Client with anxiety/depression who cannot access feelings

I did a session with a 34 yo man today who has a history of depression and anxiety. His mother made the appointment for him. He is currently unemployed, looking for work, but having a hard time because of his social anxiety. He came in and looked very sleepy (his mom says he sleeps until 1pm or so each day), and he had a difficult time answering my intake questions without closing his eyes, or looking away; not wanting to make eye contact. He has been seeing a therapist for years, on Lexapro 20 mg, and has noticed some positive changes over the years, but still looking for ways to feel better.

After initiating hypnosis, I asked him to imagine himself in a peaceful place, worked on enhancing that image, and then asked him to describe his surroundings. He said it was just blackness, but it was peaceful. That is the first time I've ever had a client not be able to imagine a peaceful place clearly.

Then I started doing parts therapy work with him, to bring up the part of him that has been blocking him, causing him to feel anxious (because he came to me for the anxiety, not the depression), and he was able to do this, but the part was very faint, almost not even there, and he couldn't do anything with it. He felt like it wasn't there enough to work with and that he was taking small steps to make it go away.

After that, I tried regressing him to a happy time in his life (because I wanted to see where that would lead us and then maybe be able to anchor some happy feelings with a finger anchor that he could use at other times). He remembered being at the beach when he was 8 or so, but he didn't fully regress. He talked like it was a snapshot in time of a good time in the past, but just a memory, nothing more. No feelings connected with it. I worked on this a while longer, and he just couldn't connect to any feelings.

He seems so numb to his feelings. So I gave him some suggestions for beginning to tune into his feelings more, to start becoming more aware of what is going on. After the session, I sent him an Mp3 to boost self confidence, and told him to keep a journal this week of how he's feeling, to notice how he feels in different situations and write it down. I'm very curious to see what will come up.

This is the first time I've had a client who could not connect with any feelings. I've had clients who could connect with a feeling, but not want to deal with it, or scared of it, but not someone who was so disconnected.

What advice do you guys have for working with someone like this?

I know he's seen a therapist and a psychiatrist for his medications, but do you think that he should be referred to a medical doctor to see if there is a chemical imbalance going on? Rule out anything medical?

He says he's close to his parents, and does have friends, he hates living here in IN, but feels stuck. I know some regression work might be helpful, but not sure that would work if he can't connect with feelings? Thoughts on that?

I'm needing some help in thinking through what approaches to take with him at our next session (next week).

Thanks so much!
Kathryn

Tags: anxiety, depression, emotionless

Favorite

0 members favorited this

▶ Reply to This

Replies to This Discussion

Permalink Reply by Kathryn Beck on October 18, 2011 at 10:51am

Well, that is definitely something I'm going to ask him about in our session if he is in the same state has he was last time.

Katie S said:

My first thought would be drugs too. Unfortunately, I have had a loved one go in that direction and your description set off all sorts of alarm bells in my head.

▶ Reply

Permalink Reply by Kathryn Beck on October 18, 2011 at 10:52am

What about STEMS technique? I was thinking that might be a good jumping off point as well with him. To get him to start connecting with his thoughts and feelings.

▶ Reply

Permalink Reply by Joe K Fobes on October 18, 2011 at 12:30pm

You mentioned he has anxiety. Sounds like a feeling to me...

And so you might find useful to ask him how he knows he has anxiety. If he says 'I just think it', you can work that. Ask 'if I took you over for a day and was being paid to be you, would it be ok to just think "I have anxiety" and otherwise feel fine in my body...'? Or 'Oh, so it's this thought, and you feel fine... so were you to think "I feel happy" in this moment, then everything is fine in your life? (If the answer is yes, he's all fixed...).

Another way to get him to feel, is to create the situation where he feels that. So if it's social anxiety, ask him if he's ready to go to the mall and meet random people. When he says 'NO!', ask him what's so terrible about that. How it feels when he thinks about doing that. And bingo, you're in the feeling.

The point being, that if he was indeed truly 'cut off' then while he might not feel pleasant, he wouldn't feel unpleasant. And so his complaint is the key here to where you want to go. It's the opening. Stay focused and work that angle of 'oh, so it feels fine but you just have a thought...'. If he says 'yes' then hold him to that and ask him to just think a new thought. You will end with either him agreeing to go to the mall, or a feeling. Either way you win.

Joe

▶ Reply

Permalink Reply by Ricky Strode on October 18, 2011 at 2:37pm

I would start this off by teaching him some self hypnosis techniques and giving him things (i.e. mental exercises to do to begin breaking his current behavior.). For instance, affirmations, other exercises to change self talk and current thought patterns. This would be something I would consider the first part that should be done during the first part of the first session before anything else should be done. This implies they have control and it is going to change before you even do any work. They have unconsciously created this behavior, so I would start with what is currently going on and work with that. He knows the answers, but he just does not know he does yet. However, you have to ask the right questions first. I would go into more detail, but I think this is something that is going to take more than a discussion board to give a truly detailed response. However, I know that it is more than possible to help them.

Your In-Trance to Success,

Ricky Strode
Florida Hypnosis

▶ Reply

Permalink Reply by Kathryn Beck on October 25, 2011 at 8:50am

Hi Joe,

He told me that his therapist had diagnosed him with the anxiety. So I started probing, like you have advised, to find out how he feels in different situations where he thinks he is anxious. The only thing he could think of was that he will feel stuck, like he can't move, but no other physical sensations when he is anxious. He said he wasn't even sure he really was anxious.

He's coming in again tomorrow (2nd session), so we'll see what happens from there. Thanks!
~Kathryn

Joe K Fobes said:

You mentioned he has anxiety. Sounds like a feeling to me...

