Capacity Is the Work: Why Therapy Is Not About Eliminating Anxiety
There is a persistent misunderstanding about therapy.
People often arrive hoping to remove something. Anxiety. Shame. Anger. Panic. Self-doubt. The goal is framed as relief, coping strategies, tips, tools, hacks. Although relief matters, it is not the primary task.
The underlying task is capacity.
Capacity does not remove the water. It strengthens what holds.
What Capacity Actually Means
Capacity is the ability to remain present with an internal experience without automatically moving to escape it.
That experience might be:
Rising anxiety
Grief
Anger toward someone important
Guilt
Longing
Relational tension
Uncertainty
Capacity is not about suppressing these states. It is not about analysing them from a distance. It is not about managing them with strategies alone.
It is ‘simply’ about being able to stay.
Long enough for the nervous system to reorganise.
Long enough for meaning to emerge naturally.
Long enough for choice to become possible.
Without capacity, insight collapses under pressure.
Why Anxiety Becomes the Central Arena
In dynamic therapies, including approaches such as ISTDP, anxiety is not treated as the enemy.
Anxiety signals proximity to something emotionally significant. The problem is rarely the presence of anxiety. The problem is what happens next.
For many people, rising affect triggers automatic protective moves:
Intellectualising
Humour
Deflection
Self-criticism
Reassurance seeking
Dissociation
Relational withdrawal
These defences are not flaws. They were once adaptive. They reduced overwhelm when overwhelm could not be physically experienced and integrated.
But when they activate reflexively in adult life, they narrow experience. They reduce choice. They limit intimacy. They restrict growth.
Capacity building means increasing the threshold at which these automatic moves take over.
Insight Without Capacity
Insight is often overvalued.
Someone can understand their attachment pattern. They can articulate childhood dynamics. They can describe how they sabotage relationships.
Yet in the moment of emotional activation, the same sequence repeats.
Why?
Because understanding does not automatically increase tolerance.
If anxiety spikes beyond what the nervous system can regulate, cognition narrows. Reflection collapses. The old defence resumes control.
Therapy that prioritises capacity recognises this structural reality.
Before deep interpretation, before symbolic integration, before narrative coherence, the system must be able to remain in contact with affect.
Otherwise therapy becomes an intellectual exercise performed above the body.
What Capacity Building Looks Like in Practice
It is usually slower than people expect.
It might involve:
Tracking anxiety in the body
Noticing the exact moment experience begins to tip
Interrupting defensive speed
Clarifying feelings in small, tolerable doses
Returning repeatedly to what is happening now
The work is often deceptively simple.
A client says, “I’m fine.”
The therapist might ask what “fine” means, and then wait.
In that pause, something often appears. A tightening in the chest. A surge of irritation. A flicker of sadness. A moment of confusion.
Staying with that, rather than moving away from it, is the work. Over time, the nervous system learns that strong affect does not automatically equal catastrophe.
That learning cannot be rushed because it accumulates.
Why Capacity Precedes Breakthrough
Breakthrough moments tend to receive attention. Emotional release. Clear insight. A decisive shift.
But those moments rest on many quieter repetitions.
Each time someone stays with an uncomfortable internal state without collapsing into avoidance, structural change occurs. Small increases in tolerance compound. Eventually, what once felt unmanageable becomes workable.
The person does not become anxiety-free; they become anxiety-capable.
The Broader Implication
Capacity building changes more than symptom levels.
It affects:
Relationship stability
Conflict tolerance
Decision-making under pressure
Creative risk
Boundary setting
The ability to face grief and loss
Life does not become simpler, but it becomes less governed by automatic retreat.
A Different Question
Instead of asking
“How do I get rid of this feeling?”
Therapy gradually shifts the question toward:
“How much of this can I stay with?”
That shift alters everything. Because when you can remain present with difficult internal states, you are no longer organised around avoidance.
You are organised around choice.
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FAQ: Capacity Building in Therapy, Anxiety and Emotional Tolerance
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Therapy often reduces anxiety over time, but that is not the primary mechanism of change. The core task is increasing a person’s capacity to experience anxiety without becoming overwhelmed or avoidant. As tolerance expands, defensive reactions decrease naturally. Symptom relief tends to follow structural change.
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Capacity building refers to strengthening a person’s ability to remain present with difficult emotions, bodily sensations, and relational tension without automatically moving to escape them. This involves increasing tolerance for anxiety, grief, anger, shame, and uncertainty so that reflection and choice remain available under pressure.
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Insight can clarify patterns, but it does not automatically increase emotional tolerance. When anxiety rises beyond a person’s regulatory threshold, reflection narrows and old defensive strategies resume control. Sustainable change requires expanding the nervous system’s ability to stay with affect, rather than just understanding it intellectually.
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Capacity is built gradually. This often involves slowing the process, tracking anxiety in the body, identifying defensive shifts as they occur, and working with feelings in tolerable doses. Repeated experiences of staying present with manageable levels of affect allow the system to reorganise over time.
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No. Anxiety is a normal and necessary signal within the nervous system. The aim of therapy is not elimination but regulation. When a person can tolerate and process anxiety without automatic avoidance, it becomes information rather than threat.
Written by Rick Cox, MBACP (Accred)
Psychodynamic Psychotherapist, UK & Online
