How Therapists Can Avoid Catching Clients’ Anxiety

As therapists, we’re exposed to worries realized and worries unrealized. Clients voice concerns about everything from finances to flying, lost sleep to losing a loved one, career missteps to climate change.  

Talking to people all day who are fearing or facing significant life stressors can convince us that danger is around every corner. How do we avoid catching clients’ anxiety?

I’ve seen—and felt—this come up first-hand in my career. As a psychologist in oncology, I have discussed with my colleagues our shared dread that everyone we love will eventually develop cancer.

This worry is fueled by the constant narratives we hear of unexpected diagnoses. 

A friend of mine assumed that their no-frills retirement saving strategy was sound—until a client shared ruminations on a dozen ways his financial future could be derailed. After caring for dozens of survivors of sexual assault, a former colleague feared for his children’s physical well-being more than he felt was healthy. 

A former supervisor admitted she never worried about germs in public places, until the vivid descriptions from her illness-wary client made her reconsider everyday activities. She began to look at restaurant silverware, movie theater seat cushions, and check-out line keypads with new unease that tipped into avoidance. 

How to avoid catching clients’ anxiety

How can we attend to our clients’ worries and hardships without them becoming our own?

It’s a tricky balance, but I’ve found a few strategies that can work to help.

Here are a few ways you can set and maintain healthy relationships to your clients’ worries. 

1. Assess realistic risk

Just as we instruct clients to examine the helpfulness and accuracy of specific thoughts, we can assess our own in the same way. For example, it can be helpful simply to ask ourselves “Am I overestimating the probability of this fear occurring based on my work as a therapist?” 

Returning to my earlier example of cancer, it’s reassuring to remind myself that I see a sizable proportion of all people treated for pancreatic cancer in a major city. While pancreatic cancer feels pervasive to me, it’s deemed rare by the National Cancer Institute, as it affects less than 15 people per 100,000. My perception of risk is skewed due to my contact with my clients and their caregivers. 

Similarly, suppose you’re working with clients who have experienced a specific type of trauma. In that case, it’s helpful to remember that the frequency of such an event is lower in the general population than in those seeking treatment. 

2. Appraise your coping skills

A second helpful question is, “Am I underestimating my ability to cope, even if this fear did come true?” We often fear situations without imagining how we would manage if they did occur. 

For example, we may worry more about our professional footing while providing support to someone who was blind-sighted by a career setback. We may imagine losing a loved one as we witness a client’s deep grief. Hearing the details of a catastrophic accident may shake our sense of safety. 

Reminding ourselves of our resourcefulness, sources of support, and hard-earned coping strategies can make us feel more capable of managing a similar challenge if one did occur. 

If we faced a professional setback, we could call on those we’ve trained with to send opportunities our way. If we experienced future loss, we could connect with an excellent therapist and seek a support group for connection. If we experience a tragic accident, we could bring our understanding of emotion-focused coping and enlist social support to aid our adjustment. 

Not underestimating our ability to cope makes possible dangers feel less overwhelming.  

3. Name your reaction

This is a personal favorite of mine. A lab-based study done in 2012 had researchers asking individuals with a fear of spiders to approach a tarantula. Participants who engaged in affect labeling or naming their emotions (e.g., “I feel terrified”) took on average more steps toward the giant spider than participants who were asked to engage in other coping strategies. The researchers concluded that articulating one’s emotions can help manage their impact. 

Following a session, describing how the time has left you feeling can be helpful. One session may leave you energized or hopeful, while another may result in feeling anxious or depleted. The exercise of naming your feelings takes no more than a few seconds, but labeling will help build insight and highlight choices for self-care. 

If a session leaves you feeling anxious, write down specific worries for one minute. Engage in a minute of diaphragmatic breathing. Mindfully observe sensations and thoughts without judging them. Validate that absorbing some of your client’s worry reflects your attunement. 

4. Identify and act on the value under the worry

Anxiety highlights what matters to us.

Let’s say you spend all day talking to couples or individuals who are dissatisfied in their relationships or experiencing conflict. It’s easy to imagine how this could shape your outlook for your partnership or the likelihood of finding a compatible partner. 

Under this worry about relationship strength is a value: connection, trust, commitment, or love are possibilities. 

Worry emphasizes what you hold dear. If you’re ruminating about relationship concerns, reflect on what action you could take in service of an underlying value. Action could be expressing appreciation to your partner, asking for feedback in a relationship, or initiating a first date.  

If your client’s health-related anxiety has you worried about your health, identify an action to take in service of your physical well-being. That might mean scheduling an annual physical, taking a walk after work, or seeking health information from a reliable source.  

Worry points to our values, but worry doesn’t need to monopolize our time. Treat worry as a highlighter and values as a compass. Using values to guide action moves us closer to what is meaningful. 

5. Cultivate self-compassion

Witnessing and tending to people’s worries is difficult work. Treating anxiety often includes teaching clients about worry’s normative and adaptive nature. Worry can help us plan and prepare. Our mind constantly creates content, and often our thoughts are intended to keep us safe. 

We are all hard-wired with a negativity bias to remember and be more vigilant about dangers than pleasures. Recalling the plant that sickened us is more important than memorizing the flower that brought us delight.

Worry is natural, and our mind’s attempts at protection.

We can extend the same acceptance, validation, and compassion of our clients’ experience of worry to our own. 

Kristin Neff, a self-compassion researcher, outlines three steps to respond to difficult feelings.  

• When a client’s worry feels infectious, first respond with mindfulness. “This is worry. This is a moment of discomfort.” 
• Next, connect with your common humanity. “Worry is part of life. Many others are experiencing worry, too.” 
• Finally, engage in self-kindness. “What do I need to hear right now? May I be compassionate with myself in this moment. May I accept myself as a person with feelings.” 

Seeing worry as a natural, shared experience can gently move us from the sticky content of specific fears to a more flexible, accepting state that allows us to respond gently to our feelings. 

The therapist-client relationship is reciprocal and full of learning. While we want to be open and receptive to the thoughts of our clients, adopting clients’ worries rarely serves us. Using questions for balanced thinking, naming our reactions, acting on the values under our worry, and encouraging self-compassion can help us work effectively while taking care of our emotional health, too. 

Lastly, our clients typically seek us during their most challenging times. After treatment has ended, we won’t see their continued growth or hear about future contentment. It can be helpful to picture the peaks of our clients’ lives, given that we often witness the valleys. It is beneficial to remind ourselves of the many worries that go unrealized and the many joys that weren’t anticipated.

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