I bet I’m the only therapist here.
The realization struck as the line grew behind me on an Upper East Side sidewalk. Glancing around, I felt out of place among the teens and tweens clutching flowers and gifts for their favorite Broadway star. I should have expected them; my own theater-loving teen client had asked me to say hi to Phillipa Soo for her.
Soo, who originated the role of Eliza Hamilton in the hit musical Hamilton, was on tour to promote Piper Chen Sings, a children’s book based on her own experience of performance anxiety as a child. When the book’s cover scrolled by on my Instagram feed, the whimsical drawing of a young girl belting into a hairbrush mic drew me in. I bought a ticket for the launch event hoping Soo might offer insights for my work beyond what I’d get from a clinical training.
I specialize in using exposure response prevention (ERP) to treat anxiety and obsessive-compulsive disorder (OCD). On any given day in my office, a client and I might watch a video of a blood draw to tackle a phobia of needles; or someone with superstitious fears may repeatedly write, “I will have a heart attack,” tempting fate to make it come true and learning that they can tolerate risk in the process.
***
“Have you seen Hamilton?”
Of course I hadn’t. I’m late or absent from most cultural phenomena. My own therapist asked me that question in 2023, eight years after the musical debuted.
“There’s this song about never being satisfied. You should look it up. That’s you. You’re never satisfied.”
She was right. In my work, I had unknowingly leaned into the “never satisfied” ethos, expecting to fix my clients like a mechanic fixes a car. We would create a hierarchy — a list of feared situations ranked by difficulty for the client to approach — and push through until we reached the most feared situation, my own self-worth ensnarled in the outcome.
Some clients do progress through an exposure hierarchy exactly as the textbook prescribes. During each exposure, their level of distress gradually declines the longer they remain exposed to their fear. With these clients, at least for the length of one therapy session, I feel satisfied. Yet they are very much the minority. For most of us, progress is not linear, and the weeks spent in therapy are rife with setbacks.
***
One of my teen clients, a natural performer and Broadway fan, struggled with anxiety around an upcoming speech she had to give. After being introduced to the Hamilton soundtrack by my therapist, my newfound fandom led me to purchase an official “I will never be satisfied” t-shirt and peruse YouTube for Hamilton-related content posted by the original cast. The session with the teen that day jogged my memory. I showed her two YouTube videos of Phillipa Soo, one an interview in which she shared the time she had forgotten the lyrics to her solo during a Hamilton performance, and another in which she disclosed that she still gets nervous before performances.
Just a few weeks after that session, I ended my day early and set off for Soo’s book launch event. I hoped I wouldn’t find the book’s message antithetical to a key, yet counterintuitive, principle of exposure therapy: the more we reassure ourselves, the more we suggest to our brains that there’s something to fear. Instead, I walked out impressed by the careful attention that Soo and her co-author, therapist Maris Pasquale Doran, had given to the language around anxiety.
The book’s young protagonist, Piper Chen, is offered the opportunity to perform a solo in a school concert and seeks help from her grandmother in understanding the physical sensations of anxiety and making the choice whether to perform or not. (No spoilers here about what she decides!)
The concept of allowing for choice stood out to me, because I recognized its absence in my clinical work. When I knew my clients could do something yet wouldn’t, I was too easily frustrated, questioning my own skillset. Sure, I gave them the choice of which exposure activity from their hierarchy to tackle on a given day, and they made the choice to keep showing up for therapy each week. Though the end goal was clear in my mind — we must eventually face their most feared situation. Rarely did I ask for their “why.”
***
At the book talk, I heard Phillipa Soo express her love for art and the stage, which remains true despite performance anxiety, and I remembered that some of my clients may similarly strive for a goal that can sustain them through challenges.
“If I had had a tool to understand my feelings,” Soo reflected, speaking to her motivation to write the book, “I would have chosen to push through [and perform].”
To illustrate this point, she shared a story from her childhood in which she refused to go onstage during a dance recital. Her teacher encouraged her to step onstage for only the curtain call, which opened her mind to the notion that performing might not be so bad after all.
