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Fear of Hospitals
Maria said that she had a fear of going into hospital and that she had to have an operation soon that was not dangerous but essential for her eventual survival. She had tried several times to attend but each time she had failed to go through the entrance doors, even when accompanied by her mother. She said that it seemed worse, in fact, when her mother was there. Maria was about 30.
She had tried hypnotherapy twice before but it had never made any real difference. She thought that perhaps counselling might help. She expected it to take quite a long time to resolve the problem. She knew that her fear was irrational but she could not help feeling a terrible panic when approaching the hospital.
It was important to understand exactly what Maria was frightened of. What was it about the hospital that frightened her?
Once she was relaxed I asked her to describe to me an imaginary visit to a hospital in as much detail as she could and to say what felt threatening. She started to list one thing after another that could go wrong. Everything that she listed was possible but highly improbable. e.g. There might be a fire because of the oxygen cylinders, a violent patient might attack her, the surgeon might make a mistake and injure or kill her, they might give her the wrong drugs by mistake and this might kill her and so on. Maria continued to list a surprising amount of things that might go wrong and I agreed with her that any of them might happen. We also agreed that they could all happen to anyone and that most people are aware of these things but not really bothered by them because of their rarity.
Maria's view seemed entirely rational but she could not help going through all of the things that might go wrong at the hospital. It was as if they all would go wrong. She didn't know why.
In fact Maria had a very rational and logical view of most things. She did voluntary work advising people how to manage complex domestic and financial problems and she did it well. She seemed annoyed with herself about her illogical fear of hospitals.
After talking this through for a while it became clear that Maria really did want to fix the problem now but that she also really wanted to know why it was happening to her. Although it is not always necessary to re-visit initial causes which often lie hidden in childhood memories it is oftem beneficial and this knowledge can underpin an eventual, "here and now", approach.
Maria was familiar with hypnosis but not the analytical or exploratory type that I recommended to her. Using visualisation techniques in trance I invited Maria's subconscious to re-visit episodes in her early life which seemed important to her and important to her problem. A few episodes were remembered before she re-visited, with visible distaste, an event at school where she had gone to see a nurse for an injection. Many of the children were crying and Maria had been very frightened and made such a fuss that she was sent home with a message for her mother.
After the trance Maria said that she could vaguely remember, before the hypnosis, this incident but that she had almost re-lived it in trance. She was surprised at how frightened she had felt.
She continued to talk about this whilst still relaxed and described how her mother had been very angry with her and told her that she would have to go to the hospital for the injection and had told her about lots of bad things that can happen in hospital. These bad things were childish and did not relate directly to her current list of fears. She was sure that she had been taken to the hospital some time later despite being terrified but her memory of this event was quite vague with some flash memories of smells and colours and nurses and feeling frightened.
It seemed that these events had been partially hidden in Maria's memory as is common with things that appear life-threatening to a young child. Hospitals, however, still provoked the fear response from Maria's, "inner child". Her adult mind colluded with this by changing the childish, "frightening possibilities", presented by her mother into more rational (even if very unlikely) adult ones. It is normal for old fears to be reinforced like this unless their source is understood and modified, often in therapy.
Now that Maria had a basis for understanding why she felt frightened we had a good foundation to address the problem, "here and now".
Fear of Hospitals
We adopted a cognitive (REBT) approach in the following two sessions.
I invited Maria write down all of the bad things that came to mind when thinking about the hospital. These were mostly things like, "I will probably be given the wrong drugs", and so on. Her list included some of her childish fears from childhood that had re-emerged. I then invited Maria to make a separate list with rational versions of her first list that she could really believe.
For example, she changed,
"I will probably be given the wrong drugs", to,
"It is remotely possible that I will be given the wrong drugs but very unlikely. It's the same for all the other people in the hospital and there is nothing that makes me special as far as getting the wrong drugs is concerned. Even if I am given the wrong drugs they are not likely to do any serious harm."
I then invited Maria to tear up her first list and to keep her rational one with her and read it when she felt like reading it.
This approach has the benefit of demonstrating quite forcefully to the subconscious that the old beliefs are not worth keeping. When reading the rational and truthful statements the old irrational beliefs no longer exist (they were torn up). The new beliefs begin to replace the old ones in the subconscious.
No mis-direction was employed. The truth that Maria believed rationally was always admitted and this was used to change old irrational beliefs using symbolic acts that are readily understood in the subconscious or, "inner mind".
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