Clients may become anxious and experience other somatic symptoms (e.g., rapid breathing and sweating) when discussing events they perceive as threatening. Remember that this is the basic fight or flight response and it can be a signal that the client perceives great threat.
Notice and describe these symptoms as they emerge in session. For example, “I’m noticing that as we discuss this topic you’ve started to breathe rapidly and are visibly very anxious.”
Inclusion in tribes was a condition of survival in earlier eras of human history. As a result, our ancestors grew extremely sensitive to the threat of rejection from the group, and we retain sensitivity to social exclusion to this day. But most of us no longer have strong group bonds akin to those that exist in tribes, and we are also potentially able to be in contact with cast numbers of other humans. Thus each and every individual we encounter can represent either a source of great comfort and safety or a looming threat of social exclusion.
One of the most common fears socially anxious clients have is of making mistakes. Social perfectionists do not allow themselves to make the sort of common human errors the rest of us do, and this both causes and maintains their anxiety. By trying to live up to a perfect standard in social situations, these clients have unrealistic expectations of themselves.
The social perfectionist has a tough time asking questions because he is afraid he may sound stupid. Exposures designed to test whether he really does sound stupid often fail because no matter what he says, or what others tell him, it sounds stupid to him. It is often more effective to expose this client to his core fears. I call this exposure “asking stupid questions.”
Clients who have ongoing problems in key relationships—with family, friends, coworkers, or a combination—can create frustration for the therapist and hinder any therapeutic progress, especially when the same maladaptive patterns are repeated.
Editor’s note: this is the second of a two-part guest post by Lynne Henderson, PhD, developer of the Social Fitness Training model and author of Helping Your Shy and Socially Anxious Client. (Read Part One here.)