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Behavioral Change...Dr. Rob Style

Posted Oct 23 2008 11:24am

We've learned before about the importance of verbally confronting clients when psychological barriers are impeding their progress. Unfortunately there are times when you can talk a problem to death with no results. When that happens a client needs to do something to see change. A classic example of this is a common phobia: no matter how much you talk about your fear of flying, until you get on the plane and sit there and feel the anxiety until it subsides not much is going to happen.

This is known as Exposure Therapy and is based on the idea that anxiety is often a physiological reaction to a perceived danger. Through multiple plane rides (called "trials" in the shrink world) the body and mind starts to recognize that inherent danger is not present and the anxiety subsides. When a client can take that final step and begin exposure trials outside the therapy room life often becomes much better because Exposure Therapy has a great track record for treating fears and aversions. When he can't take that step his therapist has to at least consider the possibility of taking it for him.

Consider my work with Bryan, a young graduate student who was working with me on a variety of dating issues for some time. Bryan put a lot of effort into therapy and we had a very strong working relationship. Most recently Bryan had been grappling with initiating phone contact with women. He could speak with them in person, get their phone numbers and even make tentative plans to go out with them but when the time came to make the call to solidify those plans, he would freeze.

Bryan and I talked about this ad nauseum over many weeks using every therapeutic technique in the book.

"C'mon Bryan, what's going through your mind right now. I can practically see the wheels spinning in your head. Talk to me."

"I don't understand it. The odds of her saying yes are so high. I can't get a grip on what I'm telling myself that's making me lock up. Dammit!"

"Are you thinking that she might say no?"

"No. I'm actually thinking how great it will feel to get this call over with no matter what she says. I just want to get over this last damn step."

"Close your eyes. What do you see when you picture making the call?"

"I see us having a great conversation that ends with a plan for dinner. Possibly seafood."

"Great," I said. "I love seafood. Go home, pick up the phone and call."

"I want to but I know that once I leave here I'll say 'screw it' and be back here complaining about the same shit next week."

"How about this: call her here, in the office, right now. I'll go outside so you can have some privacy."

"I don't know. That's so...high school."

"Maybe so but you're not getting it done outside of this office."

"No, I'll just wait and do it later."

"Bryan, who are we kidding? You just said that won't happen. Even though you've told me that this date is a slam dunk you've got something blocking you. Instead of us analyzing that obstacle until we're both tired and miserable just call her. It's going to be fine. Would I ever lead you astray?"

"I think I'll just wait..."

"Bryan, give me your Goddamn phone!"


"You heard me. Give it to me."

He reached into his pocket and cautiously handed it over.

"The number please."

He told it to me.

"It's ringing. Here. You're going to be fine. She'll say yes and you'll the next thing you know you'll be at your local eatery hoping they name a fish sandwich after me."

He took the phone, eyes wide, moved it slowly to his ear. Beads of sweat immediately appeared on his forehead. With his voice initially cracking he got out his name and a reminder on how they met. I stepped outside to give him a little space and when I no longer heard his muted voice and could make-out the snap of his cell phone closing I opened the door. Ah yes, another successful therapy session as a young man finds true love! Rob, why you aren't on every magazines' Best Doctors List is beyond me. In fact you should start your own dating site:

"So Romeo, how did it go?"

"She said no" he said staring blankly at the wall.


"She said no?"


" said that this was probably a no-brainer."

"Yeah I thought so. Apparently she was really drunk when she gave me her number and doesn't have much recollection of me."

Therapist Rule: If you believe you've made a clinical error address it head-on.

"I'm sorry about that Bryan. Maybe pushing you like that wasn't the best idea. Are you angry with me?"

"No not at all. I think I'm still coming down from the anxiety of the phone call."

"To be honest if you had made that call on your own and this had happened I would have said that while we knew there were no guarantees that she would say yes, you did what you thought was a positive action. And in fact it was positive because you took a crucial step in getting over your fear. I don't know if that's what you want to hear right now given that I basically forced you into calling her."

"I guess that's all still true, right?" Bryan asked, cracking a smile as the adrenaline began to subside.

"So, um...since we're on a roll are there any other women you'd like to call during this session?"

Shockingly Bryan was interested in making another call. Exposure Therapy usually requires more than one attempt before the fear is extinguished. Unfortunately the second woman also rejected him, leaving me to wonder where the hell he was getting the idea that all these women were into him. "Is Bryan a Narcissist?" I wondered. "Probably not, just a little too cocksure, so to speak." We called it a day after that and he spent most of the week making calls to women with varying degrees of success.

The good news however was that Bryan ultimately overcame the phone aversion through Exposure Therapy. Many clinicians might question that choice of treatment claiming that he wasn't ready and I risked traumatizing him. This is a somewhat fair point although I knew Bryan well and assumed he could handle it. And the reality is that Exposure Therapy rarely goes wrong if the client is motivated and knows that taking that step is in his best interests. It's also hard to argue with results in this case. Unless I had beaten him with a cane or something until he called that woman. That probably would have worked as well I suppose. Oh well, maybe next time.

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