Dear Therapist:

As a teenager our son saw a therapist for a while due to some burnout/depression. Baruch Hashem with some adjustments to his yeshiva life and the help he received he is doing amazing and has been for a while. He is still on a low dose of medication which has worked well for him. When he tried going off, he relapsed and our consensus is that it's best for him to stay on it for now. Now that he is starting shidduchim he is very nervous about telling it over to a girl. Not that he regrets it and he understands that the right girl will understand and appreciate him for who he is but he is worried about the process of telling it over. Which from what we discussed with our rov he will have to do. Particularly he doesn't want to make himself sound worse than he is. Any advice would be appreciated.

Response:

You seem to be describing a few related concerns. You mentioned that your son is nervous about the process of discussing his medication use with a girl. (I emphasize the words “process” and “a” in that sentence.) He may feel like having this type of discussion will be very significant—a process. It is easy—and typical—for us to overanalyze concerns about which we are anxious.

I will define anxiety as a response significantly stronger than the person logically believes that the situation calls for. In other words, if the person were able to view the situation from an objective standpoint (i.e., advising a friend who has this issue) and would recognize that the emotional reaction shouldn’t be as strong as it is, I would refer to the “excess” emotion as anxiety.

There are various reasons that we feel anxious. One important factor is the lack of logical clarity. Since anxiety is the differential between an “appropriate” response and one that is not, gaining this clarity helps to reduce anxiety. Often, the reason for lack of clarity is the fact that we react emotionally, based on unconscious fears and insecurities. For instance, if your son has low self-esteem and a fear of being rejected, these would contribute to his fear of discussing medication with a girl. Without an opportunity to logically consider his actual, logical beliefs about himself, he might be assaulted by automatic thoughts telling him that he is worthless and worthy of rejection.

The fact that our fears and insecurities are unconscious—thus causing anxiety—gives us a clue as to one way of addressing the anxiety. When we are not involved in the actual situation, anxiety often hits us the hardest. This is known as anticipatory anxiety. Once we are forced to actually handle the situation, our conscious mind is often forced to think it through logically, thus reducing anxiety. For instance, many people are far more anxious in anticipation of speaking publicly than once they are actually speaking.

When you refer to “a” girl, I assume that this means that your son is anxious about the idea of discussing his medication with a girl—and that this is not something that is pertinent to a particular girl with whom he already has a strong relationship. Although he may find that once he is in that situation his anxiety will decrease, I understand that he wants to address his current anticipatory anxiety.

One way to do this is to imagine a scenario in which he slowly builds a relationship with a girl over the course of a number of dates. He would theoretically imagine what they might talk about, how they would feel about one another, and how intimate their conversations might get. He would imagine getting to the point that they would be sharing thoughts and feelings in ways that they never have with others. If your son could truly imagine being in this position, and be considering discussing his medication with this girl (rather than “a” theoretical girl), he might find that his anxiety would decrease.

The reason that this often works is that the conscious mind is forced to become more engaged in the reality of the situation, taking reducing the unconscious mind’s ability to cause the negative automatic thoughts. Another strategy is to more directly engage the conscious mind. This can be done in various ways, like imagining advising a friend.

What I call A-to-Z thinking is part of the process through which the unconscious mind hijacks our conscious mind’s ability to think logically. In A-to-Z thinking, there is a trigger (A), like thinking about dating, then immediately the emotional response (Z), like fear and anxiety. Since there is little to no thought about how one would logically get from A to Z, the unconscious mind is in control. What the imagination strategy does is essentially help the person to identify the letters between A and Z, thus allowing them to see clearly what it is that they should be concerned about, and what is simply an emotionally-triggered reaction.  

Of course, work on self-esteem can help to alleviate many of your son’s anxieties. Additionally, recognizing that his feelings, fears, anxieties, and other reactions are normal can help him to stay grounded, rather than getting caught in a loop of feeling abnormal and therefore being afraid of others’ thoughts and reactions. These are things that you may be able to help him to recognize, but ultimately these are his issues. If he feels that he could use some help working through them, remind him that seeing a therapist is considered quite normal today, and that the stigma of medication and therapy is continuously waning.

-Yehuda Lieberman, LCSW

  psychotherapist in private practice

  Woodmere, NY

  adjunct professor at Touro College

  Graduate School of Social Work

  author of Self-Esteem: A Primer

  www.ylcsw.com / 516-218-4200

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