Helping Clients with Severe Social Anxiety to Feel More Comfortable in the First Meeting

“When you get into a tight place and everything goes against you, till it seems as though you could not hang on a minute longer, never give up then, for that is just the place and the time that the tide will turn.”

Harriet Beecher Stowe
(1811 – 1896)

Helping Clients with Severe Social Anxiety to Feel More Comfortable in the First Meeting

TISA Description of the Problem: TISA Introductory Note: Each of our clients is unique. They will cope and interact with their own symptoms in individual fashions. Understanding this uniqueness can help us to more sensitively understand the impact of our own behaviors on them in the initial interview. Such understanding leads to clinical flexibility.

By way of example, some clients, suffering with social anxiety disorder, can find the vagueness and “uncharted territory” of the first interview to be quite intimidating. A gently but well structured interview, frequently enhanced with closed ended questions, and reassuring guidelines from the interviewer often allays their fears of performance failure and “not doing what the interviewer expects”. With such clients, open ended questions sometimes paradoxically spark surprisingly intense fears of giving the wrong answers or worries such as “I wonder if I’m doing what I’m supposed to be doing”.

On the other hand, as we shall soon see in the following outstanding tip, the exact same approach may have a strikingly different impact, an impact far from what we intended, on other clients who are also coping with social anxiety. The key is to quickly assess how our individual client’s social anxiety manifests itself and to adjust our interviewing style to their unique needs as elegantly described below.

The Problem: We are trained to make eye-contact and to inquire using a direct line of questioning during an initial interview. This approach can be painfully embarrassing for a person experiencing a social anxiety disorder. Even asking such a patient to complete a standard set of forms, sign his name, or complete a standard questionnaire can result in an escalation of his or her anxiety symptoms.

Tip: If one notices a patient responding in this fashion, it is better to fit the scheduling of the interview to the needs of the individual than to risk creating so much anxiety that the patient flees and does not return to treatment. With such patients it can help if the clinician can set aside sufficient time to allow the patient to tell his or her story with all the time he or she needs to have the story unfold naturalistically.

It may be useful to avoid asking a direct line of questions. Often, people experiencing a social anxiety disorder will be more self disclosive if the clinician nondirectively listens for the data that is needed, while the client simply speaks in a stream of consciousness manner.

One can also reassure these patients that their social anxiety is not only quite common, but that most people experiencing it report feeling like, “I’m the only one that has this.” They are often also reassured to know that helping professionals have found social anxiety disorder to respond well to appropriate treatment.

You may also get a better response from such clients if you do not look directly at them. In addition, allowing your own emotional and non-verbal responses to show while listening to such clients, may also help them to feel more comfortable, for some people with social anxiety disorder feel particularly uncomfortable when counselors appear to “stare blankly”.

Result: Such a creative and flexible adjustment in interviewing style, can help the client with a social anxiety disorder, leave the initial interview with a feeling that they have been respected and that they feel comfortable in the presence of the counselor. The first step in therapy, the creation of a safe interpersonal space has been successfully undertaken, thanks to the clinician’s attention to the unique needs of the client.

TISA Follow-up:

Tip provided by:

John Jeffers, L.C.S.W., Camden, Maine