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Best Practice YouTube PowerPoint below...
On the last track we discussed becoming aware of intimate discontent. A technique for becoming aware of intimate discontent that I implement in my practice consists of three steps. The three steps to becoming aware of intimate discontent are experiencing feelings and defining what is wanted, and rediscovering old strategies.
On this track we will discuss the anxiety complex as it relates to the divorced or separated client. The focus of this track will be on uncertainty training. Intolerance of uncertainty can be a core issue for clients with anxiety, specifically when following a divorce. Therefore, you may find it productive to implement uncertainty training in two steps. Step one is examining the costs and benefits of accepting uncertainty and step two is flooding with uncertainty. This track will also examine problems associated with thought stopping regarding anxiety.
Psychologists Michel Dugas and Robert Ladouceur found that clients with anxiety cannot tolerate not knowing something for sure. In fact, one client told the researchers that he would rather know a negative for sure than be uncertain about a positive. Do your clients keep looking for a perfect solution, an answer to every possible question they can ask, and a clear prediction for every possible what-if following their divorce?
Understanding Uncertainty Training
In my practice, I find that the absence of this certainty may lead separated clients to keep worrying until they find it. Divorced clients may also avoid confronting the emotional impact of their experiences. Would you agree that this is because our clients seldom get to the point of actually facing their worst fears. Moreover, since clients are trying to think about how to solve all the problems, they do not use visual images, which can aid in understanding emotions. I tell my divorced clients that feeling an emotion is one way of finding out that you can tolerate reality.
When clients are engaged in uncertainty do you find that they are actually less anxious when they engage in the anxiety rather than setting it aside? Research indicates that this is because worry is abstract and linguistic, and when people rely on this abstract thinking, they do not experience visual images of bad outcomes. Since they avoid these highly emotional visual images, continuing to worry keeps them from experiencing anxiety. Thus, worry—and searching for certainty—can be a form of emotional avoidance.
2 Steps in Uncertainty Training
In order to foster a tolerance for uncertainty, let’s first discuss examining the costs and benefits of accepting uncertainty. With Pam, age 42, I identified unproductive worry because it involved unanswerable questions, chain reactions, unsolvable problems, things that are unknowable, demands for perfect solutions, relying on anxiety as a guide, and the demand for total control. For example, consider Pam’s worry "It’s possible that I might never find anyone else and die a lonely old hag." This worry includes a number of the elements of unproductive worry.
6 Elements of Unproductive Worry
1. The first part of Pam’s statement indicating, "It’s possible." Is an unanswerable question.
2. Her statement that "My loneliness will continue and I’ll end up alone." Is based on a chain reaction mentality.
3. The fact that she cannot eliminate possibility of lonliness makes it unsovable for Pam.
4. However, if Pam continues to remain alone, then she cannot eliminate the possibility of future loneliness. Therefore, the outcome is unknowable.
5. Since Pam demands absolute certainty, she is demanding a perfect solution.
6. Pam stated, "I have to get complete reassurance."
This, of course, is something that is impossible because it demands that she controls the outcome. Therefore, would you agree that Pam’s anxiety over the possibility of loneliness would qualify as an unproductive worry? Think of a client you are currently treating. Would playing this track for him or her be beneficial to analyze the preceding six point analysis of Pam’s statement?
I felt that I could now examine what the costs and benefits were of Pam accepting uncertainty for unproductive worry. For example, I asked Pam to ask herself, "What are the costs and benefits to me of accepting that it’s possible that I have remain alone?" The benefits were that if she accepted it as possible—and accepted that she cannot eliminate possibility—then she didn’t have to take action on it.
I stated, "Perhaps you will worry less and give up trying to control something you cannot control. The costs are that you may be immediately a bit more anxious and think you are letting your guard down. If you experience this reaction, then ask yourself, "Exactly what action can I take today that will really help me?" Since the worry is about possible future loneliness (after having had several dates), the only action available is to continue seeing more people. This is an endless enterprise." Think of your Pam. How can you help your client examine the costs and benefits of accepting uncertainty?
Next, let’s look at the second step in uncertainty training. This step requires the divorced client to flood themselves with uncertainty. Reality is clearly uncertain. I find it helpful for clients to realize they don’t know for sure what will happen tomorrow or the next day. I stated to Pam, "You can make an educated guess, but you cannot say for sure. When you do not tolerate uncertainty, your thoughts are something like the following: ‘It’s not certain that things will be OK; if I don’t know for sure, I should worry until I do know for sure; I’ve been worrying and I still don’t know for sure, so I should keep worrying until I am absolutely certain it will be OK.’"
In contrast to worry; which is the search for certainty, in uncertainty training, divorced or separated clients practice having the thought thousands of times that "I don’t know for sure" or "It’s always possible that something terrible could happen."
Pam’s thought that she might have be alone for the rest of her life even though there was no real evidence that she would. To further involve Pam in uncertainty training, I had her practice repeating daily, "It’s always possible that I could remain alone." I told her to do nothing to neutralize this thought—not to try to reassure herself, just practice having the thought "It is always possible." As expected, Pam’s anxiety went up—and then it went down as she repeated this thought hundreds of times. Whenever Pam had the thought, "I wonder if I’ll be alone forever," I had her repeat it two hundred times. Pam began to realize that having a thought about what is possible could be tolerated. In fact, she later reported that it started to become boring.
In addition to the two steps involved in uncertainty training, let’s discuss thought stopping.You already know that thought stopping involves a client noticing that he or she has an unwanted thought and then yelling, "Stop!" The idea is that the divorced client cannot stand having this thought.
I find that for divorced or separated clients thought stopping may not work and it actually can make things worse, because the client is led to believe that the thought— "It’s possible that I’ll be alone forever"—is a thought that he or she needs to fear and get rid of. In contrast to this, thought flooding about uncertainty teaches clients like Pam that she can have thoughts about what is possible, yet do nothing to neutralize the thought.
Accepting uncertainty is a core strategy for clients dealing with divorce. Once your client accepts that he or she can never know for sure, then that client can recognize that continuing to worry to gain certainty is a total waste of time. Practicing flooding themselves with uncertainty thoughts—repeating them endlessly without doing anything to gain certainty—helps clients recognize that they can live with uncertainty. Perhaps you might relate it to getting on the elevator thousands of times. It is no longer feared because it has become boring. Think of your divorced or separated client. Could he or she benefit from these techniques?
On this track we have discussed the anxiety complex and uncertainty training in two steps. Step one was examining the costs and benefits of accepting uncertainty and step two was flooding with uncertainty. We also examined problems associated with thought stopping regarding anxiety.
On the next track we will discuss the psychological impact of infedelity. We will specifically discuss the five emotional losses experienced by the client. These five emotional losses are the loss of the sense of specialness, the loss of self-respect, the loss of the feeling of control, the loss of a sense of order, and the loss of a sense of purpose.
Question 7: What are two steps in uncertainty training? To select and enter your answer, go to the Answer Booklet.
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