Treatment Resistant Anxiety

Q: What is treatment resistant anxiety?

Treatment resistant anxiety is when someone has been to many different therapists and has used many different treatments and the anxiety still remains.

Q: What causes treatment resistant anxiety?

Treatment resistant anxiety is caused by one of two things.

1. The anxiety is a complex anxiety. Not all anxiety is created equal. Some anxieties are rather ‘simple’ and easy to solve, while others are complex and have many layers. When you try to treat complex anxiety using a treatment designed to treat a simple anxiety, it will not work.
2. The client had difficulty trusting the therapist or the treatment. They have concerns about being shamed, judged, mistreated, or other concerns. This causes them to not fully disclose what is happening and what they are feeling, and often to not fully engage in the treatment. Any treatment needs the participation of the client to succeed, without that there is a much smaller chance that it will.

Q: Are you saying it’s my fault that I didn’t participate fully in the treatment?!

Nope! If you didn’t participate fully in the treatment because you have difficulty with shame, judgement, trust, or other issues, we don’t blame you for that. It’s not as if you woke up one day and decided to feel those feelings and have those thoughts. Much like we wouldn’t blame you for feeling anxious, we don’t blame you for feeling mistrust, shame, or judgement.

In our opinion, when a therapist labels a client as a ‘resistant’ or ‘bad’ client, it’s just another way of a them saying “I really have no clue what to do here about this clients feelings of mistrust, shame, fear, procrastination, etc. Instead of realizing that, I’ll blame the client”.

We do realize that. And so our approach is to notice that this process is happening and incorporate these feelings that are ‘blocking’ as part of the therapy itself. It’s a key part of our job.

Q: I have difficulty trusting people. Can you help me?

While it certainly speeds things up when clients trust us right away, it is by no means necessary. For some people trust has to be earned. If you are one of those people, we get it. We don’t expect you to trust us right away. After all the times you have been burned in the past, what’s to ensure it won’t happen again?! That’s why we will take it as slow or as fast as is comfortable for you. We firmly believe that because it’s your therapy, you set the pace and you decide if and when you can trust us.

Q: Is there anything different about therapy for treatment resistant anxiety then for general anxiety?

Yes. When working with treatment resistant anxiety we are careful to not assume that there is a simple answer. We are ready to slow things down and analyze the many possible layers involved. In addition, we are very aware of the clients need to feel safe and trusting in the therapy relationship and we are ready to slow things down to make sure that is happening. Both of these components take time. And so while it isn’t always so, in many cases therapy for treatment resistant anxiety can take more time then treatment for general anxiety.