In 1976 fresh out of graduate school I was working as a youth worker in a community center. A colleague, with a background in special ed., suggested that we start a socialization group for teenagers with learning disabilities. I had no idea what she was talking about, but we conducted research and discovered there was no such service being offered. We set up a program where applicants would come for an intake interview with parents before participating in the group. An interesting thing happened. Many of the clients interviewed never showed up for the group. This is how I discovered social anxiety in the late 1970’s.
In 1978 I started a private practice specializing in biofeedback for stress related disorders. Soon thereafter I integrated therapy for socially challenged individuals as a specialty. This was the beginning of my clinical experience 37 years ago. Since then; I have facilitated treatment for thousands of individuals of all ages with social anxiety and related disorders. Treatment has included individual, family, parenting, and group therapy. The functioning level of patients has varied tremendously. I have worked with many superstars in their professions as well as pervasively challenged individuals.
I want to share with you what I have learned regarding treatment efficacy!
First; in a private practice setting if you do not help your patients achieve their goals they will not come to therapy. Secondly; given that social anxiety is the quintessential disease of resistance, a creative and productive approach to treatment was necessary for productivity. The result was the Berent Methodology, which has been crafted, developed, and organized for 37 years.
The Berent Method has customized a treatment methodology adapted to the specific needs of social anxiety rather than fit the problem into the confines of existing modalities. This is the most important concept of this essay. The Berent model has integrated various functional psychotherapeutic modalities into it’s’ system as important tools for learning.
The starting point of treatment for social anxiety is to understand that while there are many manifestations of social anxiety there are 2 basic types of people with the problem. The 2 types are Individuals with “initiative, and individuals without “initiative”. Initiative does not mean ability it means the motivation to start up. I have not seen this variable factored into any formal research that demonstrates clinical efficacy.
For example, there is a substantial difference between the 26 year old who is experiencing relationship challenges and performance anxiety at work who initiates treatment independently vs. the 26 year old who is holed up in his room playing 100 hrs. of computer games a week and the parent initiates therapy . The fact that mental health technologies have not differentiated between the 2 basic subgroups (initiative vs non-initiative ) is a major component of the trivializing of social anxiety.
The term “evidence based” is often used for clinical marketing. The problem is that most evidence for social anxiety treatment success is quite limited. If you are going to take advice from someone it’s good to have evidence of that person’s performance. I encourage you to experience real evidence by accessing the free library of clinical interviews at www.socialanxiety.com. In fact, I challenge any therapist, hospital, university, or organization to come up with more evidence of clinical success for social anxiety!
The biggest confusion that people bring into treatment is a lack of understanding about how ingrained the problem can be. In order to understand “ingrained” it’s important to understand the architecture of the disorder.
The problem is multi-dimensional. It includes the following domains:
F. Function = physiology
A. Action = behavior
T. Thinking = cognition
Integrating FATE into treatment is essential if the objective is to resolve the core issues and to develop a “high performance mind”, which I define as proactive energy to achieve happiness and health. The two dynamics that are most absent from treatments in general for social anxiety are an understanding of the relationship of emotion to physiology and the avoidance-dependence syndrome that impacts individuals without initiative.
When my first book “Beyond Shyness” was published in 1992 by Simon & Schuster I had experienced a number of rejections by publishers. They had asked “you are writing a book about shyness why are you writing about parents”. My writing about parents was a sign that I developed a strategy to negotiate the avoidance-dependence pathology. This pathology can run very deep and is often the core of resistance. Avoidance often evolves into a compulsion.
I have been criticized by a few individuals for not having compassion for social anxiety sufferers. These people are incorrect. What they are witnessing is my energy needed to negotiate narcissistic-driven avoidance. I will discuss more on this personality dynamic at another time. At the risk of creating controversy I will tell you that too much compassion is an ingredient for the chemistry of enabling.
The philosophy behind the Berent Method is that time is your most valuable asset. Time is not elastic. It doesn’t stretch. Social anxiety accrues with time. The negative and painful mind-body response of social anxiety gets worse the more it remains the same. The average age of my patients since 1978 has been in the late 20’s. It’s extremely gratifying to work with young children as there is an opportunity to prevent the anxiety from becoming avoidant or dependent personality disorders. While the anxiety response can be very ingrained at age six, It’s much less than 26, 36 46 or 56.
Let’s first consider social anxiety without initiative. All children and most teenagers with social anxiety do not have initiative. Common examples include selective mutism, school phobia, and teenagers and adults who are pervasively avoidant and dependent.
Where initiative is not present treatment is parent focused. The goal is to empower vs enable. Parents are guided into parenting team building and teaching the dependent emotional intelligence. The concept of nurturing, which had been defined as rescuing, is re-architected into providing support and promoting growth. A crucial component of treatment is helping parents negotiate their own emotions and anxiety through the process. Adolescents and adults are integrated into therapy sessions after parents have learned appropriate skills. In the case of young children treatment is totally parent focused.
Now let’s consider treatment for social anxiety patients with initiative. Treatment is a combination of technique and core work. After a comprehensive orientation and history taking individuals are introduced to the concept of mind states. Based on the psychology of transactional analysis mind states is a productive tool in making concrete the therapeutic process. You can see that the therapeutic objective is to increase the “nurturing parent”, “adult” and “natural child” while decreasing the “critical parent” and “adapted child”.
The primary technique in the Berent model is the paradox of making friends with adrenaline. This requires a historical analysis of how the negative association to adrenaline was learned. This is concurrent with learning to accept and surf the wave of adrenaline. This technique will help to channel and harness the energy of adrenaline. Skills are implemented developmentally and are applied to the patient’s behavioral hierarchy of anxiety. This is where there is potential for immersion as a component of the behavioral strategy
Core work is based on The Sarno Method. John Sarno MD is world renown for his work with back pain and the “Mindbody Prescription”. The basic Sarno dynamic is that repressed anger and rage is the root cause of physical symptoms. This rage is so strong that it inhibits the flow of oxygen into the blood stream. This methodology facilitates an understanding of one’s “reservoir” (the unconscious memories). In the reservoir are the root causes of shame, embarrassment, and humiliation. Once the reservoir has been identified the goal is to attach on an emotional vs intellectual level. In mind state transactional analysis language the more that the natural child has not been nurtured, the more repressed rage there will be!
One of the questions you are probably asking is “how long does treatment take”? The answer depends on ones learning curve. The primary variables to the learning curve include length of the problem, severity of the problem, degree of obsessive energy, motivation, expressive ability, the ability to integrate new concepts, and readiness to face fear.
Pharmaceutical intervention is utilized when indicated. When used; the philosophy is to use the medicine as a tool to help facilitate the therapeutic process.