Is this normal in therapy?

[tiredbuttried]

Young adult step daughter is having therapy.

She says therapist is telling her to write things down wishing terrible things are going to happen, like my sibling will get seriously ill or my neighbour is going to die.
dc has been ill (just tummy bug) and DSD has been an absolute mess over it and to me just seems a lot more anxious and to be struggling more than she was before she started the therapy.

I can’t see how this can be at all helpful to anyone and seems pretty sick given it’s just causing DSD more distress but I’ve never had therapy and don’t know how it works.

is this normal, is it supposed to be helpful?

Context matters, and you won't have access to all of it, but yes, he could be getting her to test some theories about some beliefs she holds. Whether he's good at his job is another matter, but it's not an uncommon method.

yes it’s normal to feel worse before you start feeling better - someone once said to me it’s like opening a messy sock drawer and emptying it in the floor, then pairing up the socks and putting them back bit by bit. It’s like that with the mind - you have to take out the thoughts, look at them, get to know them, and put them back in better order. So feels like chaos and everything up in the air to begin with, then it starts to feel better over time. Other people describe it like a stock market graph - lots of ups and downs along the way, but a general upward trend.

If it’s her own thoughts the therapist is asking her to write down, yes that’s normal - it’s part of taking the socks out of the drawer and getting acquainted with them.

It’s a female therapist and that is what DSD says they’re doing ‘belief experiments’
but when the bad things she’s wishing for could actually happen like sibling getting ill she now thinks she is responsible and is terrified other things are going to happen. She’s never reacted this way before when dc have been ill.

I’m glad it seems to be normal.
she’s been having the therapy for 6+months though so a long period of feeling worse before she starts feeling better.

It's called exposure therapy. The idea is that you get to go through the feared thought or deed without the imagined consequence materialising, so you gradually build a model of the world without that fear, and therapy is intended to be a safe environment in which to do it.

However, it might get a bit complicated if the example is "Imagine your stepsibling getting seriously ill" and SS then gets mildly (I presume) ill — presumably the idea was to think of something less likely, such as "getting leukaemia" or "being hit by a car".

One of the weaknesses of these cognitively-based therapies is that they tend to assume a degree of rationality that may not always be present. For example, if your DSD is genuinely imagining that her thoughts can make your DC ill, it might not be a huge step to think that her "seriously" and DC's "mildly" are the same. But hopefully this will come out next time they talk. Maybe the therapist could assign something a bit more far-fetched ("I want Wayne Rooney to die") — if DSD says "But obviously that won't happen", that could be the start of some insight.

It would be normal if she has OCD
It is a way to challenge thought: action fusion ie to learn that saying something or thinking something does not make it happen.

These “things she is wishing for” are they intrusive thoughts your DSD is having or is the therapist asking her to wish ill upon people.

I think your use of the word wishing is a bit odd? Do you mean imagine? Or does she want those bad things to happen?

She has anxiety. She did mention OCD when she started but was told she didnt have it as her fears weren’t focused on a specific area

From talking to dsd the other night, she definitely doesn’t want these things to happen
Her anxiety is very general, just a feeling something is going to go wrong and the problem is that she doesn’t like to think/ talk /read or write about bad things happening because she feels like that will make them more likely to happen so won’t talk about death or car crashes.

therapist is encouraging her to think about what’s she’s worried could happen and then wish they do, I guess to prove she didn’t make them happen but what If they do? Like dc getting ill

That is thought/ action fusion or magical thinking and the way the therapist is tackling it is standard but as pp has said might need some tweaking so that the imagined events are more unlikely. I know someone who carries around a note in his pocket saying ‘my child will die of cancer’ on the advice of his therapist and has to read it out a number of times a day. It’s very much helped him to see that thinking it does not make it happen where previously he did a lot of OCD rituals to neutralise thoughts like that and was preoccupied with it all day. Therapy for anxiety disorders does involve challenging established thought patterns and this is difficult and often appears worse before it’s better.

oh my god

this sounds like a dreadful way to tackle anxiety

who are these people?! The mind boggles.

@samarrange exposure is a behavioral approach, not a cognitive one.

