This is an case study article of mine which was published by the National Hypnotherapy Society in their Summer 2022 members magazine talking about an approach I used with a client to help them with a phobia of cracks in the pavement. This account has been carefully anonymised to protect the privacy of the client.
I hope you will find this an interesting insight into some of the methods and approaches I use to support my clients in their journey.
A lady, who for the sake of this account we shall call Sofia, contacted me in October 2021 looking for a solution for her crippling phobia in respect of cracks in the pavement.
Sofia described being “uncertain” with regards to cracks in the pavement for as long as she could remember. Turning it into a game of “dodge the snake” to hide the underlying sense of anxiety as a child and to avoid the scorn of her friends and her mother. When she became a young mother herself, she found the pattern becoming more and more intrusive and harder to hide while managing a pushchair. The experience of the pandemic elevated the situation still further and Sofia at the point of seeking help found herself avoiding leaving the house wherever possible, putting a strain on her family as a whole.
The world of the psychoanalysts broadly recognises phobias as a category of anxiety disorders and so the symptom presenting itself as a phobia is often rooted in a broader context of life uncertainty which is why phobias often appear to escalate when there is less confidence in a given situation. This is very likely when we become thrust in the challenge of being a parent, and also when the world we knew to all intents and purposes falls apart due to a pandemic. This means that although the client is seeking a solution to their phobia, what they are really benefit from is a reliable means to face the ever-present uncertainty of the world.
I approach my clients holistically, looking at as many of their life factors as they are willing to present to build a picture of the elements of their lives that are not functioning as they would like. It is seldom the single problem the client presents and its symptom which is the real issue and I use interviewing techniques derived from cognitive therapy approaches to help with this.
We used the first session to explore these concepts, to help Sofia gain a sense of how her mind might be trying to protect her from a place of positive intent through this admittedly unhelpful pattern of behaviour. We agreed to a strategy of 4 sessions designed to strengthen her sense of confidence and to confront and desensitize the specific phobia itself. Sofia agreed to play detective to the patterns of her phobia over the week until she saw me next, something borrowed from cognitive behavioural therapy and a very useful tool to help understand triggers that might be focused on in future session. We ended the first session with a simple induction and ego strengthening process to gently introduce her to the hypnotherapeutic process and to aid her confidence for the week ahead.
Sofia returned for session two with notably more confidence in her posture. We explored the findings of the week and follow her detective work into her own patterns and behaviours she had started to consciously note the association of increased felt presence of her phobia and the wider pressures she might be facing. She was feeling the realisation that the phobia could be a symptomatic response to her perception of the wider challengers in her life as opposed to the intellectual understanding of the possibility she had obtained in session one. This embodiment of the therapeutic approach is a critical step to success in my experience. Too many of us feel we can intellectualise our way to a solution for our mental health issues but experientially this is simply not true.
With Sofia’s agreement we commenced the desensitisation process using a variation of Don. E. Gibbons’ Ph.D. “Rehearsal Suggestions with Fear of Flying”, from the Handbook of Hypnotic Suggestions and Metaphors (edited by D. Corydon Hammond, Ph.D.). Following the induction this involved starting Sofia’s day from a place of safety and a sense of calm and tranquillity and then slowly moving Sofia through the experience of the day to the point of contemplation of going outside and the potential encounter with cracks in the pavement. The whole process involved gently but firmly testing Sofia’s emotional responses as she moved through the visualisation process, resetting to a point of safety, and moving forward again whenever feelings of anxiety or overwhelm arose. In this session we took Sofia to a point where she was calmly able to look at cracks within the visualisation process. We ended the session with another ego strengthening metaphor and invited Sofia to continue her detective work particularly in respect of her ability to be present with cracks in the pavement. What was the distance at which she was able to feel calm and in control and how did the body feel if she chose to move forward from that?
Sofia returned for session three feeling more anxious. She had a row with her mother when she had told her she had started working with a therapist and rather than being pleased for her it turned out her mother did not think that her daughter needed therapy, but simply to “stop being so silly! “. This had understandably set Sofia back somewhat, but she had consciously noted the association between this even and a resurge in her sense of the phobia. There was the possibility at this point of exploring the root origin of the phobia within Sofia’s childhood and we discussed the process of ideo-motor response and regression and whether this was something Sofia would like to explore at this point. Sofia was curious but cautious as to whether she was ready to start upturning the stones of her past just yet, so we agreed to continue the desensitisation plan and overall confidence.
This time the visualisation enabled Sofia to stand on the cracks in a calm and curious way with no anxious response while in a state of hypnosis. We extended the trance state to cover a more generalised response to anxiety based on a script from Roger P Allen’s “Scripts & Strategies in Hypnotherapy”. Once again, we wrapped the session with a confidence boosting visualisation exercise.
Session four was the last of our planned sessions and Sofia returned quite jubilant and beaming with a new inner sense of confidence. She reported she had been able to stand on cracks in the pavement and even jump up and down on them (when no one was looking) and could not quite believe that this had finally come to pass. Critically she felt more confident in herself and better able to face the vicissitudes and challenges of life. We used this session, once again modelling the approaches of cognitive therapy, to agree strategies that Sofia could use to manage more stressful situations that would inevitably arise. This is a critical step in ensuring the client feels they are strong enough to face whatever it is that they need to so that they can overcome any subconscious temptation to regress to an unhelpful protective state. As part of this process, we agreed to have a check in call 6 weeks later to ensure Sofia was still managing successfully.
This whole therapeutic process had been a collaborative approach in building within Sofia a stronger and more capable sense of self. Her overcoming of the phobia was effectively a metaphor for her ability to stand up and face the challenges in her life with a new sense of personal courage and conviction. She was stronger than she realised, and this simple realisation was the most powerful and profound part of the therapeutic process.
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