12 Chapters
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Chapter Five - Involving the General Practitioner: The Helpfulness and Limitations of Medications

Fear, Rhona M. Karnac Books ePub

Introduction

While this book deals largely with the ways in which you can help your clients deal with their problems with anxiety, there are also times in which you are well advised to recommend that they consult their GP or other health professional, such as Community Psychiatric Nurse (CPN), or Psychological Well-being Practitioner.

Consulting the GP

It is a wise option for you to enlist the help of your client's GP for a number of reasons, and to encourage your client to make a friend of him or her. Ethically, from your own point of view as a counsellor or psychotherapist, it is wise to ask all of your clients for permission to make a note of their GP and his/her practice so that you have someone to contact and advise you if your client should ever suffer from suicidal ideation. In this way, should this become a reality, you have someone with whom to share some responsibility for the welfare of your client and any steps she may take to end her life. I recommend that you explain the limits of confidentiality to your client at their initial assessment appointment with you. I make it clear that in the event of my believing that my client may harm themselves or someone else, I may deem it appropriate to break the confidentiality contract, although I will do my best to speak to them first (you also need to talk through your use of a supervisor, explaining that no names, occupations, or other distinguishing features are discussed). I am sure that many of you now provide your clients with a contract at their first appointment that lays down these very necessary guidelines and makes the limits of confidentiality and commitments regarding payment and cancellation periods clear to them. If the contract is only verbal, it is very easily forgotten or misinterpreted perhaps as a result of the distress that the client is probably feeling at the outset of counselling. It also may prove useful insurance if you should unfortunately become the subject of a complaint.

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Chapter Four - The Labels: Anxiety States and Phobias

Fear, Rhona M. Karnac Books ePub

Panic attacks

When anxiety is experienced in a heightened form—when worry and repeated months or years of fear have taken their toll—the individual may suffer what is known as a panic attack.

Any of you, as therapists or clients, who have suffered such an experience, will not be able to forget how you felt during these periods of time. It may well be that you felt—as I did at first—that I was about to die. I felt that I would not, and could not, survive if I continued to feel like this. There is an inexplicable tendency to want to run away—though “where” precisely, one is not sure, except perhaps to the safety of home. The emphasis is upon escape from the awfulness that is being experienced in the moment. It is very difficult—or well-nigh impossible—to think clearly or reason things out during a panic attack. Thoughts race from one image to another; cognitive processes do not function. This mental confusion does not help the person to achieve their desperate wish to escape. In time, the sufferer may begin to have the awareness that this is what it means to experience “a panic attack”.

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Chapter Three - What Is the Fear of the Fear Cycle and How Is It Maintained?

Fear, Rhona M. Karnac Books ePub

Physical reactions

In the preceding chapter I have detailed the changes that occur as a result of adrenaline coursing round the body. For example, a person may develop muscle tension in the legs, chest, and/or abdomen. For similar reasons associated with an excess of adrenaline, the individual may suffer breathlessness, dizziness, or palpitations. Any of these symptoms can be wrongly attributed to a serious, life-threatening health problem. Our clients may even have the thought: “I think I'm having a heart attack!” or “These are the symptoms of a stroke!”, or “I've got bowel cancer and may die!” Alternatively, our clients may feel fearful in the “here and now”—they may feel highly embarrassed and out of control at the idea that they may unavoidably vomit in public, or faint, or lose control of bowel or bladder.

When I was twenty-one, I developed a profound fear of vomiting in public, and as a consequence I gradually stopped going out in case I fell ill and vomited in public, and I also feared that I might faint. In consequence, over a period of two years, I developed a severe compulsion to avoid going out—in reality, my “vomit phobia” morphed into full-blown agoraphobia (the fear of public spaces). Unconsciously, I had taken the decision that if I were to avoid going out in public, I would not embarrass myself by being taken ill suddenly. I did not make the connections at age twenty-one, and in the 1960s, few GP's had any real skills in dealing with mental health issues. I was prescribed tranquillisers and left to cope as best I could. I carried on with life, incrementally avoiding more and more of normal living. I had finished higher education at polytechnic, but felt totally unable to force myself to further my career by seeking a job. I dare not step outside the door. The “low-point” or crisis arrived when my husband was promoted and we moved geographical area, far away from my support network of family and friends. I realised, as it became increasingly difficult to even go out of the house to take my dog for a walk, that I had been reduced to living what I termed “a half-life”. I was then aged twenty-three—hardly a stimulating way to live, and it was causing conflict in my marriage. Through sheer determination and desperation, I managed to access a psychologist who introduced me to a systematic desensitisation programme (as I describe in Chapters Six and Seven). Over the following six months, I gradually returned to being able to live normally. I felt well enough to apply for a job and go to work daily for the next two years. Then, my husband and I were confident enough in my recovery to decide to try for a baby. The systematic desensitisation programme revolutionised my life.

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Chapter Six - Breathing and Relaxation

Fear, Rhona M. Karnac Books ePub

Deep breathing

Many people, when very anxious, involuntarily start to hyperventilate. It is partially as a result of this that an individual feels breathless during a panic attack as if she cannot catch her breath. In reality the individual is suffering from too high a concentration of oxygen in relation to the carbon dioxide in her system. In order to stop this, you can help as a therapist by teaching your client to breathe into a paper bag (not a plastic bag, because this can be dangerous and lead to suffocation). When one breathes into a paper bag for a few minutes, rather than into the atmosphere, it changes the ratio of carbon dioxide to oxygen in the blood. One breathes back the carbon dioxide that is in the bag.

It can also help to tell your client to practise what is known as seven to eleven breathing. This entails inhaling to the count of seven, and then exhaling, counting from seven to eleven. Your client will become calmer if she does this for a few minutes. It can also be carried out less visibly than making use of a paper bag. As a consequence of breathing in this way, your client will start to feel less panicky.

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Chapter Nine - Case Study: Using Systematic Desensitisation to Recover from Driving Phobia

Fear, Rhona M. Karnac Books ePub

Introduction

This case study tells us about a woman in her thirties, “Amy”, with whom I worked on a short-term, employer-paid counselling contract. This is fortunate, because it serves to prove that huge changes can be achieved within just twelve counselling sessions.

Why was this client suffering from a driving phobia?

Amy asked her employees if she could come to see me because she had started to find it difficult to complete her journey to work every day. In the earlier years of her employment, she had driven herself to her place of work, but for the past three years she had been unable to confront the reality of driving herself anywhere, even within the locality of her home town. Recently, this phobia had grown more pronounced and she now found that she could not even countenance being a passenger in anyone's car. Consequently, she was no longer able to travel to work with a colleague, so she had resorted to travelling by bus. This was highly inconvenient because it involved her changing bus routes in the centre of town in order to take a second bus to reach her office. In consequence, it was taking her an hour and a half to complete her journey to work whereas she had been used to allowing just twenty minutes. Fortunately, she had retained the ownership of her own car, and this gave her access to the practice entailed in helping her to recover from her driving phobia.

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