Next Steps in Counseling

The next step in the treatment text says, to include others who may not understand the client's difficulty or be affected by it and explain it to him or her. The husband was really beside himself, and did not know what to do. I needed to explain it to him to help him understand, so that he could explain it to others, who may not understand why it is a problem for her. Not understanding, people could be anywhere from incredulous and mocking, to frustrated and ready to abandon her as a friend. 

The treatment goes on to say, Teach the Biblical coping mechanisms of patience to the client and directly confront the phobia.  Your intentions are to enable the client to think through the facts behind the phobia when it happens, so that through the Holy Spirit, the fear can be overcome. Practically speaking, use the process of patience to ground the person to consider the facts with God.  To surrender the overwhelming emotions to Him, while waiting on God to provide a calming peace.  Asking God to draw near in considering, “Help me to trust You Father?”  Practicing this process with the client in the office, for the client to notice the importance of stopping and waiting with Him.  Many people have shared stories of their fear of flying, fear of being confronted by a supervisor and fear of earthquakes.  They stopped in a busy airport, took a seat in the bathroom stall and/or got down on their knees after an earthquake to find an ever-present God helping them to quiet their heart and mind.

And then the last part of the treatment says, if appropriate, utilize medical or psychiatric help in order to support the attempt to address the phobia.  That's what I had to do in this case, partially because it was very extreme. Her life was very crippled and difficult. So she went to a psychiatrist that I utilized who prescribed medication to help her think clearly and continue counseling. She had an extreme fear of illness, and it manifested itself through her thinking that when she would see something on the ground, especially near a restaurant, she would see that as vomit. She would be constantly scanning and searching (hyper vigilant) for someone who she should avoid because she was afraid of germs. In her mind, anything she saw on the ground such as a scrap of paper, leaves, a twig, cloth somebody dropped or any abnormality such as shading on the concrete or a wall, she would refuse to move forward, get very frightened and go back to her car. This could happen anytime she left her car, like paying a bill, going to the library, or going to a friend's house. So, many times she would try to go out of the house, and have to come back because she reacted this way. Also, she had an extreme fear that her family would get sick. She wouldn't let her year-old daughter walk on the ground going to the car. She believed there were germs in the grass, and would get them on her shoes, and the girl would get sick and die, or pass the germs on to the rest of the family. Whenever the girl came in from outside, the client would immediately take her shoes off and must wash them. 

If she opened a door at a public place, she would immediately have to go to the bathroom to wash her hands because of the germs on the door handle. When she began counseling, she was pretty much housebound. Her daughter was unhappy because she couldn’t play outside. The client also had a lot of ritualistic behaviors like hand washing. Her husband felt very confused and isolated. He didn't know what to do or how to help her, because this had been going on most of her life.  She appeared to be resigned to her helpless condition that was significantly interfering with her personal life, marriage and family relationships.  

Researching her background revealed her fears started when she was young and started to go to school. She had an insecure attachment with her parents, many fears and emotions of this adjustment and leaving her parents. Her mother was very passive and didn’t take part in her discipline. Her father disciplined harshly with a loud voice, making demands, and setting down a lot of rules. If he didn't get the behavior he wanted, he would yell at the kids, mocking and ridiculing them. She was the last child born, and the other siblings were strong-willed, and as they aged, they would yell back. All of them got into power struggles, except her, because she had this Passive-active personality. She hated the family fighting and wouldn't say anything to cope at a young age.  

When she went into school, she had a lot of trouble not knowing how to get along with people. To get her back in the classroom, the father would go to the school and yell at her in a loud voice. Unfortunately, that teacher did not try to stop him. So, she began a pattern of having trouble, his coming to school, interrupting his work and being furious, and yelling at her. She would sit there and take it until he left. Then she would get sick and go to the bathroom and throw up. She did this over the whole school year, at least two or three times every month. Nobody stopped the guy, and he didn't change his method. She kept doing it, so that by the end of that school year, she had associated anything to do with nervousness, conflict, new situations, or public crowds, with getting sick. 

Her phobia was born.  From her early years of walking on eggshells around her father, to a generalized anxiety, then intrusive memories and a distorted sense of reality based upon her false beliefs.  It wasn't so much that she was afraid of dying or anything, but she remembered and associated within her mind the illness, the stomachache, the cold sweats, the embarrassment, all the negative things. With a new situation, she created a phobia. Going out to a new restaurant or going out in front of people, where they might look at her, and think bad about her. What if her daughter gets sick? All those types of situations created in her this fear that was linked back to the past. When she would see something that could be vomit, she would react with great fear from this built-up response.

Her treatment along with the medication was getting her to understand the process of patience. We used this process to address her most difficult places: doubting God, rudeness, looking for the worst scenario, delighting in evil, and not trusting God. She had to get strength from God to examine the situation with “What are the facts?” She had to literally walk up to the object, see what it was, and realize it wasn't vomit. She had to retrain her brain, her neuro pathways to learn that the object didn't mean she would get sick, or that God couldn't help her. She started to open up these different areas in her life to God, and was able to change her thinking process. I remember one day she came in and said, “I've had a tremendous accomplishment. I let my daughter walk to the car. I didn't worry about her shoes.” She said, one time, “My husband and I have been able to go out to restaurants for the first time in years!” All these different things were scrutinized through prayer and patience, and became less problematic so that she returned to a normal lifestyle. 

I believe, in her case, the trauma was so extreme and for such a long time that the medication was absolutely critical.  I believe it was the medication, at least initially, and the process of actually looking at each situation; rather than running on emotions, that allowed the Holy Spirit to heal and restore her from this phobia. When you have someone suffering like this, then you have to follow the same pattern. You have to trace back the situation that initiated the fear, exposing the harsh realities that impacted their emotional and cognitive development.  Sharing the truth of God’s design to live life in freedom, God’s truth in “There is no fear in love, but love casts out all fear”, (1 John 4:18) and His power through the work of the Holy Spirit for healing (rewiring neural pathways). Some call it “peace of mind” and the Apostle Paul called it “peace” as a “fruit of the Spirit” (Galatians 5:22) that essentially is found in receiving God’s grace to surrender and trust Him, rather than emotional triggers and distorted beliefs.  You may need to get further diagnostic treatment from a psychiatrist, which can be an important piece of the puzzle in early steps of intervening with the intrusive thoughts and feelings. 

Copyright 1987, 1990, 1993 by Daniel D. Wilkinson. All rights reserved. For more information concerning this material, write to:
The Biblical Christian Counseling Ministries, Inc., 2730 Radcliffe Dr., Florissant, MO 63031.
Any reproduction of this material without the express written consent of the author is prohibited. Printed in the U.S.A..