A new client came to see me a few months ago, a young lady with a phobia of snakes. Avoiding snakes is her life. Here in the UK, real snakes are not a natural phenomenon that we encounter daily, but the vast majority of her snakes are imaginary. Snakes in her bedroom, snakes behind the sofa, snakes in the toilet – a new neighbour moves in.. might she have a pet snake?
So where do we begin with this?
First of all I need all the background information I can get from her in order to identify the stimulus. “That’s easy” I hear you say, “It’s snakes”. Or is it? Experience has taught me not to take a client’s initial diagnosis at face value. A while ago a client came to me with a phobia of blood. She had previously been for a course of CBT, which had not resolved the problem.
“Ok” I enquired. “So if I produced a bag of blood, like you’d have for a blood transfusion, how would you feel about that?”
“Fine” she said.
“How about if i poured it out into a dish?” I asked.
“Yeah, no problem” she replied.
“So your phobia isn’t exactly of blood then?”
“No, I suppose it isn’t.”
“So what would make you have that fear response to blood then?”
“When someone’s actually bleeding…”
Through further probing we established that the trigger was a bleeding wound, but not her own injury, that was fine. It was someone else’s bleeding wound that was always the trigger.
At which point she revealed “My other therapist didn’t ask all these questions!” Hmmm. Now we know how a whole course of CBT was wasted!
So once we have established the triggering circumstances (there may be several!) we can plan our treatment strategy. It’s not important to label the phobia by the way. It doesn’t particularly help.
Medical Doctors frequently prescribe anti-depressants for phobic and other anxiety conditions. These can help in the short-term as a way of reducing the anxiety, but should not be viewed as a long-term solution. Traditional approaches mainly involve exposure therapy, i.e. gradual exposure to the fear inducing stimulus, and, ultimately it is the best method. It is absolutely crucial, however, that exposure therapy is carried out correctly. At which point we come back to my “snake” client.
“I’ve had it for as long as I can remember” she said. “But I remember an incident at school that made it much worse. I was about seven or eight years old, and we went on a visit to a pet shop. Someone brought snakes and reptiles into the shop. My mum had told the school about my phobia, and I thought they were going to let me stand outside. Instead the teacher trapped me between her legs, and when the man brought this great big snake round, she forced me to touch it. She literally held my forearm and held my hand against it. I fought and screamed, it was the most horrific experience of my whole life.”
The moral of this story is: NEVER force a client to confront their fear.
The MAIN PRINCIPLE of exposure therapy is that the client retains control of the process from start to finish. This approach allows them to master their anxiety gradually so that it doesn’t overwhelm them at any point.
So with my “snake” client, after the initial consultation, I began with a hypnosis exercise to enable her to manage her fight or flight response more effectively
Session two will begin with more hypnosis; a guided imagery session where she imagines looking at pictures of snakes without fear – or with as little fear as she can manage – to prepare her for exposure to some photographs.
The photos will only come out when the client says she is ready, and at a distance she is comfortable with, and begin with little snakes.
I will be ready to remove the picture at any time if the client wishes me to do so (though this is unlikely as she is there voluntarily, and she is paying!)
I will ask her to rate her level of anxiety on a scale of 0-10
We will talk about the snake photo; that it’s just ink on paper, it can’t hurt her, and allow her fight or flight response to subside.
Again I’ll check her anxiety level. As it drops, ASK if it’s ok to bring the photo closer (REMEMBER, the client is in control!)
Give them lots of encouragement, reassurance, coax them, cajole them, praise them when they achieve something, but NEVER force the client to do anything. ALWAYS obtain their consent.
By the end of this session (or possibly the next session if things proceed slowly) she will almost certainly be holding photos of big snakes, sitting with the photos on her lap, and be able to touch the image of the snake without a significant increase in her level of anxiety, ALL VOLUNTARILY, AND AT HER OWN PACE.
As a reward for her hard work, my client gets to take the snake photos home! She will need to put them on the wall at home, or somewhere she will come into daily contact with them. (Past clients have taken their spider pics to work and stuck them on their desk, much to their colleagues amusement and/or disgust!)
I will encourage her to give the snakes in the pictures silly names, and to be very stern with them if they misbehave. It may sound silly, but it works.
The next session will involve rubber snakes, maybe some snakeskin products, snake videos, more general snakey exposure, just moving it forward one little step (or slither?) at a time, all the time checking the client’s level of anxiety, and are they comfortable with the next step?
Ultimately MY aim is to end up comfortably handling the real thing. A couple of weeks ago I had a woman who three weeks previously couldn’t even look at a picture of a spider, comfortably letting them walk over her hands, much to her husband’s amazement. If the client doesn’t want to go that far, that’s up to them. After all, it’s their journey, I’m just the bus driver, and if they want to get off a couple of stops early that’s up to them.
The mastery principle works the same with any phobia. The motivation has to come from the client. So if someone calls up and asks “Can you help my son/daughter/mum/dad, or whoever, overcome their fear of .. (insert relevant phobia)?” my answer is “If that’s what THEY want.., or is that what YOU want them to do?” If someone else wants them to overcome their fear, it’s not going to work. Trust me, I’ve tried.
Sometimes this work means having to be a bit resourceful. Spiders were no problem as there are plenty in my garden, and Chinese take-away boxes make great trapping equipment and temporary spider homes. For a client with a fear of dogs, we paid a couple of visits to Battersea Dogs Home, where the staff were very helpful and accommodating. For fear of needles I obtained some hypodermic syringes and let the client inject chicken breasts from the supermarket. A client with a phobia of cats called me after two sessions of hypnosis and announced that her phobia had completely disappeared.. this is quite unusual in my experience though. Snakes, however present a fresh challenge…
I’m off to Google Images now to source some snake photos.
And does anyone have a couple of snakes I can borrow?
Peter Phelps is an integrative psychotherapist, hypnotherapist, counsellor and psychologist with practices in Central London, South Woodford, and Romford.
My client has now completed her sessions and made amazing progress with her snake phobia. Thanks to the guys at The Jungle Phase in Hornchurch (http://freespace.virgin.net/jungle.phase/main.htm) for their patience and assistance with her exposure therapy.
See my testimonials page for her update from her holiday in Mexico!