Adele Cox, MA
April 2009

Many of our clients come to us seeking relief from stress-related concerns that are negatively impacting their quality of life. Stress is considered one of the most serious issues facing the health care industry today. The American Institute of Stress says that “stress-induced symptoms or diseases are responsible for 75-90 percent of visits to primary care physicians.” Furthermore, Inroads, a company specializing in stress management for business executives, states that “stress is estimated be a $300 billion profit killer in American business, resulting from issues including health care problems, substance abuse, workplace violence, and burnout.”

Consider Francis, a senior manager at an executive recruiting firm. Her daytime meals often consist of fresh fruit and energy drinks; she runs 15 to 20 miles per week; and while she is never without her iPhone®, she is usually rushing late to her meetings and appointments. She sets up a session with you, complaining of frequent headaches, sleeplessness, difficulty concentrating, and irregular digestion.

As a competent health practitioner and educator, you strive to help her create stress management processes that best fit her lifestyle. Depending on your therapeutic orientation, you might suggest weekly massage treatments, relaxation techniques, diet and nutrition changes, time management books, or herbal or aroma therapies.

But what happens when, months later, despite your sound ideas and Francis’ best efforts, her complaints have not changed? You may both feel disappointed, frustrated, and even ashamed, as if you’ve failed yourselves and each other.

Many clients and practitioners have encountered similar experiences; indeed, an entire industry has emerged dedicated to stress management. Then why so often are we stymied in finding effective stress management techniques, only to become, as one author observes, “stressed about being stressed”?

Perhaps the reason is not that we haven’t discovered the right solution, but rather that we are addressing the wrong problem.

Is Stress a Red Herring?

The American Institute of Stress concedes that “‘stress’ is not a useful term for scientists because it is such a highly subjective phenomenon that it defies definition.”

Recently, a small group of stress researchers have posited that its indefinable nature brings all of the accepted assumptions about ‘stress’ into question. Authors such as Morton C. Orman and Dr. Serge Doublet challenge the belief that ‘stress’ is the central problem we need to solve. (Most of these authors enclose the term stress in single quotes to emphasize its nebulous and intangible essence. In this article, when referring to stress from their perspective, their convention is used.)

In the webpage based on his book “The 14-Day Stress Cure”, Orman says that “‘stress’ is merely a word that we use to stand for hundreds of specific problems and conflicts we experience. Some of these problems exist outside our bodies, such as relationship conflicts and work-related pressures. Others occur inside our bodies, such as feeling tense, angry, worried, or depressed. Thus, whenever we say we are ‘suffering from stress,’ what we really mean is we are having problems or conflicts that are painful or troubling to us.”

These authors agree that people do experience uncomfortable physical symptoms and emotional reactions in relation to certain situations and events. However, they disagree with aggrandizing ‘stress’ as either the cause of those symptoms or the inevitable result of the events.

In his book, “The Stress Myth”, Doublet explains that without ‘stress’ as the key element in our experience, we have only the person or situation with which we are interacting, and our emotional reactions associated with that interaction. In his view, humans experience “negative emotional reactions” when our unconscious needs or expectations are unmet. Therefore, “the greater the emotional discomfort over time, the greater the likelihood it will start to adversely impact the person’s well-being.”

He cautions that focusing on ‘stress’ as the source of our discomfort distracts from both the true emotions and the actual source of the emotional reaction. So instead of finding ways to handle a ‘stressful’ situation, Doublet advises that we look inward to our perceptions, beliefs, and expectations about the situation to find the source of our emotional discomfort.

An Alternative Approach to ‘Stress’ Management

While their point of view may seem radical, these authors’ skepticism can paradoxically open the door to a more integral and transformative approach to helping our clients create the ease and efficiency they desire in their lives.

For example, Orman suggests, “Instead of asking ‘what can I do to cope with my stress?’ you should be asking yourself ‘what specific problems or conflicts are troubling me, and how can I deal with each of those problems effectively?’”

Let us now return to Francis. From this alternative perspective, we can wonder, without judgment or pathology, if Francis’ ‘stressful’ lifestyle might be covering perceptions, expectations, or emotional needs that, until now, have eluded her conscious awareness.

In her book, “Addicted to Stress”, Debbie Mandel describes several personas unconsciously created and fueled by “toxic feedback from the past.” For instance, she interprets the busyness of “The Great Performer” as “driven by the constant need to prove your self-worth, to show that you are a valuable person. You have built your reputation around the title of ‘doer’; you shine as a superwoman. The problem is that you can no longer separate who you are from what you do. If you fail at a task, you feel like a failure as a person because your tasks define you.”

Perhaps, as Mandel suggests, Francis has unwittingly enmeshed her self-identity with her job performance. Consequently, she may unconsciously believe that she must maintain her busy schedule in order to feel important, useful, and needed.

Or possibly, Francis may have difficulty in setting limits and saying no. This may explain why she invariably accepts more responsibilities than she can effectively fulfill. This pattern could be rooted in a fear of confrontation or rejection, or a disproportionate sense of obligation, or even a habitual need to please.

