I learned early on that people will tend to present in therapy because of something that has transpired fairly recently. We enter into the therapy sessions with a fairly narrow view of what actually brought us to counseling. I find that many times the answer to the small details may actually be found in asking big picture questions, such as what do you believe about your purpose? What do you believe about what marriage is?
Many forms of anxiety are connected to existential issues and I use a top-down approach to make sure we don’t miss any of the root causes that often live up at the 30,000 foot level. I had a patient that told me “I have an alcohol problem” to which I said “well, alcohol is symptom of a much deeper issue and it’s not helping you, but it’s not your big problem”. This person, through tragedy and loss, had begun to distrust and even doubt the God that she was brought up to believe in. No wonder she wanted to numb herself from life. We got her to see that she needed to address these big-picture beliefs if she really wanted to move forward.