Wondering Out Loud: Creative Reframes for Anxiety in Teletherapy

During online therapy with two analytical young men presenting with anxiety, I channeled Ericksonian Utilization to pivot their minds toward generating alternate interpretations of their difficulties. In both cases, anxious thoughts were disrupted via therapeutic reframing, providing catalysts for clients to envision hopeful possibilities.

Hail the Headless Cockroach

An art history educator (24) shared that he was distressed by a reoccurring dream involving cockroaches, finding it difficult to fall back asleep after these nightmares. I asked what the dream could mean, and the client said, “I really don’t know.” We explored re-writing the end of the dream to avert the cockroaches, and surmised that even one alternative would reduce his focus on the bugs by fifty percent. When the client mentioned that the cockroaches were headless, I said, “Wow. It sounds like they are dead then – like they have no power. I wonder if this dream means you have conquered a difficulty because you have slain the cockroaches.” His eyes lit up and he said, “I would have never considered that, but it totally makes sense. I have been clean for three weeks now, and maybe the dream is trying to tell me that I’m conquering my addiction.”

For homework, I invited the client to generate different meanings and endings for the dream. Opening space for alternative interpretations shifted the client from somatic to intellectual responses to the disturbance, thus reducing his anxiety while increasing his sense of control.

Befriend the Gremlins

An 18 year-old physics major shared that he had been “anxious since he was a child,” and that “anxiety was a part of his DNA.” His parents divorced when he was five, and “his mother had also been anxious as long as he could remember.” We explored what anxiety looked like in his home, and the client expressed empathy around his mother’s fears. After providing psychoeducation on anxiety and flow, I wondered out loud if the client may have “absorbed” some of his mom’s anxiety because he had previously stated that he was a “sensitive” individual. The client nodded in agreement.

Drawing on Narrative externalization, I offered another possibility. “What if anxiety isn’t actually a part of your DNA? What if there’s a little Menehune that jumps on your shoulder to warn you of potential danger, and you are perceiving these warnings as internal anxiety? If you have a strange noise in your car that can’t be explained, Hawaiians say your car has a Menehune – the Irish have Leprechauns, Indigenous Peoples have Tricksters, and Harley riders have Gremlins. These are playful but powerful creatures who warn us of danger, or teach us important lessons.” The client smiled.

I then speculated that the Gremlin was trying to tell the client something important, but because the client wasn’t listening, the Gremlin became more and more outrageous with its tapping. Since the client had previously shared that he had "dropped out of university due to extreme anxiety,” I asked if the Gremlin was trying to tell the client something important about hisstudies. Jumping forward in his chair, the client blurted, “Physics is causing me unbelievable stress. Maybe it’s not the field for me.”

For homework, I invited the client to imagine what his dream career would look like. Externalizing the client’s anxiety provided a safe space for him to acknowledge his subconscious wisdom, albeit in the form of a wise and playful messenger.

Ethics and the Therapeutic Reframe

Therapeutic reframing has been evidenced as a positive adaptation tool (Matilla, 2001) and condemned as manipulative spin (Hoffman, 1982). Through an ethics lens, it may be helpful to view reframing as unearthing openings to multiple possibilities, or a “plural realism” (Matilla, 2001, p. 101). As therapists, we have an ethical responsibility to honor client values, goals and preferences during this influential process. Therapists assist clients to expand thinking, whereas clients ultimately determine what resonates. Together, we embark on a shared journey as arbiters of meaning, contextualizing difficulties within the client worldview.

References

Hoffman, L. (1982). Foundations of family therapy. New York, NY: Basic Books.

Matilla, A. (2001). Seeing things in a new light: Reframing in therapeutic conversation. Helsinki, Finland: Helsinki University Press, 99-103.

Written By: Deborah K. Hurford, MS, MFA, MA, LMFT

Deb is a systemic psychotherapist, EMDR therapist, executive coach, multidisciplinary artist and published author. Her book on sexual violence, Running Through the Devil’s Club: A Theatrical Exploration in Healing, was published in 2001 and her work with the expressive arts as a teaching and healing tool has been cited in articles, books and dissertations in Canada, the United Kingdom and the United States. Deb works in private practice with Systemic Solutions Counseling Center (https://systemicsolutionscenter.com/deborah-k-m-hurford-msc-mfa-ma-bed/) in Florida.