There is a saying in social agencies which goes, “Always meet the client where they are.” I remember my first clinical supervisor telling me about that. It translates roughly into the concept that as therapists we should never force our own ideas on the client or expect them to want for themselves what we want for them – we are to meet them where THEY are. The following case of Victor illustrates the wisdom of “meeting the client where they are” as well as the effective use of doing “EFT homework” between sessions.
Victor’s persistent use of EFT homework between therapy sessions was admirable. It was due to his diligence in whittling away at each and every detail of his troubling phobia that aided in his completely clearing the problem.
This huge strapping young man had been referred to me by his student counseling center at the Ivy League college where he was a senior and important member (a former one as it turned out) of the university’s football team. The counseling center had tried all the standard behavioral and psychodynamic approaches with Victor with no success. The chief psychologist there knew me and knew that I was always trying “new approaches” so he sent him to me. No-one could think of anything else to do.
When Victor came to see me he was so agitated he could barely remain seated on a chair while telling me his story. He kept jumping up and pacing back and forth and then sitting down again. His face was red. He was breathless. He talked so rapidly that I had to listen with the greatest attention to catch everything he said. Later I was to discover that some of this “hyper” behavior was just the way Victor was. By nature he is an intensely active person, ambitious, and driving.
However, his normal level of intensity was greatly exaggerated by his distress at finding himself — a sturdy fellow who had thought he could conquer all obstacles – terrified to the point of trembling and almost fainting when he had to drive (or even when he was driven) through tunnels, or found himself in any enclosed space such as a plane cabin. He had never before in his life had any irrational fears but had always been daring and plucky.
The origin of Victor’s problem was clear, but up until now it had proven impossible to clear up. Several months previously he had sustained a severe shoulder injury during football which had disqualified him from the team and for which he had to obtain extensive medical treatment for several months. In the course of this his doctor had ordered an MRI to determine the extent of the injury.
When Victor entered the MRI apparatus — a narrow tunnel-like device in which one lies confined, while being mechanically moved slowly through the tunnel — he literally had to be squeezed into it in order for his broad torso to fit into the space. As he moved through the tunnel on his back the apparatus suddenly came to a halt and it wouldn’t open no matter how forcefully the staff tried. In his words, “I was stuck in the damned thing and they couldn’t get me out! They couldn’t get me out!”
Terrified by the fact that he couldn’t move, Victor had marshaled a massive effort, and using all his considerable strength (while yelling at them to “Do something!”) he somehow managed to kick and twist and push hard enough to break the apparatus and crawl out.
He didn’t sustain any bodily injury from this event, but was so shaken by it that since that time he had not been able to approach a tunnel of any sort (no matter how small) or allow himself to be confined in any small space without panicking. No application of systematic desensitization, or any other therapy technique, had been able to diminish this terror.
Victor was now at a point where he felt despair about ever finding a solution, but when I told him (as I regularly do in such cases) that we now have “new techniques for dealing with traumas like this that are ‘state of the art’ and able to accomplish things that former methods couldn’t handle at all,” and that this method has been used successfully on “Viet Nam veterans who had flashbacks for 25 years that nothing else could handle,” a look of determination crossed his face. I knew he was going to put everything he had into clearing up this problem. His drive to help himself was tremendous, just as it had been when he broke the MRI apparatus to free himself.
Victor’s cure was not a One Minute Wonder. It took us over two and a half months biweekly therapy sessions, and later weekly sessions, for him to arrive at the point where he could go about his life without fear. Apparently the trauma was deeply embedded, perhaps within a context of other long forgotten past traumas. But we never found about this possibility because Victor wasn’t AT ALL interested in delving into the past or in delving at all, for that matter. His approach was direct, practical and to the point. “Let’s do what we have to do and get this over with” was his philosophy. The words of my supervisor rung in my ears – “Meet the client where they are.” That’s the way we went.
Here is the “Victor-designed” treatment plan which he followed. He didn’t want to go near any big tunnels at first (the Holland Tunnel leading to New York City was his eventual target but he wasn’t ready for that yet) and he decided to try using EFT while driving past, but not going through, a few local under-railroad tunnels in the vicinity where he lived.
Victor responded well to EFT in our sessions together. He would regularly bring his SUDS level [0-10 intensity] down to near zero while he was in my office. But out on the road it was different. The anxiety would return in full force and at first would overwhelm him. This is something quite exceptional in the course of EFT treatment, because we usually see considerable carry-over from the office treatment into the actual real life situation.
I was eager to investigate other aspects of his problem that might be playing into this — childhood memories, fears of the future, secondary gains, etc. – but Victor wanted none of this. He insisted on sticking to the point and just getting it all over with. So that’s exactly what we did – I met the client where he was!
Victor moved ahead step by step. He went from first being able to approach only small local tunnels by stopping before he reached them (at my suggestion) to reduce his SUDS level to a zero before going through them. He would then report his progress at the next therapy session. During his sessions he would work, using “anticipatory” EFT, on the next step he was planning.
Bit by bit, Victor reduced his fear of tunnels. He tackled increasingly bigger tunnels each week, until finally one day he found himself able to drive up to the dreaded Holland Tunnel, park at a service station near the entrance, tap his fear down to a zero, and then drive straight through the tunnel. This wasn’t easy for him to do and his SUDS level rose again to a 6 while he was inside the tunnel but, as I had instructed him to do, he pulled over to the side of the road right after he emerged from the tunnel and tapped the anxiety down to a zero again.
He had to do this time after time before he could go through the Holland Tunnel without a sharp rise in anxiety. But Victor simply drove the necessary 40 miles to reach that tunnel every other day for several weeks. His determination was awe inspiring. Each time his ease with the situation increased a little bit and he would come to his therapy session for reinforcement for the next try, and then go off to tackle the monster once more.
He was in charge of the treatment plan but he wanted my help, suggestions and encouragement. I gave him all of these things. I knew he’d come out on top. There was no doubt of it in my mind, and I’m sure I conveyed my confidence to him.
What does Victor’s eventual triumph teach us? We know it had much to do with his character. He was a systematic person, a hard worker, and he had a formidable drive to “get ahead”. He was a classic Type A personality. Even before graduating, his goal was to be recruited by a Fortune 500 company and to start a successful business career immediately after graduating. He was determined that nothing should come in the way of it.
With this immense drive, he was able to overcome his fear of tunnels using EFT in a manner which took longer than I think might have been necessary had he handled some of the confounding aspects of these fears – but it was his way, and it worked. Victor has remained free of the fear of tunnels to this day. He had to do some additional work on other confined spaces such as plane cabins, but he eventually overcame these fears too, and was able to travel by plane to an important job interview just before his graduation.
Incidentally, he got the offer he was striving for from a Fortune 500 company, accepted it, and now flies all over the world for his company.
EFT Master, Dr. Patricia Carrington