"i was at this table in the bar," says the 20-something computer programmer. "there was this cute girl, and i think she might have been interested in me. my friend introduced us. but i was so self-conscious. i didn't know what to say. i talked about my work and where i live. i made some jokes, but i couldn't get them to come out right. and i'm not sure i like what i was wearing. i mean it was ok, but my shirt was kind of dorky. anyway, i need your help. how do i make sure i'm coming across well?"
how much of the time did you spend talking about her? "she talked some." what about? "she talked about work, too. maybe about her family." what did you find most interesting about what she said? "interesting? what do you mean?" just what i said, what was intriguing or impressive or fascinating about her? "i can't remember." i have a friend who likes to say, you'll never get laid that way. the young man laughs: "well, your friend is right about that night."
popular these days is the assertion that wrong thinking "causes" anxiety: substitute positive thoughts for those worries and doubts. it seems to me that humans exist simulaneously in the verbal and experiential realms. we think, we imagine, we emote, we express in our bodies, and we relate to others. none of these aspects is really primary, causing the others; there is only one whole person, viewed through different lenses. each modality can be construed as primary, to more or less powerful effect.
in the case of social anxiety, i prefer to face the problem head-on: there is a social problem? let's construe the situation socially, interpersonally. the patient is worried about how he looks or sounds? ok, now shift the locus of attention to see what we can say about the relationship. is it reciprocal? is there mutual interest? is it genuine? is it intimate? is there care or concern? to me he sounds insular and somewhat superficial. so what can the patient to be more caring, interested, intimate?
a woman tells me she's worried that she didn't show enough concern about a friend's miscarriage. what will her friend think of her now? in this case she's guilty, rather than socially anxious, but my prescription is similar: "it's not too late," i offer, "is it? what about calling her up and asking how she's feeling lately? is the miscarriage still on her mind? would she like to talk about it?"
in this case, guilt doesn't help either of them. she feels bad, and her friend suffers alone. if she shows concern, her friend will benefit and she will have something to be proud of. most likely her friend will feel appreciative and my patient will feel valued.
this is not simply education, but rather a way of life that takes practice. the young programmer brings the same scenario to me 10 times over the next 6 months. i am persistent, and keep telling him that i appreciate that he's self conscious, but i still challenge him to be genuinely interested in the women he meets. gradually, he warms to the idea. one day he reports, "you know that suggestion you gave me, ask her about the most exciting thing she's done in the last few months? i tried that on friday." what happened? "well, as a matter of fact, yeah." what did she talk about? "well, it seems she likes this band that nobody's heard of, and she went to this club to hear them, and she was really excited when she talked about them, and i'm like, whoa, that's amazing, i know that band, they're going to be in oakland next month, are you going, want to go together. and then we started talking about all sorts of other stuff. like her brother's had drug problems and - you know - my brother's been depressed and we're all worried about him, so we have that in common and...
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