As anyone who had read anything on this blog knows, I’m an anxious person. There’s not a day that can go by without me feeling anxious. The things is though that most days at this point although my average daily level of anxiety certainly remains in the clinical range the intensity is something that is very manageable.

This lulls me into a false sense of security. I can forget what it feels like when it spikes back up.

Then all of a sudden it will appear unexpectedly. It’s been 8 years since the involuntary leave saga happened. It’s bizarre that cues related to this event can activate panic so intense after so much time has passed. I had a point where anxiety relating to this was generalizing to anything tangentially related to the event. I have made a lot of progress though. There are things that were formerly consistently able to evoke anxiety that now are not anxiety provoking at all.

But there are still things than can make me anxious with thoughts about this event.

Today I was ambushed by anxiety.

Graduate school likes to create situations where students are presented with options but gently and clearly informed that there is one choice they should make. This seems to be the case with practicum selection for next year.  I reviewed the options with my current practicum supervisor and was clearly told which practicum I should apply to. I was told this information in a way that makes me think that if I deviate from this direction that I will likely not get a good recommendation for other options that I pursue for this next year. The bit about the recommendation is likely me making a slightly paranoid leap based on the information. However, I do know it is clear that I do not have the support from my supervisor for pursuing the other option which I had greater interest in.

The problem? The location is a college counseling center.

I had no idea the idea of working at a location like that would make me so anxious until I was presented with a situation that suggests it may be my only option.

My mind leaps to worries about what if I end up in the role of a cog in a big bureaucratic machine and am forced to choose between my job and doing to another student the same thing that was done to me. I have no way of knowing if this school does involuntary leaves. It’s not a thing schools like to advertise.

This is the largest burst of anxiety that I have experienced for awhile.

Then I had a bizarre moment of doing therapy on myself. I have not been doing therapy with clients for long. This is the biggest spike in anxiety I have had since getting into more of a rhythm of doing CBT with clients.

So internal therapist me said: Ok so you are worried that at this practicum you might do to someone else, a thing that was very damaging for you to experience. What would happen if this occurred?

Anxious Me: If I do that to someone, I’ll probably kill myself

Internal Therapist Me: So you’re worried that if this happened you would not be able to cope.

Anxious Me: Yes. Maybe I wouldn’t kill myself, but I would be very dysregulated and probably do something impulsive like maybe an overdose that is unsuccessful like I used to do all the time in high school.

Internal Therapist Me: So is it a 100% chance that this would happen?

Anxious Me: Ok well I guess there is a possibility that it might have other outcomes. Maybe by the time this happened I would be in a better place. But I’m worried about what I would do. Would I secretly let the student know their legal options?

Internal Therapist: Switching this issue to the question of whether you’d advise the student about legal options is a way you are using worry to avoid the catastrophe and the anxiety associated with it. You fear causing the same trauma to happen to someone else or that a similar event will happen again to you and that you will not be able to cope if it occurs. The worry here is not about the little details. The details allow you to cognitively avoid the real feared situation but they maintain the worry.

As I am writing this out for this blog I am thinking……………..

Anxious Me: But I’m still anxious. It’s probably because I’m a lousy therapist and being a lousy therapist is why my supervisor does not want me to apply for the other practicum location.

Internal Therapist: Do you see how this thought might relate to the same core belief? You are saying that you are not a good enough therapist and also that you would not be able to cope. What core belief is this?

Anxious Me: That I’m inadequate.

Internal Therapist Me: Do you have any evidence that does not support the belief?

Anxious Me: I got into this graduate program. I regularly do things that make me anxious rather than avoiding them. I have more publications early in graduate school than many people have when they graduate. But….we know that I have a big history of not coping well at times and having quickly escalating suicidally.

Internal Therapist Me: It’s true that you have had a lot of times where you had trouble coping, but some of the more serious situations were awhile ago. Are there things that have changed that make you better at coping now?

Anxious Me: Yes I’m in a much better place than I have been in the past. I tend to be able to wait longer before acting on destructive impulses. Even though I still self-harm, I am able to limit it only to the evening which generally means that by the time is it the evening often I no longer want to do it.

Internal Therapist Me: So we can’t be certain that if the feared situation occurs that you would be unable to cope.

Anxious Me: Yea maybe I would cope. But it does not matter. If it happened it would be so terrible. I just really don’t want it to happen. Or if it is going to happen I want to know and I want all of the details so I can prepare.

Internal Therapist Me: I can’t promise you that it would not happen. No one can predict the future with complete certainty. Worrying is not preparation. This is a maladaptive belief about worry. It tricks you into thinking you are preparing, but really there is nothing you can do right now impact the possibility that this even might occur.

Anxious Me: I know that intellectually but convincing myself emotionally of it is not an easy task.

Internal Therapist Me: Maybe you need to try some imaginal exposures to the catastrophe?

Anxious Me: No. exposures for worry are dumb and I’m not convinced they work.

Internal Therapist Me: Have you tried them?

Anxious Me: No. But I don’t want to.

Internal Therapist Me: Then how do you know it won’t work?

Anxious Me: Ok I don’t really know for certain but I still don’t want to do it.

Internal Therapist Me: Does thinking about doing them make you anxious?

Anxious Me: Of course. That’s kind of the point of exposures. It’s not an exposure if it’s not anxiety provoking.

Internal Therapist Me: Do you think that it is worth trying then?

Anxious Me: Maybe. But back off on this issue or I’ll pretend fire you and then have to deliberate on whether I can add myself to my list of fired therapists. 

Internal Therapist Me: Ok if not the worry exposures what else might you be able to try?

Anxious Me: I could choose to specifically pursue this practicum. My clinical supervisor isn’t the only influence over where I get placed and my advisor will support me wherever i would like to work. So I really do have a choice in this situation. Now that I know how much it makes me anxious, on some level it feels like i should do the practicum just so I can’t have anything in the back of my head making me think that going elsewhere is an avoidance behavior. If I go there it will chip at another angle of how the worry related to this event spread into a lot of different places.

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Ok that’s enough of that. I need ice cream.