Psychology Week has been and gone, and we took the opportunity to talk to our psychologists about a question of high interest- What is the most common reasons for clients coming to see you? I asked our two Clinical Psychologists, Deb Worboys and Shannon Yeardley, what they had to say about this.
In Deb’s experience, most people come to her for help with Anxiety and Assertiveness, and the next most common reason for seeking help is for high levels of perfectionism that negatively impact client’s lives. For Deb, tackling issues that are multifaceted and complex, such as assertiveness, require a multi-dimensional approach to treat them, so she employs many different approaches to help improve client’s assertiveness.
Deb makes specific note that there is no one-size-fits-all solution: each person is unique, it only makes sense that an approach must too be tailored to perfectly fit the client’s needs. Deb elaborates that when helping clients whose lives are being negatively impacted by perfectionism, she makes use of Schema Based Therapy.
Shannon notes that anxiety is the most common reason people come to her for help, and that she focuses on what she calls a ‘brain-based’ perspective. In a nutshell, this means looking at how the brain gets stuck on unhelpful pathways and learning to unhook from these reactions and learn to do them differently.
In light of all this, it’s no surprise to find out that anxiety is the most common psychological disorder in Australia, affecting 14.4% of the Australian population, being more prevalent within women than men.
There are many types of anxiety, the common ones being: Generalised Anxiety Disorder (GAD), Social Anxiety, Specific Phobias, and Panic Disorder. Other conditions where anxiety is present are Obsessive Compulsive Disorder (OCD) and Post Traumatic Stress Disorder (PTSD).
You might be thinking, “isn’t calling it anxiety enough?!”, but there are important differences between each type of anxiety, and it can get quite confusing. Here’s something to help understand the differences between each type, in a nutshell:
Generalised Anxiety Disorder (GAD) is a term that is used to categorise symptoms, and helps practitioners identify and treat these symptoms with tried and tested tools that prove greatly useful. GAD is intense worry, but not just any worry. For 6 months or more, on most days of the week, it’s worry about a plethora of things, and it just doesn’t seem to stop. it’s so persistent and debilitating that it impacts on your everyday life, like enjoying time with friends, being able to study and being able to work.
What does GAD feel like however? it can manifest in many ways: feeling like your muscles are tense and wound up like a tightly coiled spring. Being so caught up in your worries and fears that it’s hard to concentrate on anything anymore. Feeling very tired all the time- and not because of laziness- but you’re running on high and burning through your nervous energy to the point of fatigue. Feeling on edge, restless, like you just can’t relax. If you feel that you experience three or more of these symptoms, more days than not for over 6 months and to the point that it’s effecting your life negatively, you may be part of the 6% of Australians experiencing GAD at some point in their lifetime.
Social Anxiety is quite self-explanatory, but often misinterpreted. Is it shyness? Is it the stage fright of giving a speech? It’s a lot more than just that, it’s a worry that is out of proportion to the actual threat or situation. Social Anxiety, also named Social Phobia, is a fear of being judged, doing something embarrassing, or simply an anxiety and worry before, during and/or after social situations. Those situations can be as small as thinking about meeting a friend, the nervousness around being watched while eating, or being as severe as staying at home all day because you feel so nervous around people. It can mean avoiding seeing friends, avoiding going to events or places with people, but most importantly it impairs you living life you want to.
People have described the feeling of this anxiety in a number of ways, such as sweating, trembling, racing heart, a dryness in the mouth, stuttering, and a churning stomach.
If you feel your daily life is being impaired by any of these experiences, and it has persisted over 6 months and is impacting your life negatively, it could be that you are part of the 10-11% of Australians who experience Social Anxiety in their lifetime.
Specific Phobias are potentially the most well-known of the many types of anxiety, and are known as a persistent, strong and irrational fear to something. They’re well known, and sometimes not taken seriously. It can be something we accuse our more jittery friend of having when they get startled by the sight of an ibis in the Queen Street Mall . Specific Phobias however can mean that going about your regular activities is scattered with intense feelings of anxiety that can escalate to the point of panic attacks over something as small as the thought of a bird flying past you.
Some common phobias are towards the sight of blood, dogs, heights, needles or dentists. It involves a high avoidance of the object or the situation of the encountering the phobia, such as taking a longer route home, just so that you’re in a dog-free neighbourhood or avoiding booking in to have a check up on a painful tooth to avoid the dentist room. This irrational fear persists occur for over 6 months and disrupt the normal function of your day to day life. So, what does it feel like to have Specific Phobia? It can be shaking, feeling the need to vomit, sweating, difficulty speaking, a racing heartbeat and trembling when encountering the Phobia. If this sounds familiar to you, it could be possible that you have Specific Phobia.
