When should you seek a therapist’s help? If you have worked through the various steps in this program but feel stuck or frustrated because you are not yet experiencing a positive result, it may be time to consider therapy. If you are unable to activate your PMA and feel mired in a negative attitude, that is another strong sign that therapy may be advisable. You started this self-help program to improve your quality of life, and it is my personal goal in creating this program to make it possible for you to overcome your difficulties and have satisfying personal relationships. If underlying psychological or emotional issues are getting in the way, then I urge you to seek professional counseling. In deciding whether to seek therapy, consider the following:
1. Have you tried to make progress or solve the problem on your own by following the self-help program in this book?
2. How successful have you been?
3. If you have not yet been successful, do you have ideas as to why not?
4. Is the situation getting worse?
5. If the situation is in fact getting better, is it a temporary improvement or has the improvement been consistent?
A Note for Parents
If you are a parent and are concerned that your son or daughter with social problems is stuck or has not made much progress with this program, consider the following:
1. How long has there been a problem?
2. Do you feel that your son or daughter will grow out of it?
3. If the answer is yes, about how long should that take?
4. Do both parents agree about the situation?
5. Is the situation better, worse, or about the same as it was when you began working with this book?
6. Have you tried to solve the problem within the family by using this book?
7. If so, how much success have you observed?
8. Do you truly believe therapy is needed but hesitate to take action because you fear your child’s “temper tantrum” (behavior designed to manipulate and control)?
HOW TO SELECT A THERAPIST
Not every person with social anxiety needs a therapist. And not every therapist is right for every person. Especially where interactive issues are the primary concern, it is essential for the therapist-client relationship to be comfortable and relaxed; yet the therapist must be willing to confront the client’s resistance and denial in a direct manner. Therapy is an investment—of time, money, and energy—and it is perfectly appropriate to shop around to find an investment that is right for you.
Traditional Freudian psychoanalysis—with sessions spent on the couch facing away from the analyst, who focuses only on what the patient volunteers to say—is of little use to the person with social anxiety. Focusing on the past without also looking at the present is a very ineffective way to treat social anxiety. A blended approach that includes trying to understand how the problem developed and also changing the way the individual responds to anxiety is essential. And remember that the past does not equal the future.
Again, practice is everything, and face-to-face discussion is truly a vital component of the necessary therapeutic process. The establishment of a strong, trusting relationship between client and therapist is absolutely imperative for success. I shudder to think of one of my clients, who came to me after seeing two different therapists over a period of two or three months. What did I find so disturbing? My new client couldn’t even remember these therapists’ names! A good therapeutic relationship requires interaction and intimacy.
Some psychotherapists have called my practice unorthodox, but that’s fine with me. What matters to me is success—and the thousands of people who have worked through my program have persuaded me that a confrontational, open therapeutic environment is most conducive to change for socially anxious individuals. I remember early in my practice, when I was sharing office space with several other therapists, one of them expressed annoyance that my clients would chat with one another in the waiting room, rather than sitting in total silence like his own patients. But many of my clients attended group therapy together and found support in talking to each other. “Quite frankly,” I told my colleague, “I encourage them to get to know each other—after all, interaction is really at the heart of what I’m trying to do here.”
There are millions of people of all ages who are in some form of therapy now because of problems with social anxiety. Their diagnoses may differ—avoidant personality disorder, dependent personality disorder, anxiety and stress disorder—but the basic problem is the same: fear of social interaction. Because the diagnoses and treatments may vary so widely, since no comprehensive treatment program has existed until now, these people may languish for years in individual counseling without ever having the chance to experiment with and improve their interactive skills. The broad spectrum of psychotherapy offers many different therapeutic orientations, philosophies, clinical approaches, and specialties. The guidelines below should assist you in finding the right therapist for your problems of social anxiety:
1. There are numerous professional disciplines in psychotherapy, including psychiatry, psychology, social work, nursing, pastoral counseling, and the creative arts (such as art therapy and drama therapy). Make sure the therapist you choose is certified in his or her discipline.
2. Do not be afraid to interview your potential therapist. Ask questions. Let the therapist know that you would like to find the best person to help you with your particular problem—social anxiety. If you detect that the therapist is uncomfortable answering questions, chances are this therapist is not for you.
3. Find out if the therapist has had specific experience in working with social anxiety and social phobia, and with what results. (One of my clients, virtually housebound with anxiety, had tried hard with ten therapists, but to no avail. It seemed none of these therapists understood the degree of anxiety that was present, and therefore none was equipped to treat it.) Ask what the therapist’s feelings are about stress management and social skills approaches. Again, this is a revolutionary combination, but if you can find out what the therapist would advise you to do to perfect your social skills, you will get a sense of how cooperative, supportive, and innovative the professional is.
