Giving Fish Versus Teaching To Fish: Which is More Effective In Treating Anxiety?

Hello, and thank you so very much for addressing this question to me.

I find your question valuable for two reasons. First, it regards the treatment of Anxiety, of the Social variety, which is a specialty of mine. Second, it portrays the type of care NOT usually effective in such treatment, and third, your question is about the issue of communicating effectively with your therapist in order to yield the best outcome possible. Important issues all.

You may not have known this before, but you sure know it now; the "fit" between client and therapist, particularly from the perspective of the client, is a very significant predictor of therapeutic outcome. So, all in all, it is best to work with a therapist by whom you feel understood, valued, and whom you feel you can trust (trust that they are working with your best interests in mind and that they are highly skilled).

So, it seems we have a little dilemma here. Technically, and purely based on your description ("he understood what I wanted and never hesitated to give it to me"), your former therapist was treating your social anxiety by "giving you fish." In this case, "reassurance" is the fish. Perhaps you had a negative thought about how you might be seen at an upcoming social event, or perhaps you thought your therapist was critical of your sounding a bit scattered in session; in both scenarious, it sounds like the good old therapist was quick to correct your fortune telling and mind reading, and to promptly REASSURE you.

What's wrong with reassurance? In general, nothing. However, when it is elicited or sought in order to reduce anxiety, REASSURANCE ACTUALLY LEADS TO THE PERSISTENCE AND WORSENING OF ANXIETY! (based on the principle of "Negative Reinforcement" - Google it). Because although reassurance for an anxious person may yield a slight reduction in distress, it's really like a hit of "crack." It might feel great for a minute or two, or even 30 minutes or an hour, depending on how much reassurance/crack you can get, but the effects of both are terribly short-lived. They are like "temporaries stays of execution." But with each new day, the firing squad appears to line up yet again, and the anxiety is off and running, once again.

The problem with being given nice, fresh fish every day, is that never actually learn to bait a hook, drop it in the water, and try to catch a fish! And once you learn, you won't feel NEARLY so dependent on others for reassurance (which they don't ALWAYS give, right?). You will no longer have to worry about "whether or not there will be fish," or whether your therapist will give you any. The solution to this dilemma is to NOT seek fish, but to learn to fish. And indeed, as in leanring any new skill, there will be hits and misses on your way to a new set of skills. When someone hands you a fish, that all seems completely unnecessary, BUT IT DOESN'T LEAD TO CHANGE! Besides, most of us like to see ourselves as having a strong sense of agency and will and mastery in life, not as waiting for crumbs of crack to get through the day.

Ultimately, I suppose I would ask you how long you worked with the previous therapist, and during that time, by what percentage did your symptoms of social anxiety reduce? Approximately, of course. By 10%? 20%? 30%? Was the symptom severity ever measured and tracked from session to session? Were you given assignments to complete outside of session? Readings? Thought records? Exposures? These latter tools are DE RIGEUR when it comes to treating social anxiety.

So, what happens when you can't get reassurance from your therapist? Or from anyone else? THAT is precisely the right question to be asking in the treatment of social anxiety, because the answer to it is your only real long term, "inside job" solution. You learn a variety of VERY DIFFERENT ways of "greeting" anxiety (after all, it comes from inside you, so it's best to treat it as a friend and not an enemy).

My guess is that the new therapist MIGHT be trying indeed to teach you to fish, versus simply serving them up, but it is also clear that the rational for the new therapist's approach has NOT been made adequately clear to you. It is therefore quite understandable for you to feel disconnected from your therapist when you are not sure what he is saying, or why he is saying it. Anyone else in your shoes would likely have a similar reaction, especially given what you had been accustomed to.

How to deal with this? Easy! My number one recommendation to you is that you bring your original letter to me, and my response to you, with you to your very next session. Put your cards on the table and express your concerns, your disappointments, your confusion about what he's really thinking, etc. Whether or not you like the answer, you will be treating the anxiety SIMPLY by being willing to have the uncomfortable conversation. Its YOUR therapy, and YOUR LIFE that is being burdened by anxiety. It's also YOUR MONEY and YOUR TIME. Don't you think you deserve to use it as you wish? Perhaps not, and if so, this needs to go on the list of automatic thoughts ("I don't deserve to disagree with professionals, even if I'm paying; that is wrong, disrespectful, and could lead to an uncomfortable conflict or discussion"). That belief will then be subject to evaluation, and YOU will lead the charge!

Ideally, you will ultimately want to work with a psychologist well-trained and experienced with the treatment of anxiety in general, and of social anxiety in particular. They should have a strong grounding in cognitive-behavioral therapy, which is the most effective approach for this condition. Your new therapist may very well be coming from this perspective, and that may come out in the discussion I am proposing you initiate at YOUR VERY NEXT SESSION.

Your primary challenge is to relate to anxiety as a friend or as an assistant; it is not your master although you treat it as such. With self-acceptance, you need no reassurance, and without it, all of the reassurance in the world won't help you.

Please feel free to review my replies to many other questions about social anxiety, and my guess is that you will benefit from doing so.

Please do also let me know if I can be of further assistance to you, and updates on your progress would be so very welcome.

Sincerely,

Richard E. Schultz, Ph.D.