Paul J. Hannig,
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.
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
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.
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.
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.
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.
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.
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
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
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.
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 * firstname.lastname@example.org *