The Bower Place Approach to Addressing Anxiety

In Knowledge Builder anxiety is explained as both an ‘inside’ neuro-biological issue and an ‘outside’ relational matter originating in and perpetuated by relationship. This paper describes a way of assessing and then intervening by exploration through the lens of the Bower Place Method. 

As in all matters, the crucial lens is politics which focuses attention on the inequalities in the system which perpetuates and enhances the difficulties. These are particularly played out around the issue of ‘ownership’ of the problem, who has the power to create a difference and who will take responsibility to ensure change occurs. Where these are not aligned and the person who has the power or authority to change will not take responsibility to effect this, a stalemate ensues, and the symptom will continue and likely escalate. The focus then becomes a struggle about this matter rather than addressing the anxiety itself. In doing so it is important that the person showing the symptoms is willing to take charge and do those things that will calm the overactive back brain and allow the problem-solving frontal lobes to be in charge. There is a well validated literature which addresses this and includes attention to sleep and exercise, management of alcohol and caffeine, relaxation, recognition and alteration of problematic self-talk and cognitive restructuring, facing feared situations and mindfulness.  

However, all this will be much more difficult and probably unsuccessful if the anxiety is triggered by current on-going interactions and those on the outside are unwilling or unable to recognize or change these patterns. Mapping the interaction and how this weaves from the inside to the outside and loops back for all parties is a powerful and objective way of making sense of the situation and helping everyone appreciate where lines of authority and responsibility should be drawn.  

This focusses attention on the meta-frame of time, past, present and future and the turning points and transitions which align with the development of the symptom. We know many anxiety disorders originate in childhood experiences of distress and trauma so sometimes this will become apparent as we enquire about current relationships and how they trigger the symptom. A simple question “Who else has said this to you in the past?” or “When your partner says this what does it mean to you?” and “Where do you think this meaning came from?” can begin to unravel a connection to old past relationships that justifiably caused anxiety. It may be that others who are part of the current pattern are doing nothing objectively frightening or unreasonable but their willingness to adapt their reactions without taking responsibility for being the cause of the anxiety is a kind and supportive position. In return the symptom bearer than has an obligation to actively disentangle their reaction and be overtly appreciative of the help. 

In unpacking the exchanges which trigger anxiety it may be clear that the conduct of a person in the system is threatening and distressing and responding with anxiety is not unreasonable. In this case the conversation will include the necessity for this to be addressed and may transform the therapy from individually focused on the symptom to the relationship. In each case it is critical that if lasting change is to occur each person is clear about their responsibility, that they are capable of meeting it and takes active steps are taken to ensure this happens. 

The development meta-frame focusses on the age and stage of the individual and aspects of their physical being that may exacerbate anxiety or make it more challenging to manage. This may include an intellectual disability, a genetic disorder or physical limitations that make life harder. It also attends to the developmental life stage of the family for, as with the individual, different family life stages can be more challenging and anxiety provoking than others. 

For some clients the separation between their inside anxious experience and outside events which may be a trigger, is so strong that they have no cognizance of the relationship between the two. This is particularly the case for those whose anxiety is connected to childhood experiences of abuse and neglect who have powerfully dissociated form the past as a way of managing these memories. Without access to this information events which trigger distress appear crazy or excessive leading to a belief that the pathology sits within the person and must be addressed here. This does not mean that they cannot benefit from well validated approaches to the management of anxiety like relaxation, exercise, alcohol management, mindfulness and cognitive restructuring but this is not enough. Without a clear conduit between the inside world of feeling and memory and the outside world of experience which touches these nerves, the person is deprived of information. Information lies in difference and disconnection prevents apprehension of difference. 

Sometimes the place to begin is to help the person begin to differentiate feeling anxious from not feeling anxious, to help them better read themselves. A task where they are asked to stop, note their level of anxiety from 0-10 on a regular basis and ask themselves the question “What has been happening around me to give me this score?” can be very revealing. Without having to labour the point the client begins to see that the outside world is critical to both generating and relieving anxiety and perhaps it is not “All in my head”. Information derived from this task can then become the basis for exploring things that need to be removed, both inside and out that will begin to make a difference.