When people think of eye movement desensitization and reprocessing (EMDR) therapy, they generally think about a treatment for trauma, which is partially accurate. Treating trauma is what EMDR therapy was developed for and continues to do. But since its development and introduction over 25 years ago, it has become more than an intervention and is now a comprehensive psychotherapy, one that is exceptionally effective in addressing multiple issues and challenges.

A common misconception is that a person has to be struggling with mental health or major life challenges to benefit from EMDR. On the contrary, one of the most interesting and innovative uses of EMDR has been in performance enhancement in addition to its ability to decrease fear, stress, or anxiety related to performance.

How EMDR Works

In short, EMDR therapy accesses and links the multiple facets of memory (image, cognition, emotion, and sensation) and uses bilateral stimulation/dual-attention stimulus (eye movements or tactile or auditory stimulation) in order to decrease disturbance associated with specific incidents in a person’s life. It taps into the brain’s natural ability to heal and helps it file away memory appropriately so that when the memory is recalled, there is no disturbance associated with the memory.

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Other Ways EMDR Can Help

EMDR has several wonderful applications. In addition to decreasing disturbance associated with trauma, it is effective in decreasing anxiety and targeting irrational or negative thinking, both of which may get in the way of performance. In addition, it can help a person to gain confidence in his or her ability to perform a task or reach a goal. EMDR works to achieve this by installing positive beliefs, and by having a person imagine doing the thing he or she is nervous to do or wants to improve in while doing bilateral stimulation. This has the effect of simultaneously decreasing the fear, anxiety, or stress associated with the task and boosting confidence.

It seems that EMDR helps the brain to think in a healthier, more adaptive way by removing blocks (such as negative self-beliefs) and helping the person to tap into his or her strengths.

An Example of EMDR in Practice

Sometimes EMDR is hard to conceptualize without a specific example. Here is a hypothetical one.

Alice wants to implement healthy habits into her life, so she has set a goal of exercising three times per week. However, she is self-conscious when she thinks of going to the gym. She worries about other gym members and trainers judging her.

She visits an EMDR therapist to help her reduce her anxiety and to boost her confidence in going to the gym. The therapist completes a thorough history and teaches her stabilization and calming skills to utilize between sessions and (if needed) during the desensitization phase. Once fully prepared for the next phase of EMDR therapy, Alice and her therapist assess and desensitize any past experiences that feel related to the current experience.

Once there is no longer any disturbance associated with past experiences, they then assess and target the current situations that are triggering for Alice. Specifically, Alice targets the image of the gym, the belief “I am not safe,” emotions (fear and insecurity), and body sensations associated with this target. They use bilateral stimulation and work through the target until no disturbance remains, Alice is able to fully believe the thought “I can keep myself safe,” and she no longer has any negative body sensations associated with the target.

Alice and her therapist then move to the next phase of EMDR therapy, during which future situations are targeted. During this phase, Alice plays a movie in her head, imagining herself packing her gym bag, getting in her car, driving to the gym, going into the gym, completing her workout successfully, and leaving the gym feeling a sense of accomplishment. Alice finds that when thinking about this scenario, she has some anxiety and another negative belief: “I am going to fail.”

Alice plays the movie through several times, all while the therapist provides bilateral stimulation. If Alice finds she gets stuck, she lets the therapist know and the therapist helps her to work through the sticking points. She finds that each time she plays the movie in her mind, she is less anxious and more confident in her ability to go through the actions she is imagining. She eventually finds that she no longer believes she will fail and, while playing the movie the last few times, instead holds the belief “I am strong and capable.”

The next time Alice goes through the actions of preparing for and going to the gym, she has far less anxiety and much more confidence.

Of course, every case and person is different, but this is a simple example of how EMDR may be helpful in not only addressing past and present issues related to performance, but also in enhancing future performance and decreasing anxiety related to potentially triggering situations. The number of sessions will vary from person to person, but it has been my experience as a therapist that EMDR is both efficient and effective. Contact a therapist trained in EMDR if you think it might be beneficial for you.

Historically, if a human being did not belong to a social group, he or she would more than likely die due to harsh conditions. It took a village to survive and you needed to be a part of that village. In an article titled The Pain of Social Rejection, written by Kirsten Weir for the American Psychological Association, she wrote that our need to belong, for acceptance, links back to our early survival skills.

Weir quotes Kipling Williams, PhD, at Purdue University as saying, “Evolutionarily speaking, if you’re socially isolated, you’re going to die and it’s important to feel that pain.” Weir also cites brain research which reveals that the areas of the brain that register pain due to physical injury, the dorsal anterior cingulate and the anterior insula, also register the emotional pains of rejection.

It’s quite smart of our bodies to create such a strong reaction to rejection. Due to our early programming, rejection—a lack of belonging, a lack of acceptance—meant death. So the brain sends us strong signals of pain to warn us that if we don’t try to reconnect, our lives are in jeopardy.

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Rather than value this warning sign, this important bodily communication, we fear it. The pain becomes unbearable. We attach all kinds of meanings to the pain, to rejection itself. We perceive rejection as an absolute truth about who we are or what we can achieve. Somehow, this primitive survival signal creates a slow, painful death—of our spirits.

