Wondering Out Loud: Creative Reframes for Anxiety in Teletherapy
D
uring online therapy with two analytical young men presenting with anxiety, I channeled Ericksonian Utilization to pivot their minds toward generating alternate interpretations of their difficulties. In both cases, anxious thoughts were disrupted via therapeutic reframing, providing catalysts for clients to envision hopeful possibilities.
alternative interpretations shifted the client from somatic to intellectual responses to the disturbance, thus reducing his anxiety while increasing his sense of control.
the client had previously shared that he had "dropped out of university due to extreme anxiety,” I asked if the Gremlin was trying to tell the client something important about his
Befriend the Gremlins
studies. Jumping forward in his chair, the client blurted, “Physics is causing me unbelievable stress. Maybe it’s not the field for me.”
An 18 year-old physics major shared that he had been “anxious since he was a child,” and that “anxiety was a part of his DNA.” His parents divorced when he was Hail the Headless Cockroach five, and “his mother had also been anxious as long as he could remember.” An art history educator (24) shared that he was distressed by a reoccurring dream We explored what anxiety looked like in involving cockroaches, finding it difficult his home, and the client expressed to fall back asleep after these nightmares. empathy around his mother’s fears. After I asked what the dream could mean, and providing psychoeducation on anxiety and flow, I wondered out loud if the client the client said, “I really don’t know.” We explored re-writing the end of the dream may have “absorbed” some of his mom’s anxiety because he had previously stated to avert the cockroaches, and surmised that he was a “sensitive” individual. The that even one alternative would reduce client nodded in agreement. his focus on the bugs by fifty percent. When the client mentioned that the Drawing on Narrative externalization, I cockroaches were headless, I said, “Wow. offered another possibility. “What if It sounds like they are dead then – like anxiety isn’t actually a part of your DNA? they have no power. I wonder if this What if there’s a little Menehune that dream means you have conquered a jumps on your shoulder to warn you of difficulty because you have slain the potential danger, and you are perceiving cockroaches.” His eyes lit up and he said, these warnings as internal anxiety? If you “I would have never considered that, but have a strange noise in your car that can’t it totally makes sense. I have been clean be explained, Hawaiians say your car has for three weeks now, and maybe the a Menehune – the Irish have dream is trying to tell me that I’m Leprechauns, Indigenous Peoples have conquering my addiction.” Tricksters, and Harley riders have For homework, I invited the client to generate different meanings and endings for the dream. Opening space for 8
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Gremlins. These are playful but powerful creatures who warn us of danger, or teach us important lessons.” The client smiled. I then speculated that the Gremlin was trying to tell the client something important, but because the client wasn’t listening, the Gremlin became more and more outrageous with its tapping. Since
For homework, I invited the client to imagine what his dream career would look like. Externalizing the client’s anxiety provided a safe space for him to acknowledge his subconscious wisdom, albeit in the form of a wise and playful messenger. Ethics and the Therapeutic Reframe Therapeutic reframing has been evidenced as a positive adaptation tool (Matilla, 2001) and condemned as manipulative spin (Hoffman, 1982). Through an ethics lens, it may be helpful to view reframing as unearthing openings to multiple possibilities, or a “plural realism” (Matilla, 2001, p. 101). As therapists, we have an ethical responsibility to honor client values, goals and preferences during this influential process. Therapists assist clients to expand thinking, whereas clients ultimately determine what resonates. Together, we embark on a shared journey as arbiters of meaning, contextualizing difficulties within the client worldview.
