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8 Strategies That Work!
Next let's explore some specific strategies implementing the preceding 10 Principles.
I use the trial-and-error method to check on strategy and tactics rather than
thinking there is one magic overall guiding force in therapy. For example, one
patient's problem was conceptualized as fear of being controlled. One strategy
used in therapy was for the client to "gain control by giving up control."
Gain Control by Giving Up Control - 4 Tactics
Here are four tactics I use:
1. Relaxation: "Letting go of control
of your muscles causes you to feel more in control."
2. Acceptance of anxiety: "Not trying to fight and control your anxiety makes your
client feel more in control."
quickly to others' requests: "Choosing to let others be in control puts
you in control."
4. Accepting others as they are: "Trying
to control others makes you feel out of control."
Here is a review
of 8 commonly used strategies with an anxious client. Use it as a checklist or
a review of treatment options. While I explain the list, think of clients with
a general anxiety disorder, phobia, panic attack etc. Perhaps this will help you
to refocus your session if progress is slow. In some cases, conceptualization,
choice of strategy, and tactic are developed early in treatment; in other cases,
these three evolve over a period of time.
8 Strategies with an Anxious Client
♦ 1. "Go with the Flow."
The specific tactic to use with a client depends
on the strength and intensity of his anxiety. I do not encourage a client to approach
frightening situations all at once. I find out which part of the client's anxiety
formulation is weakest and attack that part. When the patient is highly defended
against learning new material, an indirect approach may have to be used, by providing
information and using stories and metaphors. For example, Devin was ashamed of
going to therapy. Without directly talking about therapy, I talked about the importance
of education and of bettering oneself. This approach seemed to alleviate Devin's
concerns, where the direct approach did not work.
♦ 2. "No Time is like the Present."
In general, as you know,
you can design a strategy that allows a problem to be worked on in the session.
This strategy also involves having a client approach, in the here-and-now problems
that he has been avoiding. A speech-anxious client outlined her speech in the
session and practiced giving a few minutes of it. It is always better to elicit
and restructure a client's cognitions when they have the motivation; that is,
thoughts that the patient is having in the session. Talking about the past or
the future is rarely as productive as focusing on the present.
♦ 3. "You Don't Know unless You Try."
Another strategy is
to encourage the client to try. One standard lead into this process is "What
will you learn if you go versus what will you learn if you don't go?" can
be applied to a variety of situations. One client wanted to avoid a wedding where
she might run into an old boyfriend. Using this strategy she decided to go. At
the wedding, she found that she no longer was emotionally overwhelmed or anxious
about seeing her old boyfriend.
♦ 4. "When You're off Track, Take the Opposite Track."
If I am not able to help
the client modify a situation for whatever reason, I find a useful strategy is
to reverse and help the person accept the situation. For example, a therapist
who was making little progress in helping the client modify his expectations of
getting cancer, reversed his approach by stating "Okay, let's say you're
going to get cancer. What will you do then?" Another way if stating the strategy
is: "If you can't beat them, join them."
♦ 5. "Client Persistence."
A general strategy with the anxious
client is to persist in helping him overcome his fears. The patient often needs
this persistence to learn new ways of thinking and acting. The therapist, by not
getting frustrated and giving up, is modeling the important strategy of patience.
Such patience is particularly necessary in dealing with the obsessively anxious
patient and with the client who has trust issues.
♦ 6. "Divide and Conquer.'
You focus on the components of
the client's anxiety that have the least resistance. I tell the client that his
anxiety is made up of three parts: his thinking, his feeling, and his actions.
The most sensible approach is to work on the parts that are most modifiable. If
the patient has a behavioral problem, my therapy focuses on thoughts and feelings;
if he has a thinking problem, therapy focuses on thoughts and behavior. Because
anxiety is primarily a feeling problem, therapy focuses on thoughts and behavior.
7. "Do the Unexpected."
therapy often emphasizes encouraging a patient to do the unexpected, to surprise
himself, to step out of character. This strategy is presented as one of the best
ways to defeat anxiety. Many patients, when given the homework "surprise
yourself," will return with a number of examples of occasions when they have
taken specific risks and surprised themselves.
---Case G: A seventy-year-old
man that has previously been in long-term therapy
intellectual stimulation as well as relief.
---Strategy: Support patient's
---Tactic: Use teaching stories and other forms of intellectual stimulation
to get points across.
♦ 8. "Simplify, Simplify, Simplify."
strategy of simplifying is used throughout therapy. We will talk about this in
more detail later. One patient had six years of psychoanalytically oriented therapy, which gave her much insight but little help in managing her anxiety. Although
she knew this, she still had a tendency to overcomplicate her problems. Throughout
therapy, the strategy of simplification was used. One of her most effective anxiety
reducing tactics was the self-instruction, "When anxious, take constructive
Some related strategies are: "Specific is better than
vague," and "Concrete is better than abstract." Many therapists
and patients have a tendency to become lost in tangential and overly abstract
discussions that are rarely helpful to the patient. The strategy of simplifying
helps to counter this tendency.
Peer-Reviewed Journal Article References:
Boswell, J. F., Iles, B. R., Gallagher, M. W., & Farchione, T. J. (2017). Behavioral activation strategies in cognitive-behavioral therapy for anxiety disorders. Psychotherapy, 54(3), 231–236.
Shikatani, B., Fredborg, B. K., Cassin, S. E., Kuo, J. R., & Antony, M. M. (2019). Acceptability and perceived helpfulness of single session mindfulness and cognitive restructuring strategies in individuals with social anxiety disorder: A pilot study. Canadian Journal of Behavioural Science / Revue canadienne des sciences du comportement, 51(2), 83–89.
Villarosa, M. C., Moorer, K. D., Madson, M. B., Zeigler-Hill, V., & Noble, J. J. (2014). Social anxiety and alcohol-related negative consequences among college drinkers: Do protective behavioral strategies mediate the association? Psychology of Addictive Behaviors, 28(3), 887–892.
What is the "Divide and conquer" intervention technique? To
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