From: mdkline@rodan.acs.syr.edu (Mark D. Kline)
Subject: Re: 15 min phobia cures (was Re: Xanax)
Organization: Syracuse University
Date: Fri, 11 Sep 92 21:20:12 EDT

In article <1992Sep10.203556.25525@samba.oit.unc.edu> wilkman@med.unc.edu (Alice Wilkman) writes:
>In article <1992Sep9.164508.2773@newstand.syr.edu> mdkline@rodan.acs.syr.edu
>(Mark D. Kline) writes... (much deleted)
>>...Or should we believe
>>in NLP because this fellow can cure phobias in 15 minutes.  I've
>>treated phobias in a single session - no drugs, no psychoanalysis, and
>>no NLP.  So what?
>
>Well, phobias and the treatment thereof have been the 
>subject of several postings lately.  This is an intriguing 
>assertion on your part.
>
>I would be very interested in hearing what you did 
>specifically to "treat" (and I presume you mean "cure" or 
>relieve the symptoms of) phobias in a single session.

As I have asserted in previous posts, many simple phobias are 
benign, self limiting conditions.  Thus its easy to cure them
and hard to be proud of it.  Most phobias do not come to 
treatment; most people either live with 'em or get over 'em.

The last phobia I treated in a single session was a lawyer with an
elevator phobia who had been offered a job in NYC -- In a skyscraper.
He had walked up 10 flights of stairs to get to my office.  On the
basis of his history and exam he clearly had a simple phobia (of
elevators) and no other psychiatric diagnosis. He and I discussed the
nature of phobias and phobic avoidance and the basic principle of
desensitization.  After an interview lasting roughly an hour, I
escorted him to the 10th floor lobby.  We talked baseball waiting for
the elevator to come.  He was quite anxious, but got into an empty
elevator car and rode it to the first floor (it was an express elevator
from 10 -> 1).  He called to cancel his second appointment because he
felt that he had gotten over his phobia.  He had been riding elevators
all over town -- at the courthouse, taking his girlfriend out to dinner
at the top of the ritziest local hotel, etc.  He took the job in NYC
and sent me a nice holiday card some months later; he was having no
problems with elevators.   At the time, I considered this intervention
more educational than anything else.

>What criteria did you use to determine that your patient had 
>a phobia?  What criteria did you use to determine success?  
>Did you do any follow-up to determine if the problem 
>returned?  How often have you done it?  How long is
>a typical session?  How often have you attempted a single 
>session treatment and failed in a single session?  What do 
>you do then?  How do you record this intervention on the 
>patient's chart?  Is this a method you learned from someone 
>else or did you develop it yourself?  The usual questions...

I don't attempt to treat anything in a single session, so I can't
report a failure rate.  The lawyer was scheduled for followup and
cancelled since he felt he didn't need it.  I don't treat simple
phobia in my office very often because these people generally don't
come to treatment.  Panic and agoraphobia are much more common in
my office.  

In general, for the treatment of phobias I believe in the behavioral
methods probably best described by Isaac Marks in his many writings;
(see for example, his chapter in Griest J: Treatment of Mental
Disorders, Oxford University Press, or his _Care and Cure of the
Neurosis_, reprinted by APA press in Washington.) Generally speaking,
psychotropics don't have a role in treating uncomplicated simple
phobia.

I hope this satisfactorily answers "the usual questions"

I hope this answers your questions satisfactorily.
--
================================================================= 
mark kline                              mdkline@rodan.acs.syr.edu
suny health science center, syracuse    voice: (315) 422-1050
================ courtesy of syracuse university ================
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