Case History - Phobia
Things aren't always what they seem - looking beyond the phobic response
Jo Nicholson BSc(Hons), RGN, PDHyp
My initial training was in nursing and I spent a brief time as a general nurse before discovering psychiatry. I had always been interested in 'what makes us tick' and so moving into psychiatric nursing seemed to be an obvious step. I trained and worked with adults before specializing in child, adolescent and family psychiatry. After some years in this area I moved away from nursing to study Psychology. It was during my final undergraduate year, when I studied a module in hypnosis, that my interest in this field developed. It seemed to pull together my earlier training. I graduated and began lecturing in health studies and psychology, my interest in hypnosis continued although it was several years later that I began my training with the LCCH. I am now an LCCH supervisor and trainee lecturer. I work as a freelance stress consultant and clinical hypnotherapist in Glasgow.
To quote Patrick Casement's book 'On Learning from the Patient', this particular patient taught me a lot about looking beyond the presenting problem. Mae was one of the first patients I saw. At the time I was working a few hours a week in an emotional health centre as a stress manager and was also just beginning to introduce hypnotherapy into the service.
Mae was referred to the service via her G.P. She had been off work for the last 6 months with depression following her husband's death 2 years earlier. Mae was initially seen by the counsellor within the health centre and had made good progress. Towards the end of her time with the counsellor, Mae began talking about her phobia of mice and was referred on to me to look at this. I had seen Mae around the centre and we had spoken briefly. She was well motivated and interested in exploring the use of clinical hypnosis.
Mae was a 52-year-old woman with three grown-up daughters, all married and living within the local area. Mae lived alone since her husband's death and had recently begun refurbishing the house but found that she had no interest in spending time in her home and had begun to view it as a bit of a millstone.
Her married life had been difficult. Her husband had enjoyed a drink but became aggressive and her time with him had been quite unhappy. She felt a mixture of relief and guilt about his death, but, through her work with the counsellor, Mae was able to address these feelings and begin to move forward. Although she had been prescribed antidepressants, Mae only took them briefly as she didn't feel comfortable taking the medication. She informed her G.P of this and at that point a referral was made to the emotional health centre.
Lifestyle Mae had a full-time job, which she found quite demanding, but wanted to maintain it until she retired in 8 years' time. Mae was just returning back to work after a 6-month absence when I began seeing her.
She had a good network of friends and met with them socially 2 or 3 times a week. Mae also visited her daughters regularly and, when able to, would look after her grandchildren. Mae was a fit and active woman, with a wonderful warm sense of humour. She was petite and recognized that in recent months her weight had dropped and she had lost some of her 'sparkle'. She was now, however, beginning to pay closer attention to her dietary needs and also taking some time out for herself away from family and friends. Mae described herself as generally a healthy person, a non-smoker, who enjoyed the occasional drink.
Case history Mae could recall having a phobia of mice from early adulthood. She remembered being heavily pregnant with her first child and moving into rented accommodation with her husband. The house was overrun with mice and she became so distressed that she packed her bags and went around to her mother's house. As her mother opened the front door to let her in, a mouse ran out and across Mae's foot. Mae remembers feeling surprised and terrified by this sequence of events. She had earlier memories of mice at her grandmother's house, but described feeling no fear. Her grandmother had told her to clap her hands if the mice came close to her. Mae did this and it became a game to her as a young child.
Mae now found it difficult to even think about mice. During her house refurbishment a mouse had found it's way into her kitchen, Mae heard the scurrying noise and ran out into the street screaming. She was unable to return home until the house had been thoroughly checked for any further evidence of mice. She was concerned that she may be looking after her grandchildren, see a mouse, and just run and leave them. She felt that, over the years, her phobia had intensified.
