Fear of Success: Helping Clients Prepare for this ‘Surprise’ Threat to Recovery

There is a small group of clients who will be particularly vulnerable to relapse at key points in their treatment and recovery – and those points appear most closely linked to success.  I have seen many clients participate well and wholeheartedly in treatment over extended periods of time, only to become anxious before completion, leading to a relapse.  While this can be a result of multiple factors, there is a group that clearly struggles with anxiety about successful transitions. 

WHY WOULD SUCCESS BE SCARY?

On the surface, it seems counterintuitive that success would generate so much anxiety that people who relapse.  It is actually not difficult to understand, and most of us can recognize this as a common occurrence. 

Successful progression in recovery, whether it is completing a challenging clinical program, or moving toward a more independent level of functioning, involves different types of risk for the client.  -

-Completing a program or moving ahead in recovery is something different than what the client has experienced in some time.  That newness may produce anxiety simply because it is different. 

- Success can create anxiety by representing something that the client can lose.  The higher they climb in their recovery, the longer they have to fall if they fail to maintain it.  Our clients have all had some form of fall in the past – and for most it was a very painful experience.  At a deep level, many will feel tempted to continue to fail instead of risk success that they imagine could lead to another painful fall.

-Similarly, their success could raise the hopes and expectations of other people in their lives, including spouses, parents, children and friends.  Past troubles that led family and friends to feel disappointment in the client are particularly painful.  Clients often want to avoid anything that could risk that happening again.

-Some clients and their families have actually gotten used to the client having the mental illness and the associated problem with functioning.  Family often have reorganized how they work together to adapt to the client’s illness.   While successful recovery may be wonderful, it also involves the client and the family reorganizing again.  This may create disincentives for change for some clients and some families.

-Disability income and other formal supports that people can accrue while they are ill, can be lost if the person recovers. Other forms of care and practical assistance can also be lost.  These can be conscious or unconscious disincentives for success.

- Most clients have developed their own “theories” about why they struggled so much during their illness.  While healthcare providers know that the symptoms are the primary factors causing the struggles, clients often have developed their own ideas about the cause.  I’ve seen many clients who know that they have a mental illness, but who also believe that they’ve had difficulties because of the following theories:

“I’m an incompetent person”

“I’m a lazy/unmotivated person”

“I’m not a bright person”

“I have a flawed or weak character”

“I don’t deserve to do well because of…..”

Successful recovery challenges these theories and forces the client to reconsider what they’ve been telling themselves.  For some, their own theories will undermine their efforts to recover. 

STRATEGIES

You’ll want to be alert for the challenge some clients face related to their anxiety about success.  There are several strategies that can help, if implemented early.  These include:

1.      Education of the client, their family and even other providers.  Anxiety about success often catches people by surprise.  You can inoculate clients and their families against this barrier simply by alerting them to it early in treatment and reminding them of it repeatedly.  They may need an explanation to understand why it is real (“Why would I be afraid to succeed?”), but those explanations and your assurance that it does happen for some clients, will give them the alert they need to prepare.

 2.     Target high risk times and add supports.  Given that anxiety about success is highest near completion of treatment, and at other points where progress is made public or is very evident, it is fairly easy to identify the points in treatment that represent the greatest risk.  You and your team can be alert at those points for signs of anxiety.  You can also add supports at those points, seeking to help clients manage the increase in anxiety without relapsing.

 3.     It is about hope – build hope with input from other peer support specialists.  Anxiety is always about something negative happening.  Some clients are anxious that “successful recovery” will result in something bad.  You can help them build hope that successful recovery is usually going to be positive.  As a Peer Support Specialist, you can use recovery stories and connections with other peers in recovery to show your clients concrete evidence that successful treatment is going to result in positive things for them, and that they can overcome any negative experiences without relapsing.

 4.     Respect the complexity – consider a referral for psychotherapy.  The reason that anxiety about success is a significant barrier is because it is often ignored.  Clinicians and clients feel that   people simply feel positive about completing treatment and recovery.  Respecting the complexity of how people feel about recovery and treatment will allow you to be appropriately vigilant for this important challenge.