4. Find out what the clinical orientation of the therapist is. The socially anxious individual will benefit most from pragmatic (or practical) clinical approaches—treatment that helps you deal with your symptoms and with present-day issues, rather than focusing on the past. Although it is important to develop insight into the development of your social anxiety, most of your initial work should focus on practical insight and productive support, as well as therapeutic strategies designed to help you move forward.
5. Does the therapist offer a practical approach to stress management and anxiety control? Many therapists say they are stress management experts, but in fact stress management is an abstract concept to them. One of my clients reported seeing several therapists over a period of several years in an attempt to learn to control his panic attacks and manage his social fears. He was extremely frustrated by these professionals. “I would ask them what to do when I have an anxiety attack,” he said, “and they would just say I had to ’work my way through it.’ But how? They never gave me a game plan.” Without a structured approach, confusion and frustration are the order of the day.
6. Does the therapist offer groups? If not, can he or she refer you to a group to supplement your treatment? Does the therapist know how to utilize community resources and does he or she believe in making them a component of treatment? My practice includes many telephone clients from other states, and so community resources are an essential backup. One of my therapists worked on the phone with a client from Chicago. While there were no therapy groups for social anxiety there, we did some research and located an assertiveness training group that we integrated into his overall therapy. Again, social anxiety is a people-oriented problem, and access to a group treatment option is an important part of your overall map for change.
7. Does the therapist give “homework
”? Productive therapy includes carryover from the session to outside the office.
8. If as a parent you seek help for your son or daughter of any age, does the therapist believe in involving the parents? Remember, given the nature of this problem and the fact that there may be related dependency issues, you need to be sure that family issues will be addressed—and therapy will include helping the parents to develop a map for change. Confidentiality should of course be maintained, but the treatment strategy should include you. If there are substantial dependency issues and the parents are not part of the process, the result could very well be a frustrating waste of time, energy, and money.
A FINAL NOTE
This chapter suggests many options for making use of a social system. In turning to your community for resources, you are embracing interaction. When you feel anxious about pursuing these self-help components, look back to your stress management and relaxation techniques to help you to control your anxiety. Of course you will feel anxious or inhibited about joining a new group. But remember: Dread, then do! You’ll be glad you did.
CHAPTER ELEVEN
“Shyness” and Society: Issues and Patterns
Research has confirmed that millions of people have identified themselves as “shy” at some point in their lives. Why, then, has there been so little research on the subject, and so few programs available to help those in need? “Shyness,” it seems, has been considered an unchangeable part of the personality, a benignly pervasive fact of life that society simply takes for granted. How unfortunate, though, for those whose social anxiety prevents them from leading the rewarding, fulfilling lives they would like to lead.
I wrote this book to offer a means of changing the supposedly unchangeable trait of “shyness.” It is my goal to replace the concept of “shyness” with a new, far more accurate term: social anxiety. As I’ve explained, anxiety is a learned response, and therefore it can be unlearned. To think of “shyness” as a bad habit that can be broken is to free yourself from social anxiety, and allow yourself to take responsibility for your own responses—indeed, you must—and work toward a healthier interactive self. Of course, the benefits include not only interactive success and higher-quality relationships, but also better physical health and longer life. There is no magic pill that a physician can prescribe to take away anxiety symptoms and their underlying cause. This self-help program is a new way of life, a new way of looking at oneself and one’s world.
During the thirteen years my program has existed, I have observed certain trends that I would like to mention here as a way of putting social anxiety into perspective.
DENIAL
Perhaps the single greatest obstacle I encounter is denial. Unquestionably, this is the biggest issue for society as a whole, and one that we are just beginning to tackle. In cases of social anxiety, denial is pervasive. The mother of a ten-year-old girl who had participated successfully in my program recently called me to say how grateful she was for the results we had brought her. “I have so many parents of elementary-age children to refer to you,” she said. “But the problem is, none of them will come. They won’t admit there’s any problem at all!”
Breaking through denial is an essential part of beginning to treat social anxiety. As I have pointed out, denial has many faces. It is very easy for a person with social anxiety to deny that a problem exists. Given the nature of social anxiety—that it is caused by a fear of humiliation, embarrassment, and scrutiny—it is obvious why a socially anxious person would come to avoid what makes him or her anxious. But to deny the problem is to enable it to continue. Parents are often actively in denial, even though their child’s patterns of social anxiety are striking. Typically, parents of young children or teens will respond in the following way: The mother is sure there is a problem, while the father says simply, “I was shy as a child too, and I grew out of it.” Or one parent won’t even acknowledge the problem exists at all. The reality, however, is that the child or adolescent is truly suffering from anxiety. The sooner intervention and self-help strategies are put into place, the better the prognosis. Later in life, anxiety can be too old a habit to break, which is a tragedy for all concerned.