Mae and I drew up a Subjective Unit of Disturbance Scale (SUDS), Mae was able to think of twenty examples that we included on the scale. Her most extreme anxiety, which she clearly rated as 100, was seeing a mouse in her home and the tails of mice particularly bothered her. Interestingly she rated the word 'mouse' as 50 on the scale. She initially would refer to them as 'm' and it seemed a real struggle for her to say the word. Iif she did she would speak it very quickly and quietly, and she would also grimace as she did so. Other aspects she found disturbing were pictures of mice. She described a pair of household rubber gloves that apparently had a mouse logo on their packaging, and she also felt uncomfortable with the cartoon mouse 'Jerry' from 'Tom and Jerry'.
The first session with Mae consisted of history taking and drawing up a SUDS. I also talked Mae through progressive relaxation and breathing techniques. We established a place of relaxation, which for Mae was a favourite holiday resort. I met up with Mae a week later and we began the hypnodesensitisation. I induced trance through progressive relaxation and installed the I.M.R's. Though Mae's level of comfort/discomfort was evident through her facial expressions during this session Mae was able to comfortably move up the scale from 0 - 30. She found the image of mice shaped sweets a bit of a struggle, but was able to relax and move on.By the end of this session Mae had moved past 50 on her scale. We ended the session with lots of ego strengthening and Mae left feeling very positive.
The following week and the third session we continued with the hypnodesensitisation. Mae had had quite a busy week at work and was finding her return to work tiring. As the session progressed there were several 'sticking points', in particular it was difficult to move further up the scale from Mae's anxiety about hearing the sound of a mouse in the house. Towards the end of the session, Mae made an interesting remark, where she linked her late husband with the appearance of a mouse in her home. Mae then dismissed this thought as silly. However we did begin to discuss what this fear meant to her. There had been some shift in Mae's thinking with the hypnodesensitisation, but we were both feeling that there was something else around that was creating this 'stuckness'. Mae was open to exploring this through regression.
On the fourth session, using regression via diagnostic scale, Mae's I.M.R's indicated several key points in her life: at the age of 2l years, married; 17 years, leaving home; and around age 2/3 years Mae's facial expressions indicated that this was a time of sadness for her. Once out of trance and during our discussion Mae recalled being in hospital as a very small child, she thought possibly about 2/3 years old. She described being in a large TB ward, where visiting was restricted. The nurses were kind but busy. Mae also remembered that there were mice about at night-time and the nurses would clap their hands and 'shoo' the mice away, just as grandmother would do a few years later. Mae didn't remember feeling scared, she saw the mice as 'playmates' and, as she continued to talk, Mae said that she felt a sadness and an overwhelminq feeling of loneliness. We talked around this and discussed how the mice seemed to have become the objects of or receptacles for these difficult feelings. Mae was able to relate to this and agreed that we would work on this next week.
Fifth session, using advanced pseudo-regressive therapy, Mae was able to 'revisit' her early experience with new insights. She comforted her 'inner child' who sobbed as she felt so scared and lonely, and Mae hugged and held her tightly. The 'inner child' work was continued on the sixth session, which also included further additional ego strengthening. Mae responded very positively to this work and, although she felt sadness about being left alone in hospital as a small child, this sadness was the sadness of an adult rather than the raw pain and isolation she felt as a child. Mae now felt able to tolerate mice. Although she said that she would never be a great lover of them, they no longer felt so powerful and she felt pleased with that.
Summary and discussion
As I mentioned at the beginning of this article, this was a great learning experience for me on so many different levels. I learned, or should I say, relearned, that things aren't always what they seem. I learned that it's okay to try alternative approaches if the first one isn't progressing (of course I had been taught that anyway, but somehow I had to experience it for myself to know that it really is okay!). I learned that the client will give you clues if you are open to them. Again I had experienced in my 'play work' with children, that the same themes and patterns will be repeated, you just have to pick up on them.
I met up with Mae several weeks later and she was very positive. She had regained her 'sparkle' and said that she had moved on with her life. She still enjoyed meeting up with friends, but also now found that she liked to have her own time at home.