It’s important to remember that our clients’ ‘stressful’ lifestyles may also have an associated “positive emotional reaction” of which they are unaware. For instance, as noted earlier, Francis’ busyness may fill a need to feel valued. It may also address the human desire to feel connected to other people. Meeting with clients in person, serving on boards of directors, and maintaining her networking affiliations affords her the pleasure of connection through frequent face-to-face interactions with interesting, passionate people.

Regardless of the historical roots, these authors would agree that Francis’ unconscious beliefs and perceptions are the prime contributors to her complaints. They maintain that relief from her discomfort can best be found through her self-exploration and adjustment of her internal system, not through a menu of ‘stress management’ programs and techniques.

Use Good Judgment

This article is not advising you engage in psychotherapy or any practice that is outside your scope of competence. Furthermore, the suggestions in this article may not be appropriate for clients who are experiencing extreme emotional reactions that interfere with their daily functioning. In those cases, it is ethically appropriate for you to refer your clients to a competent mental or physical health professional for evaluation.


As practitioners it is important we recognize that our clients may be unconsciously managing much more than too much caffeine and an overactive Blackberry®. Our clients’ busyness (or lethargy), irritability (or passivity), physical pain (or numbness) may be serving as masks for their unconscious emotional pain. Mandel reminds us to “realize that it is easier to be incredibly busy than to deal with layers of grief accumulated during the course of a lifetime.”

For your clients who are looking for personal transformation over temporary relief, your commitment to see beyond ‘stress’ as their core issue may be a great gift in support of their path toward emotional clarity and authenticity.


Awareness is always the first step in changing the unconscious experience. Through self-observation, asking precise questions, and perhaps deeper exploration with a therapist, life coach, or spiritual teacher, our clients can gain new hope for creating more internal comfort in an uncomfortable world.

Using the alternative perspectives presented here, you may have an opportunity to help your clients look inside themselves for the source of their discomfort. These suggestions can help get you started.

Focus On Feelings, Not ‘Stress’

Instead of defaulting to the vague, catch-all term ‘stress’, remind your clients to keep their focus on their actual feelings. While we are not attempting to solve their underlying issues, we can alert them to the possibility that those issues exist, and support them in finding suitable methods to identify and address those issues appropriately.

Offer Self-Exploration Questions

Specific questions or examples can help your clients begin to navigate and define their internal experience. For example:

• How do I describe my emotional experience without using the word ‘stress’?

• Might I be feeling: powerless, conflicted, out of control; angry, frustrated, resentful; fearful, anxious, embarrassed; invisible or underappreciated; disconnected, guilty, saddened; etc.?

• What unconscious expectations, beliefs, or feelings might I have about this situation (or this person, or myself) that are contributing to my discomfort? How can I best attend and respond to those feelings?

• Is some part of my identity attached to ‘being stressed’?

• Am I attempting to fill a space or need within me through my ‘stressful’ lifestyle?

Through such a practice, ‘feeling stressed’ can become a stepping stone to connecting more closely with their true felt experience.

Notice Your Unconscious Motivations

Are you invested in your clients becoming free of ‘stress’? What emotional reaction do you have when your clients ask for your advice? Are you frustrated when “they don’t want to change” or “they won’t take better care of themselves”? Do you worry that “I’m not helping them”? Is it disheartening to see them suffering, yet do you fret that “if they’re not stressed, they won’t need me anymore”?

If we have unconscious agendas or other emotional gratification at work that is out of our awareness, we are using the power differential inherent in the therapist/client relationship irresponsibly. As professionals it is our ethical duty to monitor our “blind spots”, as we can only truly support our clients when we are clear in our own intentions. (If needed, seek consultation or mentoring from a trusted colleague or supervisor.)

Tips for ‘Chronic Stress’

Some of your clients may be interacting with home, work, or life situations with which they are experiencing frequent, on-going, or extreme “negative emotional reactions.” They may feel they must control, hide, repress, or deny their normal emotional experiences (such as shock, anger, grief, repulsion, sympathy, or sorrow) in order to function efficiently.

While it is easy and habitual to assume that the ‘stressful’ situations are responsible for producing ‘stress’, the alternative view presented here can help us educate our clients toward a respite from their emotional suffering.

For instance, they may be experiencing shame or self-judgment for feeling “weak” when their true emotions seep into their consciousness. They may even be harboring a secret wish that the situation would go away or did not ever exist.

But hiding from their true feelings only exacerbates their negative emotional experience. Not only can we validate their actual feelings, we can model the strength and maturity to tolerate the discomfort of feeling their true emotions. Finally, we can encourage them to find support to safely acknowledge and express their genuine emotional reactions.

Remember That We Are, After All, Human

Remind your clients that emotions, unconscious perceptions, and physical sensations are part of the human experience, even though many work and home environments prefer to function as if these human characteristics do not exist.

Even though ‘stress’ has become the acceptable term for expressing emotions, its vacuous definition does not allow us to sufficiently address the human experience underneath. Therefore, it may be a gift to your clients to remind them that their emotions are valid and real, and thus need and deserve to be attended to. You can educate them that ‘feeling stressed’ may simply be a cue that their emotions are trying to get their attention.