Therapist: What else have you tried to do?
Client: Well,sometimes I try to talk myself out of it. I say, "This is silly, you are making a mountain out of a molehill."
T：In other words, criticize and chastise yourself. And the purpose of this criticism...?
C: To get me to stop it.
T: To get yourself to change-to stop worrying.
C: Yeah... The things I worry about are silly. I mean some of the things that come into my mind are just nuts.
T: And the idea is that if you could get rid of those worries-those thoughts-then the anxiety would be less and you'd be able to face your daily situation better.
C: Right, but it is pretty hard to convince myself to stop it, so sometimes it works but sometimes it doesn't.
T: So if you could just convince yourself that you don't need to worry, then it would work and things would start moving ahead. OK. So far we've got criticism, chastising, and attempts to convince yourself to stop. What else have you tried?
T: And this. Coming in here. Is it part of that effort to change how bad you feel as well?
C: Of course. I'm not sure what I will get out of this really, but if I could feel even a little better about myself, it would be worth it.
T: So you're hoping to remove some of the bad feelings and get more good feelings because then you would be able to move on.
C: (Pause) I guess so.
T: So this is another thing to try. Good. So let's add this therapy to the list. It is another thing you've done to feel better.
C: I've tried almost everything I know to feel better.
T: I'm sure you have. You have indeed. And this-therapy-is yet another attempt.
C: You say it as though there is an alternative.
T: Well. I don't know. Right now I just want to be clear about what you have tried and how it has worked.
C: Right, but it is pretty hard to convince myself of it, so sometimes it works but sometiems it doesn't.
T: So if you could just convince yourself, then it would work. OK. Let me ask you this. Your mind says that when you convince yourself that your concerns are silly, you will stop having those concerns, you will become less anxious, and then you will do better. Right?
T: OK. And dose that work? What does your experience tell you?
C: Sometimes. But I can't always talk myself out of them.
T: And even when it does work, if we expand the time frame a bit, would you say that over time, as you've followed the rules your mind has laid out for you, that your concerns overall are less or more?
C: ...Overall it is more.
T: That seems like a paradox, doesn't it? I mean, you do what your mind says, sometimes it even seems to work, and then somehow it seems as though the concerns and worries are getting bigger, no smaller. They are more important, not less.
C: So what should I do?
T: What does your mind tell you to do?
C: Try harder.
T: Interesting. And have you tried harder?
C: And harder and harder.
T: And how has that worked? Has it paid off in a long-term or fundamental way, so that by doing it you have transformed the situation and it is no longer a problem? Or are you, unbelievably enough, sinking in deeper as you try harder and harder?
C: ... I'm sinking in deeper.
T: If we had an investment advisor with that track record, we would have fired him long ago, but here your mind keeps leading you into efforts that don't really, fundamentally, pay off, but it keeps following you around with its "blah, blah,blah," and it is hard not to give it one more try. I mean what else can you do but what your mind tells you to do? But maybe we are coming to a point in which the question will be, "Which will you go with? Your mind or your experience?" Up to now, the answer has been "your mind," but I want you just to notice also what yor experience tells you about how well that has worked.
T: You have told me a lot of things you have tried to do, and it seems to me that you have tried to do just about everything that is logically there to be done. You've done all the obvious and reasonable things. You've thought hard, you've worked hard. You've looked for the angles. And now here you are in therapy...still trying. But you've hired me. I work for you. So it is my obligation to point something out:"This isn't working, right?"
C: I haven't figured it out yet.
T: Here is another way to say what you just said: Even trying to figure it out isn't working so far.
C: Not yet.
T: Not yet. What if it won't? What if this whole thing is a setup?
C: A setup?
T: Well, in other areas if you had worked this hard, you'd have a lot of good things to show for it. Isn't it true in your experience, although it doesn't seem that it should be this way, that the more you've struggled with emotional discomfort and disturbing thoughts-the more you have tried to get rid of them-the more difficult it has becaome? They don't seem to respond to conscious control. These feared reactions haven't gotten smaller, they have gotten bigger.
C: I don't know how to get rid of them. I'm hoping you can help. How should I get rid of them? What am I doing wrong?
T: Those are important questions because they show very cleraly what has been going on, but let's not get off on that issue quite yet. Let's start with what you know directly. You feel stuck.
C: Big time.
T: It is not clear what to do next, but it doesn't seem as though there is a way out.
T: So I'm here to say something:"You are stuck. There is no wa
C：So why am I coming in to see you? It sounds as if you are saying I will never be successful.
T: My purpose is not to help you win this struggle. That does not mean that you are hopeless or you can't be successful. In fact, my goal is to help you have your life work, and I 100% think I can help you do that if you are willing to face these monsters your have been running from.
C: If it is easy to have your life work, why haven't I done it?
T: I neve said it was easy. It is hard. Not hard effortful-it is hard tricky. This is a very tricky trap-one that catches us all. Look, it is absolutely clear to me that if you knew what to do, you would have done it. I don't believe for a minute that you are broken, weird, perverse, or self-destructive. You have done the absolute best you can. You have everything you need to move ahead from here to live a vital, committed, meaningful life. It is just that we have to start from here-here is where you are. So you look and you see whether your experience doesn't tell you that you are caught in a struggle you seemingly can't win. Are you willing to trust that experience, allow it to influence you, and then to move from here? That is what your life is asking of you right now.
T: What else did you observe?
C: Well, when I was about to go into the department meeting, I noticed I checked several times to see whether I still had my bottle of Valium in my purse. I kenw it was in there-I alsways carry it anyway-but I checked it maybe four times within 5 minutes right before the meeting.
T: What do you think the checking was in the service of?
C: I guess reassuring myself that it was there.
T: So that you could...
C: Well, so that I could always quick sneak a pill if things got too bad. I have learned to open the bottle with one hand and sort of tuck a pill in the knuckle joint. Like a magician does. Then I cough or something, and I get it in my mouth. It tastes pretty bad, but actually if I just let it dissolve it works faster anyway, so I don't need water or anything.
T: So one thing you observed is that before you go into the department meeting you make sure you have a way of dealing with your anxiety. And you check for the bottle to reassure yourself that you have that way out even if you can't just leave the room.
T: And that is in the service of keeping the anxiety away.
C: For sure.
T: Can I say it this way?: Access to tranquilizers is probably one way you dig.