Counselling in Chichester & Bognor Regis, West Sussex

Existential Work – Anxiety States

My last blog considered some initial ideas on existential thinking and how this can feed through into counselling work.  With this note I would like to look at a practical example as to how an existential approach can assist clients to deal with issues which may surface in the counselling room. One example could be dealing with anxiety states.

Traditional therapeutic approaches to working with anxiety such as psychodynamic counselling have placed much emphasis on developing a better understanding of deep rooted and perhaps unconscious concerns which have underpinned the emotional difficulties faced by the client.  Time in that therapy will often be spent on considering early influences and experiences. The expectation is that once these are bought to the fore there is likely to be a cathartic effect which will help to lessen the emotional dysfunction such as an acute anxiety state.

An alternative approach such as CBT will want to quickly move the client to a place where negative thoughts are identified, challenged and replaced by more positive responses which are intended to enable the client to rise above the emotional challenges. Sometimes likened to a medical model there is a focus on treatment with a more didactic approach which encourages the client to adapt to a more structured way of thinking. This is expected to reduce if not eradicate the sense of anxiety.

As a therapist who works in what is known as a pluralist way, I recognise that both of these approaches can in the right circumstances have real benefits for clients.  There can however be challenges associated with both.

The first approach encourages varying degrees of retrospection perhaps at the very time when the client may wish to look forward. The second CBT approach requires the client to be capable of adopting logical rational thought patterns at a time of emotional upheaval. This may not be possible particularly if there are virtual saboteurs from the client’s past still very much at work.

One alternative which starts from a very different premise is an existential approach to anxiety work. Existential work can be predicated on the acknowledgement that we live in an uncertain world. Although we continue to seek certainty the reality of our existence is that there is much in life we cannot control.

This can range from the mundanities of everyday life such as whether the roads will be clear and the bus will run on time in order that I can get to work through to deeper concerns as to whether an interview for a much sought after job has been successful or not. The issue is not as to whether these challenges and the contingent anxieties should exist. They do and are a part of our everyday existence. The key issue is how we decide to deal with them.

The starting point for existential work will not be to trivialise such concerns but to normalise them.  If an individual is anxious then this concern is real and that anxiety presents for a reason. That anxiety or concern may in itself not be an inappropriate or even a harmful reaction. For example to be anxious about a major forthcoming event in our lives may well be a very appropriate response even if that emotion runs counter to how we want to feel or publicly project ourselves.

A feeling of concern or anxiety before making a public speech or receiving the results of a health scan can be regarded as an entirely fitting emotional response rather than an indication of some underlying emotional fragility.   With an existential approach we start from an acceptance of our current reality. We live in an uncertain world and our anxiety may be no more than a natural reflection of that.

An existential response sees a client acknowledging the reality of anxiety and that there is no magic wand which will remove all concerns. Indeed in some difficult circumstances the absence of any feelings of unease or apprehension could suggest some form of detachment. That absence of feeling may actually provoke concern with regard to emotional wellbeing.

If we can accept that some anxiety is a normal part of everyday existence we are then in a much better place to consider the extent of that anxiety and the consequences of that reality. Working with a therapist can then allow us to consider whether our level of anxiety is within acceptable boundaries or whether it is disproportionate and requires further attention.

For example if we decide that our anxiety is overwhelming and prevents us from going out and engaging in work or social activity then we are likely to want to do some further work to ameliorate this extreme reaction. This could include both examining the reason for the extent of this worry and finding ways to contain the level. At this point other therapeutic strategies may be brought into play such as those already referred to in this note.

Sometimes however those initial discursive reflections on the realities of life can put the prevailing anxiety level into some form of perspective. This may be sufficient to bring down that anxiety level to something that is more tolerable. To have given ourselves permission to feel anxious and to normalise the feeling, anticipating that it will pass, may be all that is needed to manage the situation.

Existential counselling is a collaborative endeavour. Like many other forms of therapy, the relationship between client and counsellor needs to be secure and grounded.  Existential counselling is not about directing the client along set pathways. Neither is it an invitation to explore all that has remain dormant in the unconscious. Instead it is a way of encouraging and supporting the client to explore the different emotional roads existing in the present.

In particular existential work reminds the client that she or he retains choice over how to be with what is happening now and with what lies ahead. This can include just how to view that anxiety state.

When a colleague or partner says “don’t worry, there is no need to feel anxious” that statement reflects their world view. It may not be yours.  You are free to choose that which is right for you. At my practice offering therapy and counselling in Chichester I would encourage you to decide how to be with that anxiety state.

Although it is an uncomfortable feeling you may choose to accept that sense of anxiety.  Alternatively you can work in therapy to reduce that feeling to something more tolerable. Whichever choice is made the role of the therapist is to be there, to assist and support the client.

And the starting point of this work is to encourage the client not to feel anxious about feeling anxious!