In exposure, the therapist will need to exposure someone to their feared situation in a graded hierarchy and needs to induce some anxiety for habituation to take place. A good behavioral experiment (which is a cognitive intervention) will be designed in a way to test out the prediction around what will happen. Some experiments are testing that people can cope even if their prediction does come true.
Therapy for anxiety disorders is hard, but it works. @EmeraldRoulette‘these people’ are (or at least should be) trained professionals who use evidence based methods in a compassionate and empathetic way to help people overcome problems that have a huge impact on their life.
@tiredbuttried the therapist should be saying exactly why the intervention is what it is, so your step daughter knows why she has been asked to do this. If she’s not sure, she can ask the therapist. It should all be linked to her formulation. As @FloraBotticellisaid, unfortunately people can feel worse before they feel better. I hope your step daughter starts to feel the benefit of therapy soon.

@AreYouShittingMe suffered debilitating anxiety for years. Doctor wanted me to try therapy for ages (in the days there wasn't so many of us). Glad I didn't.

but no need to tell me that anxiety has a huge impact on life. I wish the best for @tiredbuttried DD 💐

Hi - the treatment they are using sounds like Exposure response prevention- and is the gold standard treatment for OCD

or it may be that the therapist is using a behavioural experiment approach to worry thoughts

often people don’t expect treatment for anxiety disorders to be so hard / challenging

there is myths about just needing some support, or some generic counselling approach

make sure not to undermine her therapy
the nature of anxiety is to avoid
so make sure you don’t inadvertently give her permission to not do these strange techniques as there will be a strong evidence base behind these unpalatable skills

I can understand the theory behind it, it just seems like a bit of a risky game that isn’t always going to work.

What if she writes down our neighbour dies and he does? He’s quite old and will at some point. Even if she wrote it down last week and he dies next year shes still going to feel like it’s her fault.

Surely a better approach is to say yes he will die but reassure her that’s ok and not her fault.
Not let’s write down we hope he does and see if that kills him.
what if dc had to go into hospital and she’d wished they got seriously ill?

With respect, you don’t understand the theory behind the treatment, you are using logic that would work on a non anxiety disordered brain
anxiety disorders require an evidence based treatment that is often very challenging-
if reassurance worked, she would not have her anxiety disorder
be careful not to undermine her treatment - it is difficult enough without you sabotaging

i agree with PP. reassurance is actually a maintaining factor for anxiety disorders. The approach you are suggesting would make it worse. People with anxiety disorders over estimate threat and risk. When they seek and are given reassurance about their worries it actually confirms that it was worth worrying about plus it only ever works for a very short time and then they start to worry again. Seeking reassurance from others means they don’t practice dealing with the anxiety on their own and promotes the idea that they can’t. I explicitly do not reassure my clients when they ask me to and I explain why. Living with uncertainty is a life skill that a lot of people find hard.

The idea is to choose something that isn’t very likely to happen. She will have been asked to estimate how likely a thing is to happen and people with anxiety disorders will overestimate this and say it’s 100% or close to that when the real chances are 1 or 2%.

If an exposure task hasn’t worked and she feels it made things worse it may just have been the wrong task but it doesn’t mean the overall approach is wrong. Please ask her to discuss it with her therapist next session and I am sure they can tweak it but don’t undermine her trust in them or the approach. CBT is a very tried and tested treatment for anxiety which is effective if done properly and followed through with.

You may share some similar anxiety patterns op. I have experience of that scenario. It can be worked with too. And there are plans in place for the event of the therapist's death. The point isn't to learn that deaths don't happen. It's too learn that thinking doesn't make it so.

Is the therapist well qualified?

This is one of the weaknesses of CBT type therapies. The task could have been set up slightly differently but the therapist will hopefully help her explore and dismantle her beliefs that she has caused the illness.

The problem with cognitive therapies is that they don't recognise that we are only partly rational beings!

Writing it down doesn’t make it any more likely to happen than keeping it in her head. It means it’s in black and white and can be used to ‘challenge’ these thoughts.

how it she framing it

’i wand ndn to die’
or
’ndn dies’