A panic attack itself is very common, 40% of Australians will experience at least one panic attack in their life time. Panic disorders however affect 5% of Australians in their lifetime. Panic attacks often make people feel as though they are having a heart attack. Take a look at the symptoms, and you’ll understand why:
- Heart palpitations/ racing heart
- Sweating
- Pain in chest
- Difficulty breathing
- Nausea
- Dizziness
- Numbness
- Detachment
No wonder panic attacks are so terrifying! These attacks feel like they are out of nowhere and feel like an intense fear and anxiety. If you ever feel that you are avoiding every day activities of fear of triggering a panic attack, and have this worry for more than a month, you may want to consider seeing your GP, as you may be experiencing panic disorder.
Now, we did mention assertiveness back at the top if you remember, so what exactly does assertiveness mean? Deb commented that low assertion can stem from an idea created about oneself from a young age, where the person sees themselves as the ‘good girl’ or the ‘good boy’ who exist in a ‘Fear Paradigm’.
Deb’s work is informed by her training with Dr Sallee McLaren’s at a specialised anxiety clinic in Melbourne, and she draws upon Dr McLaren’s training greatly when working with clients struggling with assertion. One of Dr McLaren’s assertion principles that Deb draws upon is the ‘Fear Paradigm’. The Fear Paradigm is the term used to describe living in a state where you see others as more powerful than you, and yourself as weak. The consequences of existing in a fear paradigm and viewing others as more powerful can determine how you behave in the world. In the fear paradigm, one tends to believe that there is no control or persuasive power over others, and this can result in employing unfair modes of persuasion, even if you don’t really mean to. Another behavioural consequence of low assertion is that arguments are delivered and taken personally, cooperative ways of engaging with people is blocked, communication is decreased in quality and quantity, and often, blame is placed on others, rather than 50:50 responsibility.
Through the guidance of Dr McLaren’s work, Deb has several ways to assist those who are negatively affected by low assertion, and you can book in with her to understand these mechanisms of assertion further and learn how to overcome this issue. She has a couple handful of tips that may be helpful in the meantime:
Not allowing someone have power over you: The fear paradigm, as mentioned previously, comes about usually when someone is in a place of unfair power over you by using aggression or hostility, and you assume the passive subdued role. Deb suggests this dynamic can be reduced by correcting the problematic behaviour of others that puts you in this lower position in the first place. For example, when faced with an overly critical parent, it’s reasonable to state something to the effect of, “It’s not okay for you to criticise me so harshly, you’ll notice I don’t do this to you. I’m happy to discuss this, however, if we start escalating and getting out of hand, I’ll have to leave this conversation”. If they regulate their hostility and harsh language, that’s great, and if not, just enforce the consequence and leave the conversation. It’s good to not hold onto a grudge, and next time you see them, approach them with an outlook of goodwill.
She notes the importance in body language while delivering this type of message, that the best way to deliver this is by projecting a friendly and authoritative voice, being clear and direct with the content, making eye contact, and having your palms out openly. It also helps to enter the conflict playfully, which makes it very hard to become defensive or withdrawn and quiet.
Recognising the 2-sided nature of relationships: If a relationship (whether romantic, with your family, or friends) turns out be not be mutual or satisfying, you may feel that you have no control over this, or that you can’t voice your opinion about it. The reality is however that relationships are not one sided, you do have a voice, and you shouldn’t be making overture after overture. There needs to be effort put in on both sides if you are both committed to making it work. If the other person isn’t putting in the effort, allow the relationship to reflect that, and lose interest yourself. Let it become superficial or walk away. Expectations need to be realistic for both of you.
Again, the aforementioned body language and deliverance of your opinion is the best way to approach talking about this topic, but also, Deb suggests that rather than saying that something like this makes you ‘angry’ or ‘enraged’, list the vulnerable emotion behind this. Maybe you feel angry because you feel betrayed. Maybe you feel enraged because you’re putting in 110%, and they’re giving 20%, and this makes you feel devalued. Feelings such as feeling upset, devalued, distressed, alone, and unloved are at the core of the fierier feelings. One way I conceptualise this is that deep down, there is pain and hurt, but on the outside, there is anger, which is an emotion that pushes a threat away and protects the vulnerability. To communicate where you are coming from, it is helpful to express that vulnerable part of you, the inner core that is feeling vulnerable.
Finally, Deb recommends a book for those who are suffering from low assertion, by Dr Sallee Mclaren called Smart Therapy Assertion:
A link to a program based around assisting assertion Deb recommends is https://www.cci.health.wa.gov.au/Resources/Looking-After-Yourself/Assertiveness
Struggling with anxiety and assertiveness can be debilitating. Deb and Shannon are just a few of our empathetic, dedicated and knowledgeable psychologists who want to help those struggling with the many issues that present itself in life’s journey. Don’t struggle on needlessly, reach out to one of us and discover how rich life can really be.
Author: Chelsea Perks
Sources:
Black Dog Institute https://www.blackdoginstitute.org.au/clinical-resources/anxiety/what-is-anxiety
Beyond Blue: https://www.beyondblue.org.au/the-facts/anxiety/types-of-anxiety