In this trio of blogs, three of our therapists – a psychologist and two psychotherapists – of differing modalities will be sharing their views on how to work with a fictitious client. The “client” James, is a high achieving barrister in his mid-thirties presents with severe anxiety. He has recently started a new relationship and they are thinking of moving in together.
James comes from an upper-middle class background where there was a family culture of not talking about feelings and difficulties. He was sent to boarding school ages 6 – 13. He is eldest of 3 children and his parents divorced when he was 13. There’s has been other traumatic childhood incidents that he is yet to disclose.
He presents well dressed, competent, practical and wants quick solutions. He is very busy and wants to know what therapy can do for him and how long it will take.
A gestalt psychotherapy approach
There is meaning in the way that James relates to the prospect of therapy. I imagine that if I were sitting with James, I would experience a sense of pressure – in fact I experience this when reading the paragraphs above.
The desire for quick solutions manifesting as demands on himself and the process, wanting to “get rid of” the problem. Herein may lie the clue as to the “how” of James’ anxiety.
Anxiety conceptualised from a gestalt perspective
In gestalt therapy we talk of anxiety as “excitation without breathing”. Simply put, this means that as a way of blocking emotions unwelcome to us or others around us, we physically hold our breath. For example if a child’s anger was deemed unacceptable by her parents, she may hold her breath to block this emotion. Although successful in one respect, the original anger becomes stuck in the body, trapped by the rigidity of the held breath.
This is a complex psychological-body process that, in severe anxiety, is kept out of awareness. The holding of breath has become chronic and unconscious and is no longer a pragmatic response to a given situation.
Therefore James’ present experience could be thought of as an expression of an outdated solution to events in the past. In a family environment that did not support certain experiences or expressions of vulnerability it is possible that James found ways of being that were acceptable to his family.
The importance of families
As families are vital for children to survive, this response, psychologically speaking, is a matter of life or death, and in gestalt therapy is called a creative adjustment. This adjustment contains three things: the original emotion felt in the past (i.e. fear), the unfavorable environment (the message that you should not be vulnerable) and the mechanism of holding the breath (felt as tightness in the chest, pain in the throat or a general unpleasant feeling in the core of the body). This is all kept out of awareness and the result is anxiety.
Then you have the subsequent events of boarding school, divorce and another trauma yet to be named. These possibly difficult and distressing experiences were likely more difficult to live through with the already well developed habit of non-expression of vulnerability.
The current beginning of an intimate relationship is likely to trigger early attachment wounds which would cause James to feel vulnerable, thus increasing his anxiety.
Giving time and space to his current experience may well be a challenge for James, but would be the principal task of therapy. This could support greater understanding and awareness of the processes involved in anxiety.
Julia Wright is a UKCP-registered psychotherapist with more than 15 years of experience in psychotherapy and mental health. She works from our Hove and Lewes practices with individuals, couples and groups and she also offers clinical supervision.