Janet,

I think that I have done a bad job of explaining my position and I hope it did not come across as atttacking you. It seems that you have done a great job with a difficult client. I know this because difficult clients tend to not stay in therapy if they are not satisfied. I can also tell that you really respect this client. What I also hear is that you feel stuck with this client. My intent on suggesting a different frame regarding the source of his anxiety was to try to free you from your current mindset. You know your client well and I am sure his anxiety stems from his childhood. However, it appears that he does not want to pursue this issue right now. One way that I overcome this issue is to develop a new hypothesis or pretend that there is some other reason for the anxiety and then this often leads to a new solution. However, even if you know that his childhood created the problem, can you just work on it in the here and now, giving him the resources he never got as a kid but needs now. That way you do not have to discuss his past when he does not want to go in that direction. Here are a few things that I am sure he missed given that he is anxious:
1. A sense of love
2. A sense of well being
3. A sense of comfort
4. A sense that he can handle difficult situations
5. A sense that he does not need to put himself down before others do
6. A sense of joy of living
7. A sense that he can look into the future and see himself
accomplishing his goals.

Can you give him these resources in the current context of his life so that a discussion of the past is not necessary. If you are able to do this then he might become less anxious in the moment. Just a thought and thanks for bringing such an interesting case to the forum.

John