We stop reaching out. We stop trying. We give up on finding the right partner, the right job, the right friends. While our modern-day culture allows us to survive in isolation, what quality does that bring to our life? We may not die physically, but what about mentally, emotionally, and spiritually?

Romantic relationships include various forms of rejection. You may reject your partner macro style, the total breakup, or micro style, such as the quiet zingers you launch over dinner. You may reject in obvious ways, such as sleeping in a separate room, or less direct ways, such as developing and feeding a sexual dysfunction.

As a result of these rejections, you may continue to coexist in your relationship but shut down connection. Or the whole relationship might break apart. This separation can wound so deeply that you may fear ever trying to form another relationship.

If you want to overcome your fears of rejection, here are five ways to transform how you respond to this difficult experience:

1. Rejection is not about you and it is about you. This tenet is twofold. On the one hand, rejection usually has more to do with the person rejecting and less to do with you. That person has his or her own history that influences the person’s ability to connect with and accept you. The person may have his or her own emotional obstacles to confront. At the same time, there may be threads of truth woven into the person’s perspective about you. It behooves you to try to learn what you can from the experience. It takes two to make a relationship work or to tear it apart. How does this rejection become a learning opportunity for you? How do you become constructive instead of destructive with these threads of truth?
2. Expect rejection SOME of the time. I have no idea where I heard this, but someone once said to me, “You see that gorgeous girl? Someone, somewhere, is sick of her [crap]!” Like that girl, you, too, will be rejected, no matter how attractive you are, how much money you have, or how nice you are—someone will “get sick of you” in some form. Not everyone is compatible, and you will not meet everyone’s needs at all times. If you can accept this, you can decrease the personalization of rejection, maintain faith, and keep trying.
3. Stop making rejection your whole life story. Assuming the identity of “victim” will not attract or keep a mate. The more you cling to the “rejected” role, the more you suffer. There is more to you than your rejection. Surround yourself with friends and family who support you. These people serve as a reminder of your worth. They are a part of your love story. To overcome rejection, you must connect with people who love you.
4. Vulnerability is a relationship requirement and a rejection target. If you fear rejection, you might hold up a bulb of garlic when you see the word “vulnerability.” Yet without this vital relationship skill, your mate cannot ever truly connect with you, and may, in turn, reject you. Real intimacy is possible only when both partners become vulnerable. If you can transform what you choose to do with rejection, vulnerability might not feel so scary.
5. Risk is necessary for your emotional growth. When you choose to love someone, you risk loss. Whether by death, divorce, or separation, the risk of rejection is present. Is it better to love and risk loss or rejection than to not love at all? The answer is yes, plain and simple. Science shows us that we are wired to seek connection, belonging, and acceptance. Avoiding rejection closes the doors to many potentially fulfilling relationships.

Destructive responses to rejection shut you down to all relationships. Constructive responses teach you about yourself and others. Rejection is not easy. Your response sets the stage for your relationship experiences. What do you choose?

Reference:

Weir, Kirsten (2014). The Pain of Social Rejection. American Psychological Association. Retrieved from: http://www.apa.org/monitor/2012/04/rejection.aspx

Thanks for the letter and your thoughtful questions. I am very pleased that you reached out, seeking advice on what to do.

You ask if it’s possible to become dependent on therapy, and as much as I would like to offer a simple answer, the honest answer is much more complex. Many people come to rely on the insight of their therapist and the relationship they foster in the safe confines of the therapy room. However, it is the responsibility of the ethical therapist to create conditions that do not foster or encourage dependence, and to do his or her part in helping a person in therapy learn to function and perhaps even thrive without the therapist.

The point of therapy is not to keep people in therapy indefinitely; if a person is not getting better or otherwise seeing desired results, the therapist has an ethical obligation to stop working with that person. Therapists are also bound by an ethics code that does not allow them to benefit financially if the person isn’t benefiting therapeutically. Additionally, you are always free to choose when you end therapy, unless you are court ordered to attend. On the other hand, many people maintain a relationship with a therapist long term and go in for “tune-ups” when needed—which, of course, is not the same as being “dependent.”

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Beyond any ethical obligations, please know that good therapists thrive off of people getting better. If it was about making money, most therapists would chose a different profession. Most therapists truly care about the well-being of the people they work with. That’s why they do what they do.

As for medication, yes, some meds can be addictive after long-term use. I am not a psychiatrist, so I can’t speak to which medications specifically. There is certainly a lot of fear about becoming dependent on medication, and I understand that fear. However, if you were to seek out therapy and/or medication, the clinician or physician you work with can discuss with you, at length, which medications might work best without being addictive. Also, you have a say in your treatment, so if you want to change or eliminate medication (should you decide to use it), that is always your choice. It is imperative to remember to only make changes under a doctor’s supervision, however.

You ask whether you can get better on your own. That is a question I can’t really answer. There are anecdotal accounts of people who defeated depression without the use of therapy and/or medication, but there are a lot more who did it with the assistance of a mental health professional and/or medication. I believe the best and fastest healing of the things that ail us comes through relationships. Research has consistently shown that people who go to therapy and use medication have better and long-term recovery from their mental health/emotional concerns.

