Excerpted from THE AMERICAN JOURNAL OF CLINICAL HYPNOSIS,
Volume 21, Number 4, April 1979, beginning at page 293

Description

A married, 21-year-old female Caucasian majoring in art history requested treatment for a vomiting phobia. At age nine she was ill and vomited once, and two weeks later she faked an appendicitis attack to avoid being forced to eat stuffed eggs. (An appendectomy was performed.) She had not vomited since that time but was so concerned that she might vomit, that she was unable to be in the vicinity of sick people, or enter rooms where they had been. She could not chew gum, eat a large variety of foods, or care for her husband when he was sick. She desired but did not have children because she "couldn't care for them properly." Her parents considered her concern to be "silly," something she would outgrow.

Treatment

The patient was seen for eight sessions. The basic strategy was to motivate her to perform the phobic action, i.e., vomit. Friends and family members had tried to get her to vomit. I thought that if she did vomit, cognitive, visceral, and emotional change would result.

Session one was spent motivating her to follow the therapist's instructions which she was told would be presented the following week if she agreed to follow his instructions, regardless of her agreement or understanding of them. Much of the session was spent exploring how her problem limited her life, prevented growth, and restricted her freedom to explore roles and activities. We also explored her hostility towards others. She had some awareness that her hostility was aggravated by her feelings that others were accomplishing so little compared to what life had to offer, which paralleled the fact that her problem limited her to a life of underachievement as well.

To prepare her for the cognitive change that often accompanies the removal of a central symptom, she was told to expect some mental discomfort for a few weeks if she did agree to change. ***

The second session lasted 15 minutes. The patient was anxious, agitated, and hostile. Her first words were, "Are you going to make me get sick and throw up?" When she was told "yes," she became increasingly agitated and explained she did not think she could go through with it. I agreed that her feelings were understandable and told her that I suspected there was only a 50% chance she would go through with the procedure.

We reviewed the gains she knew would come if she stopped fearing vomiting and she was pressured to acknowledge that if she did not change now (since she had "survived" in a "satisfactory way" the previous twelve years), it was likely she would not change in the future. The statement that I thought there was only a 50% chance she would complete the treatment was repeated and she was told that if she decided to go ahead with treatment, she should make an appointment with her family physician and call me with his name and telephone number.

Two nights later she called with the requested information and told me that she had decided to continue therapy.

The third session (a week later) lasted 10 minutes. I had previously talked with her physician who confirmed that there would be no medical complications if she vomited. He agreed to give her a bottle of an emetic to induce vomiting. Although the preparation is available without a prescription, it was thought that obtaining it from a physician would increase the likelihood of her using it. The "50%" admonition was repeated and she was told to return to her physician who would give her the medication. She was to take the preparation that evening and return the following day.

She was very agitated and angry when she arrived for her fourth session. She had taken the chemical and had been "extremely ill for six hours" before she vomited. She questioned my competence and judgment, and the entire procedure. She had taken only half the amount she was directed to take because she was afraid she would get "too sick." She calmed down and following discussion, agreed it was her failure to follow instructions that needlessly prolonged her discomfort. She said that she was now less afraid of vomiting since "after all, it didn't kill me" but noted no "cognitive restructuring" as I had led her to believe would happen. She was congratulated for completing the procedure and told to come back in one week unless this cognitive change, which would happen, became unduly uncomfortable.

The following evening the patient called me at home and asked to see me. She was experiencing strange thoughts and emotions and wanted to talk about them. I met her and her husband and we went for a one-hour walk (session five). They were reassured that this disturbance would last only a few days at most, and it was suggested that the disturbance was a manifestation of stress being released. ***

The following week (session six) she was much more relaxed. She felt positive about herself, less hostile towards others and had begun to seek out many of the situations she had previously avoided (e.g., she visitied a sick friend in the hospital). A very animated and positive discussion about "the new me" followed and rapport was, for the first time, excellent and entirely unrestrained. ***

Session seven was a continuation of session six. She felt fine and related further positive changes. She was eating previously avoided foods and had helped a neighbor change her baby's diaper. ***

Seven months later she stopped by the clinic and told me she was pregnant. She thought her growth potential was unlimited and she was completely free of concern about vomiting.

Things to think about