The Therapy FAD? Rethinking our Feelings, Anxiety and Defences Across Modalities
This article is intended for therapists and clinicians working in intensive, experiential, or ISTDP-informed depth therapy.
Many emotional struggles follow a similar human sequence: feelings trigger anxiety, and anxiety mobilises defences.
The “Therapy FAD” reframes this as a survival process rather than pathology. When therapists learn to read defences as signals of unprocessed feeling and memories of adaptation, and when we regulate anxiety rather than chase thoughts, therapy becomes a space for transformation rather than entrenched resistance.
Image reflecting curiosity in therapy.
Introduction
In just over 3 years of clinical work through BetterHelp, I’ve worked with a significant range of clients and here's something we, as therapists, may often overlook: when our clients defend, they are not avoiding something arbitrary or abstract. They are actively handling overwhelming feelings, right here, right now.
We may further overlook that our clients allow us to practice, and our most consistent, difficult task as therapists is reading what's really going on in a session, moment to moment.
Inviting greater emotional closeness often increases anxiety. The more we understand what’s being defended against, the more effective and compassionate we can be towards our client, and the more opportunity we have to co-create an alliance with our client for real change, instead of creating an alliance with their defences! regardless of our therapeutic orientation.
The Survival Sequence
Whether you work psychodynamically, somatically, cognitively, or relationally, the survival sequence applies:
Feelings → Anxiety → Defence.
This reflects psychological survival rather than dysfunction. But paradoxically, it keeps us in a state of psychological dis-ease. I refer to this as the Therapy FAD.
[F] Feelings vs Emotions: A Crucial Distinction
Emotions are somatic, biological, automatic, and above all, universal. The widely accepted “Big Six” primary emotions are: happiness, sadness, fear, surprise, anger, and disgust (Ekman, 1992).
Feelings, by contrast, are the conscious interpretation of our emotions, shaped by personal history, relationships, and culture.
Fear (emotion) might manifest as shame (feeling) in someone ridiculed for being vulnerable in childhood.
Anger (emotion) might appear as guilt (feeling) in someone taught never to express pain.
When a painful feeling arises, anxiety mobilises, and we deploy a defence to avoid it. As therapists, how often do we ask “How do you feel towards…?” and get a thought in response? That’s a defence, perpetuated by anxiety, protecting against what’s harder to feel.
[A] Anxiety Is Not a Thought: Another Crucial Distinction
Although many clients enter therapy with “anxious thoughts,” anxiety itself is not a thought; it’s a bodily state.
Anxiety is visceral: tight chest, shallow breath, nausea, racing heart, the sinking feeling.
We may think our way around it:..
“What if I fail?”
“What if I’m not enough?”
When we shift focus from anxious thinking to anxious feeling, we begin to work with the root system of the experience, not just the branches. That is often where the therapeutic alliance deepens, as attention shifts toward the client rather than their defence.
[D] Defences Are How We Handle Feelings
In The Ego and the Mechanisms of Defence (1936), Anna Freud described defences not as pathology, but as essential psychological tools. Defences protect the ego from being overwhelmed. But if we only see them as resistance, we miss their meaning.
Denial, repression, rationalisation, and projection, all of these are emotional strategies. Even when they look cognitive or behavioural, there are feelings underneath. Defences aren’t blocks to therapy; they’re the starting point.
Reframing Defences as Engagement
When a client is avoidant, detached, or overly rational, what are we really seeing? Not avoidance of therapy, but an attempt to manage unbearable feelings.
“Do you notice how you shifted topics just then?”
“What did you notice feeling just then?”
These interventions bring the defence into question, not the person, separating the client from their problem. This creates space for curiosity, compassion, and emotional safety.
A Universal Human Pattern
No matter the modality, the same pattern repeats:
Feeling → Anxiety → Defence
This isn’t dysfunction, it’s human nature. And when we see it clearly, we can meet our clients where they truly are.
From psychodynamic to behavioural therapy, this pattern transcends theory. Recognising it turns pathology into understanding, and understanding into transformation.
Transformation in Practice
So much of therapy is about creating the conditions for feelings to become tolerable.
Defences, feelings, and embodied emotional states are linked processes that therapy helps to integrate.
That’s the Therapy FAD:
F – Feelings are waiting to be felt
A – Anxiety isn’t a thought
D – Defences are how we handle our feelings
If this reflection resonated, you might explore:
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References
Ekman, P. (1992). An argument for basic emotions. Cognition and Emotion, 6(3–4), 169–200.
Freud, S. (1923). The Ego and the Id. London: Hogarth Press.
Freud, A. (1936). The Ego and the Mechanisms of Defence. London: Hogarth Press & Institute of Psychoanalysis.
About the Author
Rick is a UK-based Psychodynamic Psychotherapist and BetterHelp Brand Ambassador.
He focuses on emotional regulation, unconscious dynamics, and co-creating therapeutic relationships for lasting change.
Rick works with emotional regulation, unconscious dynamics, and therapeutic process in both client and clinician development.
FAQ: Understanding the Therapy FAD
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FAD stands for Feelings, Anxiety, and Defences, the universal sequence behind how we all respond to emotional stress.
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It’s not a new modality, but a unifying lens. It helps therapists and clients alike recognise how emotion, anxiety, and defence interact in any therapeutic setting.
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Because anxiety is the body’s signal that emotion is rising. It’s the bridge between feeling and defence, and the key to change.
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Noticing how you avoid feelings (defence) and what happens in your body when emotion surfaces (anxiety) helps you move from avoidance to understanding.
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No, the FAD sequence shows up across all modalities, from CBT to somatic work. It’s simply human nature observed through a therapeutic lens.
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To transform avoidance into awareness, feeling becomes tolerable, anxiety becomes information, and defences become choices rather than automatic reactions.
Acknowledgements
Glynis van der Hoek, Liza Chera, and Jon Frederickson, whose insight and guidance helped shape my practice. BetterHelp for welcoming me into their Brand Ambassador Programme.
Written by Rick Cox, MBACP (Accred)
Psychodynamic Psychotherapist, UK & Online