I’m curious, though, whether your desire to avoid therapy has less to do with cost and more to do with stigma. There’s nothing wrong or bad about needing therapy; many people do, including therapists themselves. Even just a session or two of therapy often yields insight and healing that can help a person move forward. I challenge you to view the possibility of therapy in such a light.

I suggest that you interview some therapists; ask them about their methods, how they feel about the use of medication, and how long the people they see usually remain in therapy. The foundation of a good therapeutic relationship is trust, and trust is fostered through honest communication. You can begin building that bridge immediately simply by openly expressing your concerns and sharing your fears. You have every right to ask as many questions as you have, and a good therapist will do his or her best to address and alleviate your concerns. Even if you decide ultimately not to pursue therapy, at least you will have explored all your options.

Sincerely,
Lisa

“If I am killed, I can die but once; but to live in constant dread of it is to die over and over again.” —Abraham Lincoln

“Something did happen to me somewhere that robbed me of confidence and courage and left me with a fear of discovery and change and a positive dread of everything unknown that may occur.” ―Joseph Heller

I recently came across the above quote by Joseph Heller and it hit me right to my very depths. I remember as a child actively learning to—in essence—feel constant dread, as I taught myself to avoid disappointment and failure by always anticipating the worst. That way, when it came to be, I wouldn’t be devastated—just fatalistically accepting. It gave me a sense of control when I felt none. In so doing, I—like Joseph Heller—set into motion a lifelong habit of dreading just about everything. In fact, it has so pervaded my thinking that I have often observed myself dreading a fun or enjoyable event, just because it is my habit to do so.

The above description might not be exactly true for you (I hope it is not!), but it is a common state for many people in our culture. Most of us were not taught to deal with adversity in a healthy way, so we learned or taught ourselves how to avoid pain. As for me, as I’ve gotten older, gone through several rounds of psychotherapy, and explored many different spiritual traditions for help with dread, I have learned to work with the feelings. I’ve also helped many people deal with these same kinds of feelings. So what has worked?

I think the great Sufi poet Rumi expressed it best in his poem, The Guest House (excerpt):

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The dark thought, the shame, the malice, meet them at the door laughing, and invite them in.

Be grateful for whoever comes, because each has been sent as a guide from beyond.

Most of us spend a lot of our time fighting this sense of dread, feeling powerless to combat it and completely at its whim. We push it away, only to find it resurfaces at just the wrong time! Once you recognize this cycle, you can simply accept this dread that is so often present instead of fighting it off. When it arrives, allow it to be there without beating yourself up. Take some deep, yogic breaths to quiet your mind a bit, and then ask yourself some questions:

• Are there any data to support this feeling of dread? Is there really anything to be afraid of in this particular circumstance?
• Even if you can clearly identify the fear, ask yourself, “What’s the worst-case scenario? Would I be OK if that happened? Would it change who I am, or would it just be a challenge?” Most of the time, when I answer these questions honestly, I realize that my fear has been exaggerated in my mind. I realize that I am capable of handling whatever happens, and that I am just afraid of what I don’t know or perhaps of pain or rejection. Once I have softened my “rigid” response, I feel less dread and can tolerate whatever still lingers (and by the way, it often does not miraculously disappear!).
• Ask yourself, “Is anything happening to me right now?” Usually the answer is no; the dread is arising from some anticipated event in the future. You can then take a few breaths and remind yourself that your monkey mind is hijacking the moment instead of allowing you to be present in this moment. I often bring my attention to sensations in my body or to something beautiful in my immediate environment that grounds me in the reality of that moment. And I quickly realize “I have nothing to fear but fear itself.”

The more I have practiced this, the more I have been able to “work with” the dread and not allow it to disable me from living fully. There are days when I have to go through the above steps many times, and yet others where I am fully engaged moment-to-moment and don’t have the “time” to dread.

Next time you can’t get out of dread, try teaching yourself that you can: once you loosen your attachment to those feelings, they have way less power over you than you might think.

Fear is a pretty ordinary human emotion. When we experience it, though, it feels anything but ordinary. How we respond to our fears can shape the way we live our lives and the people we are.

As children, we learn a great deal about fear from our parents. A parent’s fear for the child helps the child learn not to run into the street, that the iron is hot, that the electrical outlet is dangerous, etc. However, a parent’s fear may also teach the child that it is scary to go down the slide, to stay with the babysitter, to go to school, to have a sleepover, etc. In these situations, the parent is often frightened, but he or she doesn’t want to feel afraid and doesn’t want the child to experience fear, either. So, to get rid of unwanted feelings, the message is “don’t do it.” This is a different message from “yes, it’s scary, but you can do it anyway.”

Taryn was a scared child who developed into a scared adult who makes safe life choices. She came to see me because she was unhappy with her life. At 29, she was a music teacher in a suburban public school, unmarried, who lived and worked in the town next to where she grew up and where her parents still resided. She had been an “A” student in high school, and went to the local state college where she got her master’s degree in music education. In our first session, she told me: “I really wanted to be a singer. But my parents always discouraged me, saying it was no way to make a living. They encouraged me to be a teacher. I got a scholarship for college, and it wasn’t hard to get my teaching job. I lived at home the first three years I taught, and now I share an apartment with a roommate. I feel so bored. I date occasionally, but every day seems the same as the last one. I just don’t know what I want; I just know I feel empty and blah.”

