PSYCHOTHERAPY BEYOND THE FRINGE, continued
An Encopretic Enuretic
Nathan’s case was not as easy as the others presented in this chapter. Like another patient, Neil, who had been treated successfully by Felicity at an earlier time, Nathan was unable to urinate in a public washroom. In fact, he even found it hard to urinate at home with the washroom door unlocked. But in a public place he just could not do it – the stream would not start and he was on edge, looking furtively around to see and hear if anyone else was entering the washroom. Like most people with this sort of problem, as a child he had worried that his peers would laugh at the size of his penis, he had half-remembered fantasies (or memories) of being interfered with sexually by adult males, and he was anxious or guilty about nocturnal tumescence or emissions – that is, erections or ‘wet dreams’ at night. But the real problem was that he was afraid of urinating in any public place and he could not allow himself to do so.
Nathan was half-heartedly interested in exploring the early experiences which may have led to his present problems. But he was definitely in a hurry to deal with his problem. He was a travelling salesman, and his problem was getting in the way of taking business trips any great distance from his home. His physician had tried him on all sorts of medications with no success. He now wanted results.
Felicity started him on a programme of systematic anxiety desensitization using Wolpe’s reciprocal inhibition therapy (RIT) method. Nathan was trained in the art of deep muscle relaxation. When sufficiently relaxed, he was asked repeatedly to picture a series of situations leading from the first sensations of bladder pressure when he was away from home, through urinating at home with the bathroom door locked, then unlocked. Then he was asked to picture himself driving to a restaurant, then walking into the restaurant to have a coffee, then going to the washroom to wash his hands. While washing his hands in the public washroom, he was asked to picture one, then two, then several men entering the washroom and urinating at the urinals. Finally, he was asked to picture himself urinating in a locked cubicle in a public washroom, then in an unlocked cubicle, then alone at a urinal, and then at a urinal with increasing numbers of others in the washroom.
With difficulty, over a long period of time (more than six months) he was able to feel comfortable imagining these scenes while relaxed. But he reported, “It pisses me off that I can’t piss in the real situation.” At irregular intervals, the desensitization treatment continued, with each new short burst of treatments addressing ‘ideas’ or ‘insights’ he had developed about the underlying nature of ‘the problem’. Pictures were presented related to childhood experiences in the neighbourhood in which he grew up, related to present life irritants concerned with his wife and his son, related to work crises, and related to his own sleeping habits. While relaxing with Felicity, he was apparently able to experience these scenes in his imagination comfortably without interfering with his relaxation. But his anxiety about, and avoidance of, urinating in public washrooms continued.