Background to my interest in teaching children with autism

PSYCHOTHERAPY BEYOND THE FRINGE, continued

A Fountain Mountain

Noel was a married professional man in his early forties. He was referred to Felicity for an aquaphobia. Now let’s be clear. This was not hydrophobia – a symptom of rabies. This was aquaphobia. He was afraid of water. The real presenting problem was concerned with the two major effects his phobia had on his life. He could not drink water, and his physician had told him he had to drink water for his health. And he could not take a bath, and his wife had told him that she could no longer stand being near him – given his growing aromatic body odour.

It would have been deleterious to his health, his marriage and his work with other people to spend time trying to unravel the dark and mysterious causes, buried deep in his unconscious, which might underlie this strange condition. Instead, without further ado, Felicity began training Noel in the art of deep muscle relaxation. In two hours of training, Noel had achieved a deep enough level of relaxation to begin the systematic desensitization of his anxiety – using Wolpe’s reciprocal inhibition therapy (RIT) method.

The imaginal presentations began with him looking at a drinking fountain at the end of a long hall, and very slowly approaching closer and closer to it. The pictures then began at a distance again, watching somebody turn on the drinking fountain and take a drink. Again, in imagination he was moved closer and closer, watching while the person took drink after drink. Privately, Felicity was worried Noel might suddenly become panicky for fear the man drinking at the fountain would drown himself. However, apparently the man did not drown, nor did the idea or the terror occur to Noel. Then he was asked to picture himself walking into a washroom and seeing a basin and tap, and slowly moving closer and closer to it. That sequence was repeated while he watched someone else turn on the tap and wash his hands in the water, and then his face. Then the pictures involved standing at a drinking fountain, and then at a tap, and merely turning on the water and looking at it. Then he was asked to picture himself washing his hands under the tap, then filling a cup from the tap, then drinking some water from the cup, and then drinking some water from the drinking fountain. Then he was asked to picture himself wetting his hands and rubbing the moist hands over his face, then washing his face in water splashed by his hands from the tap. Then he was asked to picture himself running an inch of water into the bath tub and standing in it barefoot. Then more and more water was added to the tub as he stood in it naked. Then he sat in the water in the tub. Finally he bathed himself in the water in the tub.

The pictures never progressed to the shower or to getting near, let alone in, a swimming pool. He terminated contact before these images could be introduced since he had met his goals – he was drinking water and bathing his body at the sink (not yet in the tub). The sequence of presentations was a long one, and progress through it was laboured and slow. He was obviously opposed to the idea of dealing with water, and was not going to yield as easily as Nicole had done. But the result was as expected, and he was finally able to do the steps up to, but not including, the last situations ‘desensitized’. It would seem that the ‘real life’ situation is essentially ‘one hierarchy step’ above the scene as it is represented by the imagined picture.

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