As Taryn and I worked together and I got to know more about her life, past and present, I could visualize Taryn as a precocious little girl: cute, smart, and lively. She had memories of happy times with her parents—being read to, singing in the car, feeling their pride in how well she did in school. She also had memories of sleep problems, fear of going to school, and a lot of worries. In particular, she talked about not being able to fall asleep on her own until she was 10 and her parents having to stay in her room until she fell asleep. She also had separation anxiety around school, sleepovers, and in general when she felt her parents were out of contact. She recalled: “When I was 12, my friends were going away to camp for two weeks and I started to think about going too. I remember telling my parents that I was worried that I would be homesick. They encouraged me not to go and said it was silly for me to put myself through the worry. When I decided to stay home, I thought they were more relieved than I was.”

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Taryn’s experience illustrates growing up with parents who are unable to contain their anxiety. To manage their feelings, anxious parents typically need their children to share their anxiety. As long as the child is anxious, the parent can feel less anxious and expect that the child will refrain from taking risks. The parent’s anxious demeanor and behavior communicate life lessons to the child: it’s not OK to take risks; it’s not OK to feel anxious; one must act in ways to get rid of the anxiety rather than feel the feelings and see what happens when action is taken.

Being a parent is by definition anxiety producing. No one teaches us how to parent. We have no road maps about how to respond to our children’s behaviors and feelings. Moreover, we have no set of instructions to help us manage our feelings. Frequently, we rely on our experiences in our families of origin to model what we should do and not do in raising our children. It is rare to hear of a parent who says to their anxious young adult child, “Don’t be an anxious parent like me. Try to contain your anxiety with your child and help him to get comfortable with all his feelings so he can go into the world and take risks. I didn’t help you with that, but maybe you can be a better parent.”

Some of us realize that it would be helpful to our children to provide them with an experience different from the one we had growing up. Glenn is the father of 4-year-old Callie. He is very aware of his tendency to worry and get anxious in the face of any possible danger. He is also aware that he is repeating with Callie the over-involved, hovering, scared demeanor that his mother had with him. In therapy, he wanted help with containing his anxiety and not communicating his fears to Callie: “When I take her to the playground, I can feel myself becoming scared and vigilant when she approaches the slide or starts running around. I think to myself, ‘Oh, no, she’s going to get hurt, I have to stop her.’ It takes so much self-control to keep my mouth shut and I don’t always succeed. I also am having conflict with my wife because I don’t want to put Callie in preschool. I keep thinking how sad and abandoned she will feel. My wife thinks I’m nuts. Maybe I am.”

Fortunately, Glenn has the ability to understand that his anxious behavior doesn’t serve Callie. He has been thinking about Callie’s future and his worries: “I can see myself holding her back in all kinds of ways. I know how scared I was trying new things. I can imagine going along with her fears. Like if she’s timid socially or nervous about trying out for a sports team, I know I’ll think of my fears as a kid and not be able to help her. I want her to be strong, able to go away to college rather than go to a commuter school like I did. I want a different experience for her.”

Even if Glenn is not yet able to change his feelings, he has been trying to alter some of his behaviors. We have agreed to work together to see if Glenn’s feelings can move closer to what he is able to know intellectually. Glenn is highly motivated. His ability to recognize the way his anxiety developed from his parents’ communications to him, his memory of his conflicts about wanting more but being terrified of the risks, and his desire to not repeat this pattern with his daughter are extremely motivating.

Worry, fear, anxiety—they serve as important warning signs that keep us safe. But if we think of the fight-or-flight continuum, parents who always signal their children to flee are, in many life circumstances, depriving their children of the diversity life has to offer. Not only are they being denied access to the wide variety of ways to participate in the world, they are being robbed of the ability to develop into individuals who are resilient, confident, and know what they want and how to get it. If parents can respond to a child with the reassuring idea that it is OK to be afraid and still choose to take risks and explore the world, they will be helping the child to learn that fear is to be respected and considered, but is not always a signal for saying no to the scary but exciting and fascinating new experiences that make us the unique individuals we keep becoming.

Note: To protect privacy, names in the preceding article have been changed and the dialogues described are a composite.

You are single, feeling good about yourself, looking your best, and decide to go out for a night on the town. In the back of your mind, there is a small nugget of hope that perhaps tonight you will finally meet the person of your dreams and begin the relationship you have been fantasizing about.

As you arrive at the party, bar, or dance club, you settle in to the festive atmosphere and begin to enjoy yourself when you spot that potential mate across the room. Their physical appearance fulfills all your requirements and they appear to be witty, vivacious, and fun as you observe them interacting with their friends.

Suddenly, you find yourself unable to move, your feet stuck to the ground, and all of your desire to connect stymied by a sudden loss of will and resolution. As much as you may wish to follow through and walk the 20 feet across the floor, you find yourself unable to gather up the courage to make what now feels like a million-mile march.

