Therapist: What else have you tried to do?
Client: Well,sometimes I try to talk myself out of it. I say, "This is silly, you are making a mountain out of a molehill."
T：In other words, criticize and chastise yourself. And the purpose of this criticism...?
C: To get me to stop it.
T: To get yourself to change-to stop worrying.
C: Yeah... The things I worry about are silly. I mean some of the things that come into my mind are just nuts.
T: And the idea is that if you could get rid of those worries-those thoughts-then the anxiety would be less and you'd be able to face your daily situation better.
C: Right, but it is pretty hard to convince myself to stop it, so sometimes it works but sometimes it doesn't.
T: So if you could just convince yourself that you don't need to worry, then it would work and things would start moving ahead. OK. So far we've got criticism, chastising, and attempts to convince yourself to stop. What else have you tried?
T: And this. Coming in here. Is it part of that effort to change how bad you feel as well?
C: Of course. I'm not sure what I will get out of this really, but if I could feel even a little better about myself, it would be worth it.
T: So you're hoping to remove some of the bad feelings and get more good feelings because then you would be able to move on.
C: (Pause) I guess so.
T: So this is another thing to try. Good. So let's add this therapy to the list. It is another thing you've done to feel better.
C: I've tried almost everything I know to feel better.
T: I'm sure you have. You have indeed. And this-therapy-is yet another attempt.
C: You say it as though there is an alternative.
T: Well. I don't know. Right now I just want to be clear about what you have tried and how it has worked.
C: Right, but it is pretty hard to convince myself of it, so sometimes it works but sometiems it doesn't.
T: So if you could just convince yourself, then it would work. OK. Let me ask you this. Your mind says that when you convince yourself that your concerns are silly, you will stop having those concerns, you will become less anxious, and then you will do better. Right?
T: OK. And dose that work? What does your experience tell you?
C: Sometimes. But I can't always talk myself out of them.
T: And even when it does work, if we expand the time frame a bit, would you say that over time, as you've followed the rules your mind has laid out for you, that your concerns overall are less or more?
C: ...Overall it is more.
T: That seems like a paradox, doesn't it? I mean, you do what your mind says, sometimes it even seems to work, and then somehow it seems as though the concerns and worries are getting bigger, no smaller. They are more important, not less.
C: So what should I do?
T: What does your mind tell you to do?
C: Try harder.
T: Interesting. And have you tried harder?
C: And harder and harder.
T: And how has that worked? Has it paid off in a long-term or fundamental way, so that by doing it you have transformed the situation and it is no longer a problem? Or are you, unbelievably enough, sinking in deeper as you try harder and harder?
C: ... I'm sinking in deeper.