Not only does it bring a client great joy when they conquer an anxiety or phobia, but it also brings me as a practitioner great satisfaction to see a client drive off, having mastered the worry that they have.
Over the last two weeks, I have been working with a client who had a phobia of driving along unfamiliar roads. In 4 sessions of an hour and a half planned over two weeks, we have conquered it, and the client drove off ahead of me along the road, where the route had previously elicited panic attacks unable to proceed further for hours; a route they had since avoided driving, despite the need to access services along that route.
In the first session in the clinic, we discussed the route and from memory the client elicited the landmarks that they recognised, and where along the route they thought their worst anxiety would be. On a sheet they rated their anticipated anxiety at each landmark as we imagined travelling what they perceived as a treacherous journey. The journey of eight kms one-way should, at the speed limit and with low traffic, take only 8 minutes. Then, for each landmark, they rated how high they anticipated their anxiety to be, with 100% being the worst anxiety or panic they had ever experienced. They rated their anticipated anxiety for each landmark along the journey under the following three conditions (a) as if they were the passenger with me driving; then (b) with her driving and me beside her; then (c.) if they were driving alone without me. These stages mirror the planned interventions for the subsequent sessions. We anticipated that if there were particular stages of the journey that were bad, that we might park the car and go on foot to observe various points of the route, and to walk them and examine them in detail.
TRAVELLING AS A PASSENGER:
In the second session, we met at a location that they agreed they were able to drive to without concerns. The first time I drove the target route, as they recorded their anxiety on the page as we passed the landmarks and back to the starting point. The second time I drove, they were asked to look really hard at the road, and notice the places that lanes were added, or merged, turns left and right, junctions, and details of the journey; and they made notes of what they needed to do (which lane to be in, etc) and encouraged to make the journey as simple as possible in their mind. We discussed various points at which she felt that her anxiety was highest, and tried to elicit what it was about this point of the road that was such a risk, and to challenge those thoughts, asking if they seemed rational. It transpired that none of the landmarks were rated so anxiety-inducing that we decided to skip walking stages of the journey. For homework, the client was asked to simulate driving alone along the route using google maps, and to again record their anticipated anxiety in the next session at each landmark.
DRIVING WITH THERAPIST AS A PASSENGER:
In the third session, we met at the meeting point. The first time I drove, and the client recorded their anticipated anxiety driving, with me as the passenger for each landmark. The second time the client drove, and I was the passenger, recording their anxiety as they drove. We addressed various thoughts that came up suggesting that certain aspects of the route should be more anxiety provoking, and challenged those thoughts to see if they logically made sense to the client. Again, for homework, the client was asked to simulate driving the route alone using google maps, and to again record her anticipated anxiety in the next session in which they would drive alone.
DRIVING WITH THERAPIST ON THE PHONE:
In the third session, we met at the meeting point. The first time the client drove and I sat in the backseat saying as little as possible, asking only for the client to rate their anxiety on a scale of 0-100% for each landmark. The second time, using hands free technology, the client drove alone and rated their anxiety at each landmark. I drove some distance behind her, using hands free technology, listening and offering encouraging statements to anticipate positively that her anxiety was going to be low for the journey. The client experienced several insights along this journey about where the worries had stemmed from, and was able to separate from these, and keep the anxiety of the journey low. These insights will be addressed in later conventional clinic sessions.
At the end of the session, the client drove alone, without any active call, completing the whole journey. They later messaged me to say “Thank you so much for your kind words and help. I felt pretty calm the whole way, there and back which is amazing!”
There will be a need for the client to repeat the journey several times in the weeks ahead, to ensure that the learning is maintained, and the avoidance behaviour is kept to an absolute minimum.
I sat at the traffic lights, where I needed to turn to go home, and the client drove past me alone. I experienced a sense of pride in the clients’ achievement, a degree of sadness that they no longer needed me but a pride in the fact that I had set them free, to fly ahead in their mastery of their phobia of driving.