This sudden shift is driven by a common fear among people both LGBT (lesbian, gay, bisexual, transgender) and straight: the fear of rejection. Rejection is a concern that many people carry in the dating world, as it can influence one’s ability to make a connection to someone who could potentially be a great friend, a fun fling, or even a partner.

The fear of rejection is often rooted in the misguided belief that we are not good enough for a person. We fear giving that person the power to make us feel foolish or less than in comparison to them. We build a construct around the person we are hoping to meet that makes them better than us, even though this is often not the truth.

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Here is the kicker to the fear of rejection: It is very possible that someone at that same party, bar, or club finds you to be the object of their attraction and is fearful of approaching you because they imagine you will reject them. It might even be that person you were attracted to, the one standing 20 feet away.

This ultimately leads to a room full of people, many attracted to others, and yet all equally fearful to step across the room and introduce themselves. Thus, the room is frozen in a static energy of missed connections.

There is a powerful means to counteract the fear of rejection—and that is by recognizing that almost everyone is being influenced by it. With this knowledge, you can choose to empower yourself and be the person who breaks the shackles of the rejection construct and risks crossing the room to say hello.

By taking this risk, you reveal yourself as someone who is not constrained by social encumbrance, someone who will take the time and energy to reach out for connection. This presentation of self-assurance and risk taking can be quite sexy to the person you are approaching. Confidence is a proven aphrodisiac.

It also helps to make the approach with a deep sense of curiosity about the person rather than being overwhelmed by your preconceived ideas of who this person is based on how they represent themselves in the moment. They may be projecting a little bit of attitude that is founded in their fear of rejection protecting them from harm. If you assume everyone is holding a tiny bit of fear of rejection, it can help you to be kind and gentle in your approach.

As you begin to release your fear of rejection, you will notice that other people begin to find you more approachable, and the potential for deeper connections will begin to blossom.

Parenthood makes worry inevitable, but the threats parents worry about change with each generation. The National Poll on Children’s Health, conducted annually by the University of Michigan C.S. Mott Children’s Hospital, is a phone survey that asks a nationwide sample of adults to list the top 10 threats faced by children in their communities, as well as for children across the country.

The most recent poll suggests that violence and health are ongoing concerns for most parents. Over the years, obesity tends to top the list of concerns among those polled, along with bullying and substance abuse, and this year’s poll brings gun-related injuries and school violence into the mix.

What Do Parents Fear?

When parents were surveyed on the biggest threats to children across the United States, 55% put childhood obesity on the list, making childhood obesity the greatest concern of all.

The top 10 “big problems” affecting children nationwide, according to adults surveyed, include:

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1. Childhood obesity – 55%
2. Bullying – 52%
3. Substance abuse – 49%
4. Smoking – 47%
5. Violence at school – 44%
6. Child abuse – 42%
7. Alcohol abuse – 41%
8. Internet safety – 40%
9. Gun-related injuries – 39%
10. Teen pregnancy – 37%

Adults frequently expressed different concerns for children living in their local communities. Childhood obesity still topped the list, with 29% of parents ranking it as a major local threat.

The top 10 biggest local threats included:

1. Childhood obesity – 29%
2. Smoking – 26%
3. Drug abuse – 26%
4. Bullying – 23%
5. Stress – 22%
6. Alcohol abuse – 19%
7. Internet safety – 18%
8. Child abuse and neglect – 18%
9. Teen pregnancy – 16%
10. Not enough physical activity – 15%

The Most Common Threats for Children

Parents’ fears can be influenced by media coverage of frightening events, such as mass shootings. In some cases, parental fear is reflective of common threats. Child abuse, for example, is startlingly common, with more than 6 million cases reported to state child protection organizations in 2012.

Parents don’t always worry about the biggest threats, though. Some leading causes of childhood deaths didn’t make the list. Among babies, the leading causes of death are sudden infant death syndrome (SIDS), developmental and congenital conditions, and low birth weight. Among children ages 1–14, cancer, developmental and genetic conditions, and accidents are the leading causes of death. Suicide, homicide, and accidents top the list among older teenagers.

Though parents’ worries might not always directly reflect the threats their children face, it makes sense that parents might feel anxious in general. In 2013, UNICEF rated child welfare in industrialized countries. The U.S. had the second-highest child poverty rate, and overall, the U.S. ranked 26 out of 29 countries on measures of child welfare.

References:

1. Child abuse and neglect stats. (2014, August). Retrieved from https://www.firststar.org/library/national-statistics.aspx
2. Death among children and adolescents. (2012, August 1). Retrieved from http://www.nlm.nih.gov/medlineplus/ency/article/001915.htm
3. School violence, gun-related injury among top 10 child health concerns nationally. (2014, August 11). Retrieved from http://www.mottchildren.org/news/archive/201408/school-violence-gun-related-injury-among-top-10-child-health
4. Schwayder, M. (2013, April 11). UNICEF report on child well-being shows U.S. near bottom of list. Retrieved from http://www.ibtimes.com/unicef-report-child-well-being-shows-us-near-bottom-list-1186975

Having paranoid thoughts does not mean you are crazy. Some people have these thoughts as a result of feeling anxious or stressed. So you have company; other people have feelings like these too. Nevertheless, paranoid feelings are tough to live with and there are ways to help.

