Client won't give up control
I had what I think must be my most difficult client the other day.
She was a young woman who came in because she has a fear of injections. However, that was only one of her multiple problems. She also has a fear that she will stop breathing when she is going to sleep. She has fear of losing control, she wants to have things remain the same, and hates change. For example rearranging the furniture at home sends her into a frenzy and she must move it back again. She is never on time and never seems to be able to get things finished on time.
All of these symptoms suggest someone with a touch of OCD. It seemed to me that these are all aspects of a collusive disorder. However, I am not a psychiatrist so I just deal with what is presented to me.
Why go to a hypnotist, if you don't want hypnosis?
She seemed very nervous, so I tried to create rapport and establish a common ground. Eventually she relaxed enough to let down her guard and chatted in a friendly way until I brought up the idea of hypnosis. She was absolutely dead against it. She said she could never give up control and did not want to be hypnotized. I explained that hypnosis was natural and normal and that she went into hypnosis several times a day, and gave her examples of daydreaming etc. She agreed that she did all these things but still would not try formal hypnosis.
I explained what metaphor therapy was and she agreed that she could do that. So I moved her to the big comfy chair and said 'This is not hypnosis, I am just going to ask you to breathe.' This brought out an instant opposition. She was not going to focus on breathing because it would remind her of sleeping and the fear of stopping breathing. Ok, I said "just close your eyes". Again total opposition, not going to close her eyes, because it would be like losing control.
Progressing when the Client won't give up control
I then tried a simple relaxation routine. I asked her to raise her hands then then slowly let them down and feel the body relaxing as they are lowered.
Lowering her hands six inches took about five minutes. She was totally reluctant to do any thing that would make her relax because of the loss of control. So I abandoned that idea. I then asked her to imagine that her arms and legs were so tired that she couldn't move them. She said 'Oh yes, I know what that is like. I don't like it.' So that was out.
I then tried a progressive relaxation. I had her lift up her shoulders and let them slump. Then tense her arms and let go the tension. This generated lots of giggles, but eventually I persuaded her to tense and release her chest, tummy, hips etc all the way down to her feet. She was a bit less tense by the end, so I did it again. And after a third time she agreed that she did feel less tense, and would like to do the metaphor therapy to get rid of the needle phobia.
"Close your eyes." She still couldn't close her eyes. I therefore tried the oldest hypnotic trick in the book, a eye fixation induction. I told to keep relaxed in her body, but to fix her gaze on a spot somewhere. Then I did a long, gradual series of suggestions that her eyes were getting heavy and her eyelids wanted to close. This took so long that by the end, my eyelids wanted to close! This was hard work.
How to give up control
Eventually she started flickering her eyelids. I then developed the safe place induction: imagine lying in some comfortable place etc. Her eyes finally closed and I could get on with the therapy.
I started with the therapy, and asked her to get the feeling she gets when she thinks about the needle. As might be predicted, even fully relaxed and with her eyes closed, she said could not get the feeling. More suggestions about relaxing and eventually she said that she could feel it. I was able to make some progress on the phobia and she agreed that it had been cleared.
I then gave her some general suggestions to help with the intrusive thoughts of the OCD pattern and brought her out. And the first thing she said was 'I just felt tired, that's why I had my eyes closed, it wasn't anything you did.'
I cannot recall ever having a client who was so unable to give up control.
What would you do in this case?
