If a patient has a fixed idea or theory about The Cause of their symptom, how can this information be successfully dealt with so that it does not hinder progress towards the relevant/right information?
© Helen Lesser 2013
QUESTION: I have been treating a lady with a fear of escalators. She is loving every minute of treatment and goes along beautifully with everything.
Earlier today she had session 3 but she has just phoned; she was very excited and said that when she got home she was feeling lovely and relaxed and decided to make herself a cup of tea and as she was doing so an incident popped into her head where she had stumbled at the top of an escalator and almost fell. The recollection was so strong she felt all the sensations of tripping and the fear that went with it and she has decided that this was the cause of her problems although she doesn’t remember when the incident took place or any detail about it.
Could she be right? What do I do from here? Do I simply carry on with treatment in Session 4 and maybe that incident will come up or should I try and discourage her from giving this too much thought or credence? And if so – how?
So she has some sort of fear about using escalators. Either she remembers a time when she experienced fear at an escalator or assumes that such an event must have occured. The event she has related to you did not even involve her experiencing any sort of harm – just a fear of it. This then is an example of her suffering the symptom and therefore cannot possibly be the Cause.
Is it her belief that she WILL be hurt in some way? If so why?
Is it her belief that escalators are dangerous in some way? If so why?
Did she just give herself a bit of fright at that one incident, but is expecting a recurrence? If so why?
If I were to stumble at the top of an escalator, I have no doubt at all that my heart-rate would rise and I would momentarily feel fright – in fact, that is the physical reaction which would have enabled me to act sufficiently quickly to prevent the ‘stumble’ turning into a ‘tumble’! Good old subconscious doing its job.
Would I then expect to experience fear every time I thought about getting on an escalator? Of course not. I might be slightly over-careful the next time or two I use them, but that would soon fade and I’d return to my normal ‘Thank heavens I don’t have to walk up stairs’ kind of use of them. But she didn’t – why not?
I’m sure that, since sending your original email on this, you have thought of all of the above; the only reason that I am putting it all in my reply is because these are the points you need to make and the questions you need to address to your patient.
Perhaps this event was the start of her problem, may be it started at some other time; but either way, it needs to be addressed and dismissed. She will very likely be utterly convinced that this event is The Cause – and will therefore have this event firmly stuck in her mind to mislead future treatment sessions.
You have to ensure that she understands WHY this cannot be The Cause – and this must be done consciously/ before induction, like this:-
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