First off, you have support from your community. You are lucky that people are standing behind you. I see from your letter that your friends are trying to be helpful and reassuring, and that your family tells you that you are safe. Even though you believe them on the one hand, on the other hand you’re not always sure that they should be believed and you’re still scared. Your folks are telling you that “everything is OK,” but that doesn’t necessarily make it so. People want to make things OK for their loved ones, but reassurance often doesn’t work. It’s like someone is telling you there are no monsters, when they don’t believe in monsters but you do and you know better than they do. What they have to say may not be entirely credible to you, just as you are not entirely credible to them. You might let them know that you are grateful that they want to help, but that telling you everything is OK actually doesn’t work that well. If they truly want to help, they can start by believing that you are having upsetting experiences and that things are not at all OK, as far as you’re concerned. The top way for them to help would be to encourage you to get medical advice, perhaps by accompanying you to the doctor.

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The best course of action is for you to get checked out by a medical doctor who will give you a thorough physical examination to determine if, for example, you have high blood pressure, which can cause many different types of unpleasant thoughts and feelings, as can various types of seizure disorders. Certain substances and recreational drugs can also cause feelings of intense fear and suspicion, so if you do use marijuana, hash, meth, LSD, cocaine, alcohol to excess, etc., be aware that this is a possible side effect of drug use and tell your doctor.

You write that these experiences first began about three years ago, and I wonder if you associate this time to any other events in your life. This is a question that your doctor should ask you. You should be completely open and frank in all your responses to help find out what is going on.

Perhaps your doctor will refer you to someone who specializes in understanding experiences such as yours; that person might determine if you in fact are having paranoid thoughts, and what you might do next. A psychiatrist, if you decide to see one, might prescribe a medication that will help control your anxiety, and/or you might be referred to a psychologist or mental health counselor who will engage in talk therapy with you. The therapist will try to understand the meanings of your experiences.

Often people are frightened of seeing a practitioner who specializes in these kinds of issues, perhaps because of feelings of shame or because they don’t really know what happens in a psychiatrist’s or psychologist’s office. Some folks are afraid that if they are prescribed medication, the medicine will somehow make them different in a way that they don’t want, as though the medicine will take them over, as they also fear the doctor might. People are afraid of losing control, or a sense of themselves.

There is a lot of prejudice and misinformation about emotional issues—we tend to see things as though we are living in a movie, maybe a scary one, but not trying to find out what is going on with oneself is much scarier. Please see a doctor and let me know what happens.

Here are some things people sometimes fear about psychiatry:

1. They will think I am “crazy” and lock me up.
2. They will give me medicine that will make me a zombie.
3. They will take control of my life.
4. People will find out and look down on me.
5. It will affect my work life.
6. It will affect my love life.
7. Movies and video games make this whole subject really scary.

People are scared because they don’t know what actually happens in a doctor’s office. In fact, first you will see your regular doctor who will give you a thorough physical checkup. If the doctor decides it is warranted, you will be referred to a psychiatrist or psychologist or mental health worker. The psychiatrist might prescribe medication. The psychologist or mental health worker will talk with you, and then, working together with you, try to find out the meanings behind your fears and what to do about them.

Thanks for writing. I wish you success!

All my best,
Lynn

Thanks for your thoughtful question. I’m going to do my best to answer it and to alleviate some of the concerns you have expressed.

The most important thing to address here is your statement that if your personal issues were to get out, it would be damaging to your reputation. I’m not sure how much you know about the ethics of counseling and therapy, but one of the most important guidelines is that anything that a person shares with his or her therapist is confidential (with the exception of imminent risk to self or others or in the case of child/elder/dependent abuse). There are other, less common situations where confidentiality is not protected, but those are very rare. Also, the laws may differ by state, but by and large those are the two most common cases where confidentiality isn’t guaranteed. With that said, I understand your concern about privacy and your desire to be sure that you are protected as best as you can be. I hope that this knowledge will help you to feel safer as you consider whether to seek a therapist.

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As for the next aspect of your question, it is not uncommon for people to seek out therapists with similar belief systems, especially when it comes to religion or spirituality. After all, some people tend to feel more comfortable with someone who shares those beliefs. There are some therapists who have no problem sharing their beliefs with a person considering therapy, and even those who specify their spiritual or religious affiliations up front. The other aspects you’re looking for (political, social) in your therapist might be more challenging to find, as many therapists might not feel comfortable discussing those views so early in the therapeutic relationship, if at all. It is quite likely, in fact, that a therapist will not discuss those issues, as they are intensely personal and private matters. Ethically, the therapist is not prevented from discussing personal views so long as it is in service to a person’s progress, but I would venture that many would feel that answering those questions prior to an appointment might be out of bounds.

As you already mentioned, therapy is not about your therapist but rather about you and your process. While you might feel more comfortable with a therapist who has similar views, it is quite possible that you may not find someone who meets your expectations. I do wonder why you feel that you can work only with someone who shares your beliefs. Given the laws and ethics governing confidentiality in therapy, whatever you tell the therapist (outside of the rare exceptions I outlined above) will remain confidential. Unless what you are sharing with the therapist is putting you or others in imminent danger or involves abusing others, you are protected. Regardless of political, social, or spiritual beliefs, ALL therapists are bound by this code of conduct. Not only is violating the confidentiality of a person in therapy unethical, it is illegal. That protects you far more than a shared belief system.