And so you might find useful to ask him how he knows he has anxiety. If he says 'I just think it', you can work that. Ask 'if I took you over for a day and was being paid to be you, would it be ok to just think "I have anxiety" and otherwise feel fine in my body...'? Or 'Oh, so it's this thought, and you feel fine... so were you to think "I feel happy" in this moment, then everything is fine in your life? (If the answer is yes, he's all fixed...).

Another way to get him to feel, is to create the situation where he feels that. So if it's social anxiety, ask him if he's ready to go to the mall and meet random people. When he says 'NO!', ask him what's so terrible about that. How it feels when he thinks about doing that. And bingo, you're in the feeling.

The point being, that if he was indeed truly 'cut off' then while he might not feel pleasant, he wouldn't feel unpleasant. And so his complaint is the key here to where you want to go. It's the opening. Stay focused and work that angle of 'oh, so it feels fine but you just have a thought...'. If he says 'yes' then hold him to that and ask him to just think a new thought. You will end with either him agreeing to go to the mall, or a feeling. Either way you win.

Joe

▶ Reply

Permalink Reply by Joe K Fobes on October 25, 2011 at 9:53am

Excellent!

And so work with the stuck feeling (if that's what he wants to change). It seems like he can get a good sense of that.

If he's happy with the stuck feeling, and he can't find anxiety, well then what does he want to change...?

And so it seems like the reason he can't connect with feelings of anxiety is because he might not have them. And isn't that wonderful.

Once again, ask him what he wants, and them have him be in that situation and find out what he's feeling that he doesn't want to feel. If there's nothing that feels unpleasant, then mirror that back so he can realize that he feels fine despite what anyone else tells him.

Joe

Kathryn Beck said:

Hi Joe,

He told me that his therapist had diagnosed him with the anxiety. So I started probing, like you have advised, to find out how he feels in different situations where he thinks he is anxious. The only thing he could think of was that he will feel stuck, like he can't move, but no other physical sensations when he is anxious. He said he wasn't even sure he really was anxious.

He's coming in again tomorrow (2nd session), so we'll see what happens from there. Thanks!
~Kathryn

Joe K Fobes said:

You mentioned he has anxiety. Sounds like a feeling to me...

And so you might find useful to ask him how he knows he has anxiety. If he says 'I just think it', you can work that. Ask 'if I took you over for a day and was being paid to be you, would it be ok to just think "I have anxiety" and otherwise feel fine in my body...'? Or 'Oh, so it's this thought, and you feel fine... so were you to think "I feel happy" in this moment, then everything is fine in your life? (If the answer is yes, he's all fixed...).

Another way to get him to feel, is to create the situation where he feels that. So if it's social anxiety, ask him if he's ready to go to the mall and meet random people. When he says 'NO!', ask him what's so terrible about that. How it feels when he thinks about doing that. And bingo, you're in the feeling.

The point being, that if he was indeed truly 'cut off' then while he might not feel pleasant, he wouldn't feel unpleasant. And so his complaint is the key here to where you want to go. It's the opening. Stay focused and work that angle of 'oh, so it feels fine but you just have a thought...'. If he says 'yes' then hold him to that and ask him to just think a new thought. You will end with either him agreeing to go to the mall, or a feeling. Either way you win.

Joe

▶ Reply

Permalink Reply by Kathryn Beck on October 25, 2011 at 12:04pm

Great! Thanks! :)
~Kathryn

Joe K Fobes said:

Excellent!

And so work with the stuck feeling (if that's what he wants to change). It seems like he can get a good sense of that.

If he's happy with the stuck feeling, and he can't find anxiety, well then what does he want to change...?

And so it seems like the reason he can't connect with feelings of anxiety is because he might not have them. And isn't that wonderful.

Once again, ask him what he wants, and them have him be in that situation and find out what he's feeling that he doesn't want to feel. If there's nothing that feels unpleasant, then mirror that back so he can realize that he feels fine despite what anyone else tells him.

Joe

Kathryn Beck said:

Hi Joe,

He told me that his therapist had diagnosed him with the anxiety. So I started probing, like you have advised, to find out how he feels in different situations where he thinks he is anxious. The only thing he could think of was that he will feel stuck, like he can't move, but no other physical sensations when he is anxious. He said he wasn't even sure he really was anxious.

He's coming in again tomorrow (2nd session), so we'll see what happens from there. Thanks!
~Kathryn

Joe K Fobes said:

You mentioned he has anxiety. Sounds like a feeling to me...

And so you might find useful to ask him how he knows he has anxiety. If he says 'I just think it', you can work that. Ask 'if I took you over for a day and was being paid to be you, would it be ok to just think "I have anxiety" and otherwise feel fine in my body...'? Or 'Oh, so it's this thought, and you feel fine... so were you to think "I feel happy" in this moment, then everything is fine in your life? (If the answer is yes, he's all fixed...).

Another way to get him to feel, is to create the situation where he feels that. So if it's social anxiety, ask him if he's ready to go to the mall and meet random people. When he says 'NO!', ask him what's so terrible about that. How it feels when he thinks about doing that. And bingo, you're in the feeling.

The point being, that if he was indeed truly 'cut off' then while he might not feel pleasant, he wouldn't feel unpleasant. And so his complaint is the key here to where you want to go. It's the opening. Stay focused and work that angle of 'oh, so it feels fine but you just have a thought...'. If he says 'yes' then hold him to that and ask him to just think a new thought. You will end with either him agreeing to go to the mall, or a feeling. Either way you win.

Joe