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Behavior:
Client presented feeling stuck and reported feeling trapped between anxiety and avoidance. Client stated, "I know what I should be doing, but I just can't make myself do it." Client discussed wanting to apply for new jobs due to dissatisfaction in his current role but described experiencing a wave of anxiety when attempting to work on his resume or look at job postings, leading to avoidance and subsequent feelings of guilt, which exacerbated the anxiety. Client identified values of growth, challenge, and contributing something meaningful during the session.
Intervention:
The session lasted 45 minutes and took place in-office. Therapist introduced ACT defusion exercises to help the client distance himself from anxious thoughts, including techniques such as noticing the thought, saying it in different ways, singing it, using a cartoon voice, and repeating it until it lost intensity. Therapist facilitated values clarification work, exploring what matters most to the client and connecting job application efforts to his identified values.
Response:
Client engaged in the defusion exercises, laughed during the process, and reported that the anxious thoughts felt less heavy afterward. Client appeared to gain insight into the relationship between anxiety and avoidance and expressed understanding that anxiety does not indicate wrongdoing but rather reflects caring. By the end of the session, client seemed slightly more willing to take value-aligned actions despite the discomfort.
Plan:
Client will complete homework to take one small value-aligned action, such as updating one section of his resume, while practicing defusion techniques when anxious thoughts arise. Therapist and client will meet again next week to review progress and continue addressing anxiety and avoidance within the context of his values.
Today's session was 45 minutes, in-office. Ravi came in looking stuck and said he's been feeling trapped between his anxiety and his avoidance. He said quote 'I know what I should be doing, but I just can't make myself do it' unquote. He talked about how he's been wanting to apply for new jobs because he's unhappy in his current role, but every time he sits down to work on his resume or look at job postings, this wave of anxiety hits and he just shuts down. Then he feels terrible about avoiding it, which makes the anxiety worse.
We talked about how anxiety and avoidance feed into each other, and that trying to get rid of the anxiety first isn't really the answer, it's about learning to move forward even with the discomfort present. I introduced some ACT defusion exercises to help him get some distance from the anxious thoughts. We practiced noticing the thought and then saying it in different ways, singing it, saying it in a cartoon voice, repeating it over and over until it lost some of its power. He laughed a little, which was good, and said it felt less heavy when he did that.
Then we did some values clarification work. I asked him what really matters to him, beyond just escaping the anxiety. He said growth, challenge, and feeling like he's contributing something meaningful. We talked about how applying for jobs is actually a value-aligned action, even if it brings up anxiety. The anxiety doesn't mean he's doing the wrong thing, it just means he cares. His homework is to pick one small value-aligned action this week, like updating one section of his resume, and to practice defusion when the anxious thoughts show up. He doesn't have to feel ready or confident, he just has to take the action.
Actually, one more thing, he seemed a little more willing to try by the end. We'll meet again next week to see how it went.
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