Your letter also mentions that you live in a small community. That factor alone makes it more difficult to find a therapist in your area who will share your beliefs because there are likely to be fewer therapists to choose from. If that is the case, I would hate for you to not seek therapy as a result. I wonder if your desire for your therapist to share your beliefs isn’t a way to limit the possibility that you will seek help if you can’t find the “perfect” fit. I hear that you feel vulnerable, and I want to acknowledge that this process can be very scary and feel risky. Indeed, it is risky to trust someone with your deepest secrets, and I applaud you for considering taking this journey.
I would also like to invite you consider your other possibilities. There are therapists who may not share your beliefs but who can be great catalysts for change nonetheless because what facilitates change in a therapeutic relationship is not shared values or similar beliefs—it’s the relationship between the therapist and the person in therapy. That je ne sais quoi of the healing relationship is not something that can be predicted by anything other than a mutual willingness to engage in the process.

I encourage you to reconsider your position given the information I have shared and to at least explore some of your options. Call and make some consultation appointments. Go meet some therapists and see how you FEEL when you are with them. Talk about your concerns about confidentiality and how you feel vulnerable undertaking this process. Give them a chance to see you and be seen. You might be pleasantly surprised to find that even someone whose belief systems are unknown to you can be very welcoming, accepting, nurturing, and can be a great agent of change.

Best wishes,
Lisa

This is a gut-wrenching position you find yourself in. On the one hand, you’ve done some great work with this therapist and built a strong relationship with her; on the other hand, the work seems to have stalled because you are preoccupied with her potential departure. Should you stay or should you go?

It sounds like the therapeutic relationship is actually bringing out some of the relational issues you are working to address—fear of abandonment, distrust, and generally feeling unsafe. While it is deeply uncomfortable, and I in no way wish to minimize that, this can be a powerful way to work through these issues. The therapeutic relationship is different from any other relationship in large part because it is designed to serve the needs of one person—the person who sought therapy. You can raise the issues you are having in the relationship and deal with how they are affecting you, how they are connected to the past, how they are connected to other relationships in your life, and perhaps most importantly, how to heal from them. You do not need to be concerned with how your therapist is affected by this. If necessary, she can take care of herself through supervision and her own therapy. This relationship is 100% about you and your healing and growth.

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It seems like you are having a very difficult time engaging in this process because of the deep-seated fear you have of her taking another extended leave. Presumably, if she were to go on another maternity leave, there would be a period of time for the two of you to work on preparing for this. Maybe you could even have a joint session with your therapist and the therapist who would cover for her during the leave, so that you three could talk about where you are in treatment, how you could best be supported during the leave, and what could be worked on. While it would not be easy, this sort of process could really contribute to your healing.

Finally, while your therapist has acknowledged that she may not be the safest therapist for you due to potential maternity leaves, it seems important to acknowledge that there are no guarantees in therapy. There is no therapist on the planet who can promise, beyond a shadow of a doubt, that he or she will be able to be there for you from the start of your work until you reach resolution. Illness, death, relocation, job change, and other issues can come up for anyone, including therapists, at any time. This is a frightening and painful truth about life, and this therapeutic relationship just might help you come to terms with that. I suspect that would be deeply liberating for you.

Best wishes,
Sarah

Robert’s palms were sweating and his heart was pounding. His big presentation was scheduled in less than an hour and he was starting to panic. What if he forgot his lines? What if he made a complete fool out of himself? His job was on the line and his anxiety was building.

Jenny was also apprehensive. She’d been trying to muster the courage to ask her boss for a raise for several weeks now, but every time she thought about doing so, she became too nervous to say anything.

We have all experienced anxiety at one time or another, although some people tend to struggle with nervousness more than others. Some of the common symptoms of anxiety are feelings of fear or panic, repetitive thoughts about the situation, difficulties sleeping, muscle tension, increased heart rate, shortness of breath, restlessness, nausea, and cold or sweaty palms and feet.

Part of our discomfort stems from our fear of being criticized, ridiculed, or rejected. We all have a basic need for love, acceptance, and validation, and tend to avoid situations that will jeopardize our relationships with others in any way. This is especially true if we have grown up in dysfunctional families, where these primary needs were not met and we were taught instead to behave in certain ways to please others and discount our own needs and emotions.

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We also frequently tend to play over and over in our minds the worst-case scenario, which only leads us to feel even more anxious about the situation. Rather than visualizing the outcome that we are hoping for, we make ourselves sick with our inner horror stories.

