Wednesday, March 15, 2006

Insight Therapy for Agoraphobia

If you have agoraphobia, insight therapy can either help you make a major breakthrough or turn out to be an expensive trap. Insight therapy has not been proven by research to be as effective as the cognitve-behavioral approach, but some therapists do practice it. If you are going to try insight therapy, it's good to know something about it.

Insight therapy comes from Freudian Psychoanalysis which was popular in the early 20th century. In this type of therapy, the patient talks at length about his or her thought and feelings, and the therapist analyzes them. The goal of insight therapy is to figure out the deeper reason behind why you are suffering from a particular psychological disorder. In the case of agoraphobia, the goal would be to figure out what about your life is behind all the fear.

Before you go to a therapist, it might be worth it to try to figure out what is behind your fear on your own. Ultimately, the answer will come out of you, with or without the therapist. Therapists are trained to help you figure it out if you can't do it on your own.

Here are three questions to ask yourself to gain insight into your fear:

1) What life circumstances coincide with your fear?

To answer this question it might be helpful to journal. Recall the times in your life when you have felt the most fear and anxiety, and struggled the most with agoraphobia. Write down what was going on in your life during each of these times and then look for themes.

Many people with agoraphobia discover that their symptoms are the worst during times when they
- felt stuck in a bad situation they couldn't get out of
- felt like they really needed to or should do something but felt helpless or powerless to do it
- felt like they were being negatively affected by circumstances beyond their control
- felt like they were never good enough for themselves or for someone else they could not please

2) What emotions went along with these circumstances?

The answer to this question could be one of a myriad of negative emotions. You may have felt angry, frustrated, sorrowful, sad, ashamed, anxious, nervous, guilty, weak, helpless, overwhelmed or simply out of control.

3) What type of fear did your circumstances or emotions lead to?

Some possibilities would be:

- fear of failure
- fear of insignificance, or lack of purpose
- fear of losing control
- fear of loss
- fear of identity or role loss
- fear of losing approval
- fear of abandonment or isolation

The idea behing insight therapy is that once you can answer these questions you can start to do something about getting free from agoraphobia. You can exert power to change your circumstances once you know what is leading to the fear. Cognitive-behavioral therapy offers a faster road to recovery from the symptoms of agoraphobia, while insight therapy offers the possibility of slowly removing the psychological roots of the fear so it won't come back.

Put another way, cognitive-behavioral therapy may help you get well, and insight therapy can help you stay well.

Here is an example of how insight therapy can be used on your own to recover from agoraphobia:

A young boy grows up with parents who put immense pressure upon him to perform in school, but he is more interested in sports. Though he makes b's in the classroom, he excels in sports. The b's are not good enough for his parents and he is scolded and punished for doing so "poorly" in school every time he brings home a report card. When he begins high school, he starts falling behind in classes because sports are taking so much of his time. After receiving poor grades on his first tests, he starts having panic attacks every time he goes to class. he becomes afraid to go to school because of the panic attacks and its not long before he is housebound with agoraphobia.

Although he "recovers" and finishes high school, he experiences panic attacks and hyperventilation two more times in his life. One time is when he is in a job with boss he can not please no matter what he does. The other time is during a relationship with and engagement to a woman whom he can never please either.

After journaling about the times in his life when he experienced panic atttacks, he comes to the realization that they all had one thing in common - they occured when he was caught in a relationship of some form with someone significant he felt unable to please. This made him feel helpless and nervous and led to fears of failure and loss (loss of approval, a job, and a fiancee).

After choosing to work for and be in relationships with people whom he could please, his anxiety lessened and he quit having panic attacks.

Of course, this example is overly simplified, but it illustrates how insight therapy can work.

Sometimes it is not so easy to get insight. In some cases your feelings may be unknown to you or lurking at a subconscious level. That's when it might be helpful to consult a therapist, but if you do you should proceed carefully and follow a few guidelines:

1) Tell the therapist what your goal is - that you are recovering from agoraphobia and that you need help discovering the life circumstances and feelings that are behind your fear.

2) Make sure the therapist is willing to share direct and honest conclusions with you.

3) Agree on how many sessions the therapy is expected to last. Make sure the therapy can be done in no more than 5-6 one-hour sessions. An experienced therapist should be able to provide the insight you need within that length of time.

Following these guidelines will keep you out of an expensive trap with a therapist who takes forever leading you to your own conclusions. If you pay for professional help, you are paying for the therapist's insights and you don't want to get caught in a never-ending therapy program where you are expected to keep coming to therapy until you make your own.

Also, it's easy to get too comfortable with therapy or attached to the therapist if it goes on too long. Especially if you are isolated, lonely, and need someone to talk to. Remember that if you have agoraphobia, your goal is to get well, not to settle into a comfort zone and get content with just talking about your illness with a friendly, caring person.

Your life is too valuable to spend suffering from agoraphobia.

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