In-office exposure therapy for socially anxious clients

By Jennifer Shannon, LMFT

One of the most common fears socially anxious clients have is of making mistakes. Social perfectionists do not allow themselves to make the sort of common human errors the rest of us do, and this both causes and maintains their anxiety. By trying to live up to a perfect standard in social situations, these clients have unrealistic expectations of themselves.  

The social perfectionist has a tough time asking questions because he is afraid he may sound stupid. Exposures designed to test whether he really does sound stupid often fail because no matter what he says, or what others tell him, it sounds stupid to him. It is often more effective to expose this client to his core fears. I call this exposure “asking stupid questions.”

A great example of the “asking stupid questions” exposure is calling retail stores. Because your client may also feel anxious using the phone, you may be killing two birds with one stone. Here are some ideas:

• Call a pet store and ask if they sell pet food, pet supplies, or pets.

• Call a department store and ask if they sell clothes.

• Call an appliance store and ask if they sell appliances.

• Call a book store and ask if they sell books.

You get the idea. Sometimes just calling for store hours may be perceived by your client as a stupid question. As with any intervention you and your client come up with, you want to make sure to have made a hierarchy of feared situations he is working on and a clear rationale for each exposure. With each stupid question, your client is learning to cope with the negative judgments of others, which reinforces resilience as opposed to avoidance.

Jennifer Shannon, LMFT is clinical director and cofounder of the Santa Rosa Center for Cognitive-Behavioral Therapy in Santa Rosa, CA. She is the author of The Shyness and Social Anxiety Workbook for Teens and the upcoming Anxiety Survival Guide for Teens, out August 2015.

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