So how do we go about coping with anxiety in a healthier way? The following are some helpful techniques to begin to get our fears under control:

1. Take 10 deep breaths, focusing on the sensation of expansion in your chest and abdomen that occurs while inhaling and the release while exhaling.
2. Take some time the day before a stressful event to become physically active. Working out or going for a long walk are ways to decrease your stress levels. Doing so will also help you get a better night’s sleep.
3. Before bedtime, journal about your feelings of anxiety and the obsessive thoughts you have been having. Putting your emotions down on paper can often get them off your chest and prevent you from ruminating about them throughout the night.
4. Whenever you start to imagine the worst-case scenario, try to picture what you would like to happen instead. For example, if you are worried about an upcoming speech that you have to give, imagine remembering your words with ease and receiving a standing ovation afterward.
5. Lower your stress levels by doing relaxation techniques and/or listening to calming music. Help your physical body to relax by lying down or getting into a comfortable position, then progressively focus on contracting each of your muscles then releasing them. Start with your toes and feet and slowly work your way up to your face and scalp.
6. Try to gain some perspective about your fears by thinking about other times in your life that you may have dealt with a similarly difficult or stressful situation. How did you cope at that time? What are some of the strengths that you used then and can call on again?
7. If you are feeling anxious about talking to your boss (or another authority figure) about a specific problem, consider trying to role-play the conversation with a friend or therapist first. Practicing what you will say can help you feel more comfortable when the time comes to actually have that conversation.
8. Use mindfulness to tune into the emotions that you are feeling and allow yourself to feel them fully. Much of the time, we avoid the direct experience of our emotions, especially those that are uncomfortable, such as fear and anxiety. This tends to intensify the uncomfortable feelings rather than diminish them. To experience them, try to tune into the actual physical location in your body where the tension or fear is stored. Do you feel a knot in the pit of your stomach? Are your neck and shoulders tensed up? Allow yourself to fully experience the physical sensations and you will often find that they shift as you accept and honor them.

If you have tried some or all of these techniques and are still experiencing a considerable amount of anxiety, you may want to consider working with an empathic therapist. Although a certain amount of anxiety is a normal part of life, when stress becomes overwhelming and starts to interfere with our ability to function on a day-by-day basis, help is likely needed. Working with a compassionate therapist can assist you with facing some of your fears in a safe setting and bring you back in touch with your innate sense of peace and joy.

Hypnosis is often recognized as being used by performers in comedy or entertainment and is typically seen as fun and harmless in those situations. However, hypnosis has a broader application when used in helping practices. Essentially, there are three main platforms for hypnosis:

1. Hypnosis used for entertainment.

2. Hypnosis is used by a person trained in specialized uses, such as helping people to stop smoking, manage weight, or deal with sleeping problems.

3. Hypnosis is used by a licensed mental health practitioner (hypnotherapist) as one of the tools in the counseling/therapeutic toolbox.

Hypnosis and hypnotherapy have an extensive history as reputable methods used the therapeutic process by trained and skilled hypnotists and hypnotherapists alike. The difference between hypnosis and hypnotherapy is that hypnosis is defined as a state of mind, while hypnotherapy is the name of the therapeutic modality in which hypnosis is used.

A trained hypnotist uses hypnosis to help people with issues such as smoking cessation and weight management, but is not licensed as to practice hypnotherapy. Hypnotherapy is practiced by a hypnotherapist who is a trained, licensed, and/or certified professional. Only a hypnotherapist may use hypnotherapy to work with such mental health concerns as phobias, stage fright, eating disorders, and certain medical conditions.

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How Does Hypnosis Work?

Hypnosis is defined as a harmless altered trance state characterized by very deep relaxation, highly focused attention, and an extreme openness to suggestions which are usually positive and foster positive therapeutic changes. However, a hypnotic trance is not necessarily therapeutic on its own. For example, when someone is driving to the mall, seemingly suddenly arrives, and is not sure exactly how he or she got there so soon, he/she has experienced an altered, hypnotic state. People may also experience this altered state when they are just beginning to fall asleep and are in a dreamy and drowsy state, aware but not completely focused—just focused enough to have a simple conversation but not remember talking at all.

When used for therapeutic approaches, specific suggestions and images given to people in a trance can alter their behavior in a positive manner. When in this state of hypnosis, you are more inclined to permanent change and more likely to be successful in making the lasting changes you desire. Almost all lasting changes happen in your subconscious mind.

Another example of how visualization in hypnosis works is when a hypnotherapist helps a person experiencing claustrophobia to visualize being in a very open space, without fear, when entering an elevator. By learning to positively visualize entering the elevator without fear, the person is often able to then do it in reality. The subconscious mind does not distinguish between a genuine experience and a suggested one. If you visualize it in a trance state, your body will react to it.

Who Can Be Hypnotized?

The simplest answer is that almost anyone can be hypnotized if they want to be. Modern research has shown that most people can be hypnotized to some degree and that the real question is how deep and to what degree they go into trance. Being able to be hypnotized is not a sign of being weak-minded, gullible, or giving up control. The ability to be hypnotized—or “hypnotizability”—is actually correlated with intelligence and the ability to have heightened awareness and focus while being in complete control.

For example, if while in a hypnotic trance you were asked to give the hypnotherapist your wallet or take off all of your clothes, you wouldn’t unless you truly wanted to. Likewise, if you were in the audience of a stage performance by a hypnotist and you were selected to participate in the show, you would quack like a duck only if you truly wanted to. In fact, the participants are usually chosen because the hypnotist believes you want to act silly and be part of the show. This is in contrast to someone who is not showing any indication he or she wants to be at the event or even have fun.