Social Anxiety Therapy Development Group

Entry for 8 January 2008:

When we starting planning the Social Anxiety study over a year ago, one of the things we all were looking forward to was the opportunity to look at each other’s work with clients. Now, finally, our first two clients have started therapy. Today was the first meeting of the Social Anxiety study group since we started seeing clients, meeting under a revised name (Social Anxiety Therapy Development Group) and format. Rather than working on the research protocol and screening process, our main focus has become looking at the work in order to figure out what we’re doing and how to do it better; this also provides supervision.

At the end of a stimulating and fascinating conversation I proposed that some of us write about what we are learning after each meeting. Here is my list for this first meeting:

1. Because Social Anxiety (SA) is fundamentally a kind of difficulty with interpersonal relationships, it can be useful to listen for SA exemplars in sessions, that is, instances of the client’s difficulty as they occur in the moment. This is not transference work, because it's not really interpretive, but does introduce relational work, that is, attending empathically to the client’s experience of being with the therapist in the session. For example, a client may introduce an instance of social anxiety with regard to the therapist, such as a concern that the therapist will judge or view them poorly.

2. It looks like it is going to be important to work with what can be variously called ambivalence, polarities, multivocality or conflict splits around the social anxiety. Thus, it seems likely that a key issue will be the tension between a part of the person who is terrified of social situations and another part that isn’t happy with the consequences of the SA and wants to change. This explains why Motivational Interviewing is being used with anxiety problems by Westra and others as a prelude to CBT exposure work.

3. We also saw instances of self-focused attention, where the client’s experience of the immediate moment/interaction with the therapy was mediated by their attention to self. The most striking example of this was how one of the clients responded rapidly and seamlessly to their therapist’s apology by blaming themselves for the problem. I have observed clients’ tendency to blame themselves for therapist limitations for years, but here it was clear how this was part of the client’s SA process.

4. What most struck us as we reviewed the tapes today was how central dialogue/ presence is in this work. It appeared to be quite important for the therapist to make contact with the client directly and transparently in the opening minutes of the first session. This got labelled variously as empathy, congruence and presence, but it appeared to be critical.

All in all a great beginning!