Therapy for Phobias

Photo of the word phobia in a dictionary
 
A phobia transforms anxiety into fear by attaching it to a very specific object or situation.

Almost any object or situation can be used to form a phobia – spiders, snowman, buttons, open spaces…

By transforming anxiety into fear a phobia can make life liveable. A phobia is far from being a purely negative thing.
 

The Cost of a Phobia

However, the gain provided by a phobia comes at a price.

If the phobia is of something that can turn up unexpectedly – such as spiders – then the price may be the maintenance of a state of alertness and vigilance.

By transforming anxiety into fear a phobia can make life liveable

Or if the phobia is of specific situations – open spaces, for example – then the price may be the organisation of day-to-day life so as to avoid them.

This can involve prohibitions as to where you can or cannot go, and what you can or cannot do.

So a life which would otherwise be characterised by continual anxiety becomes organised and structured by a phobia, though at a price.

Many adults reach an accommodation with their phobia enabling them to get by.
 

Too High a Price?

However, a crisis can occur following a change in personal circumstances.

Suddenly, the alertness and vigilance towards the phobic object may increase and even become constant, leaving little attention for anything else.

Or, the organisation of day-to-day life so as to avoid the phobic situation may lead to severe, incapacitating prohibitions.

It is at such times of crisis that adults may turn to therapy.
 

Therapy for Phobias

Given a phobia transforms anxiety into fear, attempts to quickly remove a phobia are to be discouraged: it removes the protection from anxiety that a phobia provides.

attempts to quickly remove a phobia are to be discouraged

Instead, therapy involves elaborating, articulating and working-through the anxiety that the phobic object or situation shields you from.

We can get a better idea of what therapy involves by considering the following first-hand account of a phobia.
 

A Life-long Fear of Spiders

In a radio programme from 2013, a middle-aged man – Phill – speaks candidly about the beginning of his life-long fear of spiders.
 
Phill: I am arachnophobic. I have had it for 43 years. When I was six…er… the family decamped to a place in Essex called Horndon-on-the-Hill and we lived in a very lovely shack called Brelades.

It had only just got electricity and we had an outside toilet and this outside toilet was spider central basically, and there wasn’t a light in there, and so you had an oil lamp, and so the first thing to do was check there weren’t any on or under the seat, and…
 
Map showing Horndon-on-the-Hill
 
…and I spent a year – of every time I went – checking, and I don’t remember being frightened of them before, I don’t remember them even bothering me before…

… but when you’re sitting wondering if one is going… appear next to your face, drop down and appear two inches from your eyeball, with its legs moving…

… or, if, if you sit down and you’re just looking at four of them moving slowly around on a door while you’re sat there…

… and admittedly, in a quirky kind of way, it did help speed things along, as it were – but I… I…er… you’d leg it out there, and you’d go in and you’d just, it was like: eyes shut, do your business, get out.

And I spent a year doing that, we were at Brelades for a year, it left me… it left me very frightened of them. It’s just…

…the spiders were there before you and it’s only when they kind of break cover that you see them.

They’re there all the time, they’re constant-… that’s what bothers me.

I know… they’re in this room, right now, less than ten feet from me. Under these floorboards, there.

I bet there’s one about this big…

Interviewer’s Voice Over: [Phill] is visibly sweating now. His eyes are darting all over the room checking for creepy crawlies. It’s actually quite disconcerting.

Interviewer to Phill: …so then where is the scariness for you?

Phill: It’s the movement, it is the movement.
 

The Kernel of the Phobia

Phill uses the word ‘movement’ to describe the kernel of his phobia

Interviewer: …so then where is the scariness for you?

Phill: It’s the movement, it is the movement.

For Phill, the word ‘movement’ reduces his phobia to its simplest expression, its kernel.

Therapy might begin by sifting through Phill’s account of his phobia, identifying and elaborating references to its kernel, to ‘movement’.
 

Elaborating the Kernel

What is striking in Phill’s account of his phobia is the number of references there are to movement.

Phill’s phobia even begins with a movement: his family decamping when he was six to the shack in Horndon-on-the-Hill, Essex. As Phill says,

I don’t remember being frightened of [spiders] before, I don’t remember them even bothering me before

Following this move at the age of six, spiders and the idea of a spiders became frightening, powerful and even mythical figures around which he began to organise and structure his world.

he began to organise and structure his world

Sifting through Phill’s many references to movement, we learn that movement can be both sudden,

but when you’re sitting wondering if one is going… appear next to your face, drop down and appear two inches from your eyeball, with its legs moving…

or slow,

or, if, if you sit down and you’re just looking at four of them moving slowly around on a door while you’re sat there

Phill tells us he began to establish and maintain boundaries in order that movement could be regulated,

the first thing to do was check there weren’t any on or under the seat, and… and I spent a year – of every time I went – checking

Once boundaries are established, movement from the outside to the inside and from the inside to the outside can be controlled, including the passage of six-year old Phill’s faeces,

and admittedly, in a quirky kind of way, it did help speed things along, as it were… it was like: eyes shut, do your business, get out

It would have been interesting to hear Phill say something about his use of the word quirky here.

Even the interviewer emphasises movement when she says in her introduction,

Phill’s phobia of spiders has followed him around for the last 40 or so years of his life.

There are many other explicit references to ‘movement’ in Phill’s account of the beginning of his phobia.

Is there also at least one implicit reference to movement: Brelades, the shack his family moved to? Wikipedia tells us Brelades derives from the name of a 6th-century Celtic or Welsh wandering saint.
 

A New Place in the World

Rather than seeking a quick removal of a phobia, therapy involves a number of conversations aimed at elaborating the kernel of a phobia in the way suggested above.

Elaboration would also extend to what has only been half-said. For example, it would be interesting to hear Phill say more about his use of the words ‘decamped’ and ‘shack’ when he was describing the beginning of his phobia.

spiders no longer required to be mythical figures

An elaboration can then support the articulation and working-through of the anxiety from which the phobia protects.

In time, this working-through can result the establishment of a different relationship to the world – maybe in this case, one that does not require spiders to be such powerful, frightening and mythical figures.
 

Notes

I’m Suzy and I’m a Phobic was first broadcast on BBC Radio 4, 2 January 2013. Produced by David Morley. A Perfectly Normal production for BBC Radio 4. My transcription is of 14’30” to 17’00”.

In the radio programme, Suzy undergoes ‘psychological desensitisation’ – also know as ‘exposure therapy’ – for a quick removal of her phobia: she is increasingly exposed to her phobic situation for increasing amounts of time. As a consequence she experiences high levels of distress and anxiety which result – as she tells us at the end of the programme – in the formation of a new phobia.

The Wikipedia page was accessed September 2019, https://en.m.wikipedia.org/wiki/Saint_Br%C3%A9lade