of dysfunctional communication. This sets the stage for the work that is to be done, namely unraveling communication problems and teaching them how to state their needs.

• Step 2: Couple is instructed to sit on the floor or a mattress facing each other, holding hands and making full eye contact. Therapist is seated within hearing distance, outside the physical boundaries of potential struggle. This sets the norm that they will be talking to each other.

• Step 3: Lights are dimmed and instrumental music is played in the background to assist in opening up non-verbal areas of the brain. Therapist's role is clearly explained and ground rules are spelled out.

• Step 4: Couple is asked to decide who will speak first and to what length. Since this setting is different from all other therapeutic environments, they are encouraged to express anything that they want. This breaks down some of the inhibitions that anxious people have. The recommendation is to be as honest as possible, using more "I" statements than "you" statements. This gives the couple a reference point to go back to when they get off track and caught up in blaming, accusing, shifting responsibility, projecting, transferring, or becoming anxious. An explanation of how the retreating from feelings and defending by going up into their heads is defensive and unproductive.

• Step 5: Anxiety levels start to rise and misperceptions and accusations begin enflaming the situation. Inventions such as, "Your anxiety is rising. Take a moment and let it register. What caused the rise of tension? It looks like you've gotten in to a power struggle as to whose perceptions are right. That doesn't work!" are made by the therapist at this time. It is at this point where the process of how they escalated into a fight and the futility of getting into a cerebral head-knocking contest is explained.

• Step 6: At this point it is necessary for the therapist to help the couple get real. This is done by encouraging one partner to ventilate their feelings, while the therapist (alter ego) substitutes the real feeling message underneath their verbal salvos. It is suggested that they try to use feeling phrases. Postures change as feelings of hurt and anger come to the surface. Resistances, transferences and projections present themselves and are confronted directly while encouraging the expression of real underlying feelings. This sets the norm that a new approach will replace their dysfunctional problem solving methods. The therapist must interrupt old patterns until the couple can do it on their own.

• Step 7: When the real feeling starts to emerge, the therapist sets up a role play. One of the partners plays him/herself and the therapist plays the parental introjects that underlie the conflict. The full expression of the deepest hurt and rage is encouraged. At this point, emotions that have never been fully expressed burst forth and genuine relief and healing starts to take place. Instead of fighting, a modicum of mutual acceptance sets in.

• Step 8: Both parties are now usually crying and hearing each other for the first time. Hardness begins to melt into softness, brought about by the breakthrough of insightful feeling. Contact and intimacy start to happen after a long drought. After therapeutic explanations and interpretations are made, lifestyle changes from cerebral head banging to deep feeling relating are discussed. Homework assignments of how they can set up their home to be more feeling oriented rather than conflict oriented are given. If appropriate, it is suggested that they put together a music tape for cathartic cleansing and if they can, designate a part or all of their home to be a feeling sanctuary for self-exploration rather than marital warfare.

• Step 9: Couple is coached about the dangers of their old lifestyle overtaking them and what they can do to keep their gains progressing after they leave the office. Fees are paid and the next appointment is scheduled. Reading material suitable for their particular issues is given.

Conclusion

Fighting, arguing, and avoiding are part of the lifestyle of anxious couples. The old method of fighting through to resolution may mistakenly reinforce their family transmitted method of conflict non-resolution. A new way that arouses deeper feeling resources must be found. Old ways are hard to die and when old triggers enter the picture, the couple will automatically regress to old fight styles. The therapist must be an agent of change. S/he must stand for the future, what the couple can become, rather than a willing supporter of the status quo.

Paul J. Hannig, Ph.D., MFCC, CCMHC, NCC * www.nvo.com/psych_help * phannigphd@socal.rr.com * 818-882-7404