Whose tools for anxiety?

The more I familiarise myself with the various tools and techniques of different psychotherapies, the more I get the impression that these tools serve a calming function for the therapists as much as for the patients.

It’s scary, and anxiety-provoking, being the person allocated responsibility for reducing someone’s emotional and psychological distress. As all clinicians who are in any kind of ‘caring’ roles are. That’s a heavy weight to bear and we all (should) appreciate that.

It’s even more scary going into a room with the aim and desire to help someone, but feeling yourself incompetent, or not having the required ‘skills’ or powers to do so. That often provokes added frustration and anger at your perceived inability, which can easily be transformed into frustration at the patient themselves, as they appear to be the one putting you into that situation in the first place – they are right there in front of you, so you might easily make the leap, no matter how misguided it is.

It is no surprise, then, that a book of ‘evidence-based’ tools and techniques, with step-by-step instructions, would feel a welcome relief to therapists who might not feel they know how to help someone. And often they are! I’m not denying that methodological techniques are useful to patients, but I think it should be acknowledged that they are also acting to reduce the therapist’s anxiety too. Which probably helps the therapist be a better therapist in their more general interactions with the patient – because they are less focused on themselves and their skills/lack-of.

There is a danger though, that the tools themselves take center-stage, and the patient sitting in front of the therapist gets forgotten about. That is what I really appreciate about the phenomenological-turn happening in psychiatry and psychopathology at the moment. It is trying to return the spotlight to the infinitely complex human being that is the patient, who needs to be seen and responded to as such, rather than just a ‘problem’ to be solved.

Often, the problem is precisely that this person has not often enough been seen in their lives as the unique individual that they are, so when this happens once again in therapy it’s not going to do much good. In those cases I don’t think it’s actually the tools themselves that will help them. Tools can help only when applied in such a way that appreciates the complexity and richness of a human subjectivity, not when applied generically or inflexibly.

My guess is that the most healing parts of psychotherapy are when the patient feels truly heard and seen by the therapist, or if not perfectly, then when they sense that the therapist is at least making the effort to try to understand them fully. And I imagine that these moments are so so rare, perhaps a precious 1% of therapy (even by the best therapists) but that this makes them all the more special when they do occur.

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