Advice for working with someone with GAD

This section is for questions relating to therapy, assessment, formulation and other aspects of working with people in mental health services.

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Advice for working with someone with GAD

Post by jo2212 » Tue Mar 19, 2019 9:13 pm


I'm currently working with a client who is experiencing GAD. The client's goal is to reduce overthinking in order to stop procrastinating. However, the client does not view herself as a worrier and believes that it's a helpful approach. I suppose this came as quite a surprise to me as she had described worrying as having a negative impact on her wellbeing, but then didn't want see herself as being a 'worrier'.

I was wondering if anyone had any ideas on how to approach this disagreement e.g. I can see that the worrying is unhelpful, but the client is finding this difficult/disagrees. I don't want to damage the therapeutic relationship or for her to think I'm dismissing her viewpoint. I've considered using a metacognitive model to show how positive beliefs about worry can be a maintenance factor but I have concerns that this will convey the idea that my way is the 'right' way. How do you go about challenging someones belief without being offensive?

Writing this has also emphasised to me the difficulties I encounter with any form of confrontation and resistance...need to work on that also!

Any help would be much appreciated!

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Re: Advice for working with someone with GAD

Post by Lancelot » Tue Mar 19, 2019 9:43 pm

Good CBT isn't about challenging someone's beliefs, it is about helping them to evaluate them. Be impartial. Lets find out if worry works for you. The client may be right, how about starting from here - how does it help you? what effect does it have on your mood? Unpack the meaning, explore a specific example. Track it in diary, lets see how it it helping. Normalise! I can see why you think that.

At the end of evidence collecting and evaluation, it is up to the client to decide what they make of it and what they want to do in the future.

It is about keeping an open mind in CBT - the client could be right! Their perspective may be accurate? But working to find out as team first via unpack the meaning, evaluating and/or testing out beliefs. You don't have to come down on a particular side.

p.s. you don't need to be a 'worrier' to engage in worry.

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Re: Advice for working with someone with GAD

Post by ell » Fri Mar 22, 2019 9:14 am

If her goal is to reduce overthinking (which I assume is a goal she generated), but doesn't see herself as worrying, then I think there might be some value in talking about exactly what she means by those terms. It may be you each have different definitions of those words. Alternatively, she may feel that 'overthinking' is a more acceptable thing than 'worrying'.

My approach would be to use the client's language to create a shared language in therapy, but in doing so, making sure that there's a shared understanding of what those words mean to the client.

Also, as you are probably aware, this is the kind of thing to take to supervision, as that will be a place where you can talk about this within the context of more case details (as any suggestions here are going to be generic rather than specific to your case).

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