Dear Therapist:

When I was a teenager, I developed a severe phobia. I don’t think it is relevant to be more specific as to what it was. What matters is that my father learned a lot about it, got a lot of books and workbooks, and took it upon himself to help me work through it. The best method he said is a CBT approach called “exposure therapy.” This led to him pushing me very hard to be in the exact situations that were making me afraid. This exposure was supposed to lead to me becoming less and less afraid as the time went on. This turned out to be an extremely difficult process for me and created a lot of tension in the relationship with my father. I don’t know if the phobia is better or worse now because it just isn’t really that relevant in my life, but I am extremely anxious and depressed and have recently started wondering if I can trace that back to the stressful times when I did my “exposure therapy.” Can you please share your thought on exposure therapy and how/if this type of thing can be done without a professional? Can you explain how this can work and what some of the risks are? Lastly, do you think that this may be related to my current mental health and if yes how can this be helped? Thank you.

Response:

The human brain is far too complex to guess at causes and triggers for emotional issues. You are referring to a very specific teenage experience, and are asking whether this contributed to your current anxiety and depression. To some extent, all of our experiences impact on others. Our emotional states, coping skills, fears, insecurities, triggers, and other aspects of our personalities and selves developed as a combination of our innumerable experiences and the thoughts and feelings associated with these.

It is likely that your experience with your father’s application of exposure therapy affected you in some way. Perhaps it contributed to your general anxiety—or perhaps your anxiety is now lower than it might have otherwise been. Perhaps your feelings of depression are more significant, but you are not debilitated by crushing phobic fears and rituals. There are so many possibilities.

Most important, however, is the question of whether there is a point to identifying early causes for your current symptoms. Although they may be of academic interest, will it help you to identify these causes? For some people, doing so can be extremely helpful in the process of changing problematic emotions and behaviors. For others, it can actually be detrimental. This is a complicated subject, and the determination should be made in conjunction with a therapist who is experienced in these areas.

Generally speaking, work on contributing causes should be done to help achieve a specific goal. In therapy, goals are ascertained and specific strategies identified to help the person to achieve these goals. Some strategies incorporate a psychoanalytic aspect, while others do not. Connecting early causes with current symptoms is not a goal if itself, but rather a tool that can be utilized when deemed appropriate.

Regardless, you shared the fact that you are anxious and depressed. You mentioned your phobia as a teenager, your father’s approach, and the resultant strain within your relationship with him. These are all issues that clearly affect you, and should be addressed (together or separately).

As with any psychological treatment—and indeed any medical treatment—administration should be left to the professionals. Although you might apply antibiotic ointment to a scratch, you would likely not ask a friend to repair your ruptured appendix. Not only does your friend not have the training to perform the specific procedure, but he also does not have the broad training and knowledge necessary to understand various ways in which the procedure can affect other organs and the body as a whole.

Although exposure therapy might have been a strategy implemented by a professional at the time, this would have been decided only after a full assessment was done. This would have addressed areas of concern, related issues, and other possible strategies. The implications—both general and specific to you—of any strategy or combination thereof would have been addressed as well.  

-Yehuda Lieberman, LCSW

  psychotherapist in private practice

  Woodmere, NY

  adjunct professor at Touro College

  Graduate School of Social Work

  author of Self-Esteem: A Primer

  www.ylcsw.com / 516-218-4200

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