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I often hear clients expressing concern about an event or a situation of some kind for which they are experiencing something known as anticipatory anxiety. This is a heightened sense of worry and vigilance about some dreaded event or experience that the anxious individual fears might overwhelm him, sometimes known as the "what-will-happen-next" fear.

When most couples call me for a couples therapy consultation, they have reached a point where the severity of their ongoing conflict has reached the danger zone.  Some couples seek help when the early signs of trouble begin to develop. Others wait…and wait, either hoping that their difficulties will resolve themselves or that they will find a way to address their problems independent of professional help. Some couples, it seems, have chosen to consult a therapist as the "option of last resort" prior to initiating divorce proceedings.

There is a strong tendency on the part of many people to confuse fears, feelings, and facts. In therapy sessions, I often hear statements like the following: "I am definitely not going to get that promotion (raise, award, scholarship, etc.)" or "she is not going to want to go out with me again!" or "there is no way I will get that mortgage I applied for." Certainly, there may be validity to some of these assertions or beliefs, but I wonder why the optimism or hopefulness is missing when these individuals express themselves. Why are they not saying "I hope I get that promotion," or "I would like to think she'll go out with me again," etc.?

Rebecca, a new client in my psychotherapy practice, was a recent arrival to New York thanks to a company transfer. She was eager to begin dating and so indicated an intention to join several internet dating services to "get the ball rolling" on her social and romantic life in her new city. She also vowed to join two organizations as additional ways of meeting new people…especially men. After several sessions, I noticed that Rebecca had done nothing along these lines, despite her declared eagerness to do everything she said she would and more.

The terms ego-syntonic and ego-dystonic are part of my standard thinking vocabulary as a psychotherapist. I find them extremely useful in my work when evaluating a client for treatment and I have introduced these terms to clients on many occasions as one way of helping them to better understand themselves.

As a clinical social work psychotherapist, I am often asked a number of very understandable and meaningful questions by clients: “How exactly do people change?” “How will I know when I am really different?” Questions like these often provide an excellent opportunity to clarify the objectives of the treatment. This will help both clinician and client keep a sharp eye on the process so that the goal of eventual change is not lost.