“At the Moment” is the door into therapy and the door out of therapy.

Many therapists planning to do an exposure with a client fear the client will develop resistance. Resistance is a momentary feeling. It’s an awesome helpful feeling that tells us that investing in exposure at that very moment would not be wise. It doesn’t mean that exposure will not work for a client in future moments. Like now, or now, or 3 months of now’s from now.

Early in therapy, you get to set up this world view with your client. If you set the stage that any decision about treatment is a decision “At the Moment” or “Right Now” you open up the rest of someone’s entire life to the possibility of exposure, excellent therapy, and success in beating anxiety.

How do we use this in therapy?

A client comes to you saying they want help with social anxiety. You did an excellent phone screen in which you let them know that exposure would likely be necessary for successful treatment of anxiety, and explained roughly what that would look like. They agreed to see you knowing exposure was part of the package. They arrive at your office, and complete the diagnostic interview and Brief Mood Survey. You open the Empathy phase of therapy learning more about the problem – mentally noting likely underlying self-defeating beliefs, devising potential exposures to test these beliefs. You’ve created a strong rapport with the client and they are giving you feedback that the empathy feels excellent and right on for them! You offer an invitation to work on the problem, they agree. You use specificity to find they have some social anxiety thoughts and feelings. You do masterful agenda setting using the Miracle Cure Question, The Magic Button, Positive Reframing, The Acid Test, Magic Dial. You have Dangled some Carrot, issued a Gentle Ultimatum, and Sat with Open Hands. You may have utilized some Cognitive Methods and explored the Hidden Emotion Model. You know the client already said they were game for exposure. You are a Therapist On Fire! And suddenly: RESISTANCE!

“What?” you think. Where did this come from?

“Yes, I’d like to do that exposure, but not yet.”

What do you do, Therapist On Fire who feels as if a bucket of cold water has been thrown on you?

Use, “Right now” or “At the Moment.”

As the savvy therapist you are, you know to fall back to empathy, but you don’t have to get lost in Empathy Land.

“It sounds as if you don’t want to try Exposure A at the moment. That makes a lot of sense to me….” EMPATHY, EMPATHY, EMPATHY

Then we dangle the carrot of the goodness we could bring to their life, offer the gentle ultimatum with open hands, while resting firmly and comfortably in our fallback position. For those of us in private practice, running our practice closely aligned to the TEAM model, who want to incorporate “at the moment,” it might sound like this. * Note that fallback positions vary from setting to setting. Here we demonstrate an idea of TEAM-aligned Carrot-Gentle Ultimatum-Fallback.

“I would love to help you to feel peace and joy in your life. I’m quite confident if we use the exposure methods we discussed, it will have a dramatic impact on your life and you will be feeling a newfound peace and joy. To get to that, these exposure exercises would be required. I can understand that this doesn’t feel like the road for you at the moment. Perhaps it makes more sense for us to focus on something else or for you to take a break from our therapy while you think it over. My door is open to you whenever you are ready to move ahead, face those fears, and change your life. I’d love to do that work with you, but only when you are ready.”

Ideally, we communicate our enthusiasm for working with the client whenever they are ready. I often tell folks they can come back in a day, a week, a year, or more. Not feeling pressured can leave doors open and allow people to think more freely about what they want and are willing to do.

If you are a seasoned TEAM therapist you will notice that this sounds just like your regular process resistance step, with the addition of the “at the moment.” And you might already be using “at the moment” in your language. If so, cool! We’ve come to the same strategy. If not, I hope you have fun considering this mini-add to the typical sequence.