Avoidance in Therapy: How to Name It and Move It
By Kristen McClure, MSW, LCSW | TherapistWorksheet.com
Avoidance is the mechanism that maintains almost every anxiety disorder and many depressive presentations. It is also one of the most common dynamics you will encounter in the therapy room — including, sometimes, avoidance of the therapy itself. Understanding how to name and work with avoidance is a core clinical skill.
Why Avoidance Persists
Avoidance works. In the short term, it reduces distress reliably. When someone avoids a feared situation, they feel better immediately — which negatively reinforces the avoidance behavior. The problem: every act of avoidance prevents the nervous system from learning that the feared outcome either will not happen or is manageable. The fear grows.
This is the maintenance cycle of anxiety: perceived threat → avoidance → short-term relief → increased sensitivity to the threat → more avoidance.
Types of Avoidance
Situational avoidance
Avoiding specific external situations — social events, places, activities, certain people.
Experiential avoidance
Avoiding internal experiences — feelings, thoughts, memories, bodily sensations. This is the target of ACT’s acceptance work. “I don’t let myself feel sad” is experiential avoidance.
Cognitive avoidance
Distraction, thought suppression, worry (as a form of avoidance of uncertainty or imagery), rumination. Yes — worry is often a form of cognitive avoidance.
Safety behaviors
Actions taken to prevent feared outcomes that prevent corrective learning — checking, reassurance-seeking, over-preparing, having an exit plan, clutching a phone, sitting near the door. Safety behaviors maintain anxiety even when the person technically approaches the feared situation.
Avoidance in the therapy room
Topic-switching, intellectualizing, arriving late, missing sessions, answering questions with questions, excessive joking, and a hundred other small moves that steer away from difficult material.
How to Name Avoidance Without Creating Shame
Naming avoidance directly — “You’re avoiding this” — usually triggers defensiveness or shame. A more effective approach:
Get curious about the pattern
“I notice we tend to move away from [topic] pretty quickly. I’m curious what happens when we get near it. What’s that like for you?”
Name the function
“It sounds like [behavior] has been a way of creating some distance from [difficult feeling]. That makes a lot of sense — it has probably worked. Can we also look at what it might be costing?”
Invite the approach
“I wonder what would happen if we got a little closer to [thing being avoided], just a little, and noticed what comes up. You don’t have to jump in — we can take it slowly.”
Working with Avoidance: Clinical Approaches
Exposure (CBT/ERP)
For situational and cognitive avoidance, exposure — approaching the feared situation in a graduated hierarchy — is the most evidence-supported intervention. The key is staying with the feared situation long enough for habituation and new learning to occur, without using safety behaviors.
Acceptance (ACT)
For experiential avoidance, ACT’s acceptance work targets the struggle with internal experience. The goal is not to make difficult feelings go away but to change the relationship to them — making room without being overwhelmed.
Behavioral activation (CBT for depression)
For the avoidance that drives and maintains depression, behavioral activation targets the withdrawal and inactivity that reduce positive reinforcement. Small, planned activities — not waiting to feel better first — interrupt the avoidance cycle.
Addressing avoidance in the room
When avoidance is happening in session — the topic-switching, the humor, the head-turning — naming it in the relationship and inviting approach is the intervention. “We just moved away from something important. Can we come back to it?”
Frequently Asked Questions
Is all avoidance pathological?
No. Some avoidance is adaptive — not every feared situation warrants approach. The clinical question is whether avoidance is limiting the client’s ability to live according to their values, maintaining distress, or narrowing their life. Avoidance of a genuinely dangerous situation is appropriate.
What about avoidance of trauma memories — is exposure always indicated?
Not always and not without careful assessment. Exposure for PTSD (prolonged exposure) requires adequate stabilization, a solid therapeutic relationship, and appropriate client readiness. Premature exposure can retraumatize. Consult and refer appropriately.
How do I address avoidance when a client does not see it as a problem?
Explore the cost rather than the label. “I’m curious — what would your life look like if [the avoided thing] were not an obstacle? What would be possible that isn’t now?” When the client sees the gap between their current life and their values, the cost of avoidance becomes visible.
Can I be too direct about naming avoidance?
Yes. Confronting avoidance without sufficient alliance tends to produce withdrawal or defensiveness. The relational context matters as much as the clinical accuracy. Build the relationship first, then name the pattern from a place of genuine curiosity and care.
Kristen McClure, MSW, LCSW is a licensed therapist who creates practical clinical tools to help therapists navigate the hardest moments in their work.