How do I help my clients?

What does my approach to therapy involve?

I’m an existential psychotherapist who uses tools drawn from ERP, ACT, and IFS.

Enough acronyms. What you need to know is that my therapeutic approach centers the idea that avoidance reinforces distress.

Avoidance and existential threats

When you’re a child, you learn to avoid things that cause you distress. This is a natural, adaptive response. When fire burns you, you stop trying to touch it. When your sibling bonks you on the head for taking their cookie, you learn not to take people’s stuff. That’s how children learn to survive and adapt to their environments.

But avoidance can go wrong. It most often goes wrong early in life when you find yourself in a hostile or chaotic environment and learn to avoid unusual things. For example, if your parents are violent and unpredictable, you might learn to avoid asking for what you need unless it’s absolutely necessary. If other kids won’t play with you because they think you’re weird, you might learn to avoid talking about your interests or acting differently from other people.

You might also learn to avoid certain thoughts or feelings. If your parents yelled at you every time you expressed anger, or if you were shushed every time you brought up an uncomfortable topic like sex or death, you might learn that it’s not acceptable to have these kinds of thoughts or feelings, even in your own head.

Again, it’s normal to adapt to an adverse environment this way. You do what you need to do to stay emotionally and physically safe. You adapt to fit in with your family and social group. It’s how humans have survived for millions of years. The things we fear are deeply, evolutionarily ingrained in our brains. Our fears invariably have to do with things that would have been dire existential threats to our ancestors: uncertainty, helplessness, rejection, abandonment, disease, and disaster.

When avoidance goes wrong

The problem with the types of avoidance we learn in hostile environments is that when you get out of those environments, your survival strategies aren’t adaptive anymore. You might need to do things in your new environment that would have been unthinkable in your old one.

For example, as an adult, you might need to ask authority figures for help—say, if your boss doesn’t give you enough supplies to get a work project done—even if asking for difficult or inconvenient things is something you’ve learned not to do. Perhaps you know on an intellectual level that your boss is reasonable and won’t yell at you or hit you, but it feels wrong to do it anyway. These situations might cause you so much fear that you do weird things to avoid them, like buying work supplies with your own money.

Avoiding certain thoughts and feelings is another problem you might have when you escape a hostile situation. For example, if you grew up with a very sensitive, anxious parent who couldn’t tolerate it when you were upset, you might have learned that it wasn’t okay to have negative feelings at all. Maybe you learned to distract yourself from those feelings, or maybe you told yourself that having these feelings made you weak or whiny. This strategy might have helped you survive your childhood, but as an adult, you might need to be able to identify your feelings and express them to form healthy relationships. Maybe your spouse actually wants to know when you’re feeling sad! But it’s hard to tell people you’re sad if you don’t even feel like you’re allowed to feel sad, let alone express it.

The avoidance reinforcement cycle

Unfortunately, avoidance reinforces itself. When you avoid a situation—whether it’s a physical experience, an emotion, or a thought—you never learn to feel safe in that situation. In fact, avoidance increases fear, which increases your need to avoid the situation. You never learn that these situations are tolerable. And because you refuse to tolerate those situations, your fear level only goes up, not down.

One thing most people don’t realize is that the state of being we call “anxiety” is actually a form of avoidance. Anxiety isn’t a simple emotion like anger or fear. Anxiety is the act of avoiding a distressing emotion. You might use physical methods of avoiding those emotions, like numbing yourself with alcohol or staying away from distressing situations altogether. Or you might use mental tactics, like pushing away uncomfortable thoughts or reassuring yourself that bad things won’t happen to you. We call these “compulsions” (also known as “safety behaviors,” “rituals,” or just “avoidance”).

Compulsions feel useful because they temporarily bring your distress levels down. For example, if you overapologize for a small wrong, you might feel relief at the idea that the other person won’t be mad at you. Or if you mentally check and re-check whether you locked your door, you might feel less fear that an intruder could harm you.

But the problem with anxiety—that is, with continually performing compulsions—is that it never works work for long. You have to keep doing them if you don’t want the bad feelings to come back. That’s a lot of responsibility! No wonder you might feel tense, vigilant, and hyperalert, even in safe situations. Even if you’re not physically doing anything, it’s likely that if you feel anxious, you’re performing some kind of compulsion, even if it’s just a mental one.

Breaking the reinforcement cycle

Therapy can help you interrupt the avoidance cycle that has reinforced your fears. In therapy, you’ll do this by gradually, safely approaching fearful situations at your own pace. We might do this in a session by talking about things that make you feel afraid. But most often, we’ll work together to figure out how to approach address avoidance behaviors in real life outside of our sessions.

A lot of people worry that they’ll be asked to do things in therapy that make them uncomfortable or panicked. Rest assured, I won’t tell you to do anything of the sort. In fact, I won’t tell you to do anything at all. You’ll be the one coming up with the ideas, and you’ll decide what level of discomfort you can tolerate.

One important factor in the type of therapy that I practice is that we’ll also address the larger meanings of your fears. This will help you learn what you’re avoiding on a larger scale than just “earthquakes” or “PowerPoint presentations.” Instead of just treating surface behaviors, you’ll actively confront difficult existential questions and learn to make peace with the inherent problems of being human.

What if your avoidance is mostly mental? That is, what if you don’t do anything physical to avoid fear, but instead get into cycles of overthinking, mental review, thought avoidance, or hypervigilance? No problem. We’ll address those symptoms, too. You can click here to download a handout on my approach to mental compulsions.

how is this different from learning “coping skills”?

This approach to therapy is focused not on your experience in the moment, but on your long-term results. Instead of temporarily bringing down your distress in a given moment or using simplistic affirmations like “I’m a worthy person” or “I’m not afraid today”—come on, does anyone think that actually works?—you’ll work on developing the skills to decrease avoidance behaviors and bring your levels of fear, discomfort, and distress down in the long term.

You might have heard this referred to as “exposure” or “behavioral experimentation,” depending on the style of therapy. I prefer to think of it as just living without avoidance. You won’t have to do anything extreme or unusual. The treatment process simply involves figuring out what you’re avoiding, when you’re avoiding it, and what it costs you.

As you learn to approach fearful situations and thoughts, two important things will happen:

• Distress tolerance. This is the ability to let yourself feel negative emotions like fear without escaping from them. The more you practice tolerating distress, the easier it will be to do it in the future. You may still feel distress, but you’ll be able to live your life without having to perform compulsions that take you out of the moment. You’ll also be able to stop avoiding situations that trigger fearful or intrusive thoughts because you’ll know you can stop engaging with them. You might find yourself doing more things you enjoy, even if you’re still feeling some level of distress.

• Distress reduction. This is when your overall levels of distress go down. It usually takes longer to develop than distress tolerance, but it will happen with practice. Once you stop avoiding distressing situations, your brain will learn that it’s safe to experience these situations and stop bombarding you with fear and other distressing emotions. Avoidance will stop feeling so urgent, and you’ll enjoy life more now that you can do things you like to do without feeling so distressed.

Is this type of therapy just for anxiety disorders or OCD?

No. Avoidance can create or reinforce many kinds of life problems, and not just the kinds that might be labeled as psychiatric disorders. Non-avoidance is a skill that can help with issues as diverse as trauma, depression, and relational issues. It’s an approach that goes beyond diagnosis and addresses the processes that contribute to the problems you’re having.