The story resonated. The summer before ninth grade, I experienced intense performance anxiety for the first time. Before, I had loved performing onstage at my music and arts day camp, and suddenly I couldn’t do it without panicking.
For the first of two dance performances, I got as far as backstage, and just before the rest of the class stepped into the spotlight, I fled, in tears, filled with shame that I didn’t have the word for.
The teacher, a vocal performance major at a nearby college, intercepted me and drew me to her side while the rest of the class danced. She toggled between projecting a bright, encouraging affect towards them on the stage while cuddling me against her with one arm and speaking calmly. The teacher didn’t write me off as someone better suited backstage or express disappointment or annoyance. She knew that I had wanted to perform and gotten as far as I could that day.
Piper Chen experiences similar encouragement from adult mentors. Besides her grandmother, Nǎi Nai, her music teacher normalizes her nervousness and emphasizes her self-determination in making the decision whether to sing a solo or not.
To honor my choice to try to get onstage for the next performance, my dance teacher included me in rehearsals with the expectation that I would perform, yet she adjusted the choreography so that a partnered part of the dance could work whether I was there or not.
I never performed that dance on stage. At the second performance, I again got as far as backstage, panic took over, and I fled. Again, the teacher provided hugs and validation. When I tried to refuse the candy she brought for our class because I hadn’t “earned” it by doing the performance, she insisted, “You were part of a class!”
Now, I finally take her point. I was not an avid dancer who studied throughout the school year, and to even sign up to take the class while at camp was a step outside my comfort zone.
The memory of my summer camp dance recital gave me pause. If I had been the therapist to my younger self in that moment, I would have expressed empathy but then turned immediately goal-oriented. “What got in the way of doing the dance?” “What will help you to do it next time?” “What’s a step that you can practice before the next performance?” I’d have skipped the vital step of helping her to identify and validate her own emotions, a gift given to the character of Piper Chen by her grandmother.
Perhaps more critically, I would never have asked whether and why she wanted to perform the dance at all. If I know what my client values, I can better guide them towards making choices in line with those values.
The week after attending the talk, I found myself relaxing more in my sessions with clients. I loosened my expectations for how far their exposure work should go. I also stopped assuming the end goal of treatment without including them in the decision. I began to ask questions like, “Are you satisfied with checking for your wallet once every time you get in the car?” I reconsidered my belief that the client must eliminate all checking or risk letting OCD win. I’d neglected to appreciate that an insistence on getting everything “right,” treatment included, can be its own manifestation of OCD.
***
After one of my young clients read through Piper Chen Sings in a session, he noted that what he liked about the story was “she didn’t fix it” when she got anxious. In the book, butterflies, beautifully illustrated by Qin Leng, represent Piper’s anxious sensation. They first appear when she discloses her nervousness about singing a solo to her grandmother, Nǎi Nai, and show up again the day of the performance. Nǎi Nai shares about her own experiences with butterflies, which for her represent exciting changes such as moving to a new home, graduating school, and starting a family. Armed with Nǎi Nai’s wisdom, Piper greets the butterflies with a “hello” as she walks onstage.
I reached for the book in a session with another young client who reported feeling anxious before tests. She wanted a strategy to make the butterflies in her stomach go away. My advice to “stop giving them attention” didn’t satisfy her, so we turned to the final page of Piper Chen Sings together for another take on the concept.
“See, the butterflies are still there,” I pointed out to the teen client as I held open the book’s final page. “They didn’t go away, but she’s singing anyway. If you trap your butterflies in a cage and try to control them, they’ll stick with you longer and bother you more.”
The teen smiled at the image of trapped butterflies. The following week, she referenced the metaphor of butterflies on her own, reflecting that she could still take tests even when feeling nervous, just as Piper could sing with the butterflies fluttering around, greeting them with a “hello” rather than shooing them away. The goal was never to vanquish the anxiety, but to learn to co-exist.
Image by Navi on unsplash.com, licensed under CC 2.0.
- Getting to Satisfied: What an Exposure Therapist Learned from a Children’s Book - February 18, 2026