To help yourself overcome denial, use the “Adult”—the objective computer part of your personality—to gain perspective on your situation. Do not allow yourself to confuse denial with strength of character. The first step toward controlling anxiety is to abandon your denial. Make a commitment to yourself to improve the situation that exists. Your success graph will have its ups and downs. But stay with the program. In order to move toward self-actualization—fulfillment on a personal and professional level—you must adopt a work ethic. Self-help requires discipline. There are no instant answers. But a concentrated effort will reward you time and time again.
MEN AND WOMEN
About 65 percent of the calls I receive from around the country are from men or from parents concerned about their adolescent or adult sons. Does this mean that most of the people who suffer from social anxiety are men? Are women for the most part immune to social anxiety? My more informal research says no. My theory—not to be sexist—is that society expects more from men, despite recent gains in equality for women. Men are under far more pressure to succeed, both in their careers and in their social lives, than women are. Women can be considered “shy,” “demure,” “quiet”—all stereotypically feminine characteristics and all characteristics that can mask social anxiety, which can perpetuate overprotective and enabling behavior.
LEARNING DISABILITIES
I have found that there is a strong correlation between social anxiety, difficulty with social skills, and learning disabilities. Learning disabilities—problems with taking in, storing, and retrieving information from the brain—are considered a hidden handicap. Despite difficulty processing information, a learning-disabled person may go undiagnosed throughout his or her formative years. Learning disabilities are not the mark of an unintelligent person; on the contrary, many learning-disabled people are of above-average intelligence, and, with help, can become highly successful in their careers and their personal lives. Functioning level is determined not totally by the disability but also by the available compensation strategies.
Again, there is a wide range within the category of “learning disabled.” Consider: William, a forty-seven-year-old married father of two, is the head of a venture-capital firm that has yearly transactions totaling millions of dollars. He suffers from dyslexia, but has clearly been able to overcome his disability and achieve success. Matt, age thirty-one, suffers from more pervasive developmental problems; he was in special education throughout school, and secured a job with the parks department upon graduating. His salary is $14,000 a year, and he lives at home with his parents. Both men have learning disabilities, but their functioning levels are vastly different. It is important not to stigmatize the learning disabled.
Unfortunately, although there is much new research to draw upon, little has been documented about the connection between learning disabilities and interactive difficulties. But in my thirteen years of clinical practice, several things have become clear. The high correlation between learning disabilities, social anxiety, and poor interactive skills stems from two things. First, the person with a learning disability is more susceptible to mistakes and failure, and at an earlier age, and may have more trouble picking up on the normal social cues that guide the rest of us through a social encounter. This lack of skill leads to anxiety and confusion, which leads to avoidance—a pattern similar to the one described in Chapter 1. But here, the confusion starts with the learning disability.
The second component that may cause a learning-disabled person to withdraw is low self-esteem. As we’ve discussed, low self-esteem is pervasive among those with social anxiety. In the case of the learning disabled, a poor self-image may result from years of being frustrated in school and among peers. If you suspect that you have learning disabilities (or that your socially anxious son or daughter does), seek testi
ng from a qualified professional. The best way to cope with learning disabilities is to understand the limitations they cause and to explore new ways of compensating for them, NOTE: The connection between interactive abilities and learning disabilities could be the subject of a book in itself. What is presented here is merely a synopsis.
ELECTIVE MUTISM
Social anxiety appears in many forms, some of which are only now coming to light. Socially anxious children, for example, are usually thought of as quiet and reserved and of course “shy.” But some children, though they function fairly well in their home environment, have great difficulty talking in social situations. Donny was one such child. At fourteen, he managed quite well at home, but never talked to his peers. His parents encouraged him to join in group activities, and even sent him off to an overnight camp. But he remained silent, even when he became lost in the woods. The child was alone for several hours; dusk was approaching, and he began to get cold, but he still could not bring himself to call out. The counselors were near enough for him to attract their attention and yet he remained mute.
Alarm bells went off for Melanie when she noticed that her daughter at age three had trouble talking with people outside their home. When the little girl went to see Santa Claus, and he asked her what she wanted for Christmas, she became hysterical and couldn’t respond verbally. And the problem continued: She would speak only with the immediate family, and never to peers or potential playmates.
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