During graduate school for counseling I attended practicum hours at a Department of Veterans Affairs (VA) facility, assigned to the Mental Health Intensive Case Management (MHICM) program. I was partnered with a team consisting of a female social worker and two female nurses.
Our team conducted community visits concerning veterans diagnosed with schizophrenia, bipolar disorder, schizoaffective disorder, major depression recurrent with psychosis, and posttraumatic stress disorder (PTSD) with psychosis. Many of our clients also experienced high hospital usage along with severe functional impairment.
At that time, there were few male counselors, social workers, and psychiatric nurses at the VA facility. Therefore, I was honored when the female social worker by whom I was mentored asked me to partake in a systematic desensitization exercise she devised around my male identity.
According to one source:
Systematic desensitization, or graduated exposure therapy, is a behavior therapy developed by the psychiatrist Joseph Wolpe. It is used when a phobia or anxiety disorder is maintained by classical conditioning. It shares the same elements of both cognitive-behavioral therapy [CBT] and applied behavior analysis. When used in applied behavior analysis, it is based on radical behaviorism as it incorporates counterconditioning principles. These include meditation (a private behavior or covert conditioning) and breathing (a public behavior or overt conditioning). From the cognitive psychology perspective, cognitions and feelings precede behavior, so it initially uses cognitive restructuring.
A female veteran with a PTSD diagnosis, who was served by the MHICM team, had a background of military sexual trauma (MST). Because there were males at the VA facility, she altogether forewent behavioral treatment for her condition and opted instead for psychiatric medication management.
The MHICM social worker and nurses routinely visited the veteran who experienced agoraphobia—avoidance of places and situations which may correlate with fear, anxiety, panic, or helplessness. Essentially, she was housebound due to severe PTSD symptoms.
I was told that the veteran maintained a history of childhood sexual trauma in addition to MST, as her sexual abuse history was said to have involved male perpetrators. The veteran absolutely refused any contact with men, to include interacting with the familiar postal employee who frequently delivered her mail.
The MHICM team worked with the veteran on a goal to begin treating the client’s symptoms through CBT. The ultimate goal was to visit the VA facility. Thus, a treatment plan was established as a means to take steps to fulfill the veteran’s interests and goals.
Not always are people willing to follow through with their treatment plans. Regarding this matter, I stated in a blogpost entitled Doing the Work:
Engagement in the process, or “doing the work,” relates to clients showing up to their scheduled appointments on time. It also involves active participation from the client. After all, REBT [Rational Emotive Behavior Therapy] is a directive modality (i.e., mutual dialogue) and I’m not prepared to do all of the talking.
I submit that in order to fully benefit from psychotherapy, one should, must, and ought to do the work necessary in order to achieve goals. It isn’t enough to merely understand or believe in the process of change, because dedicated practice is needed.
To begin the process of systematic desensitization, the social worker and nurses spoke with the veteran about visiting with me. Although I wasn’t present for those sessions, I was informed of how difficult it was for the client to even consider such a visit.
The next step was to practice visualization—the process of mentally picturing what a visit with me would be like. Once the veteran cleared that psychotherapeutic hurdle, I was allowed to go with the MHICM team to the client’s home, though remain seated in the vehicle.
The veteran was made aware of my presence while the team conducted a visit without me entering her home. For the next visit, the client cleared another hurdle by being able to look out of the window at me sitting in the vehicle.
I was informed that her reaction to beliefs about seeing me evoked significant distress. Still, at the next visit, she was able to exit her front door and conduct a therapy session on the porch of her home. The systematic steps of the desensitization process were working!
At our next visit, the veteran was invited to walk to the vehicle and return to her porch. However, she surprised the MHICM team by requesting to enter the vehicle.
I sat in the backseat behind the passenger of a government sport utility vehicle. Given my military training, I understood that sitting in the front passenger seat of a vehicle with someone seated in the backseat could result in death from being choked, stabbed, shot, or otherwise.
It’s likely that the veteran considered all of these possibilities, as well. Nevertheless, she entered the vehicle and sat in front of me with her passenger window rolled all the way down. The social worker sat in the driver seat, a nurse sat beside me, and the other nurse stood outside and spoke with the client.
I was so proud of the veteran, because her effort toward doing the work paid off. Although I wasn’t initially allowed to speak, the veteran conducted deep breathing exercises until she was comfortable enough to hear my voice.
It took only a couple visits after that for the client to visit the VA facility and meet with a male psychiatrist. When the work pays off, the benefit is truly something to behold!
That was one of the most meaningful experiences I had from my practicum placement. Since then, I’ve been helping people face their fears in similar ways.
As an example, during the COVID-19 lockdown, I was introduced to a client who also developed agoraphobia. Using systematic desensitization – in alignment with the behavioral component of reBt – this individual was able to eventually rejoin the rest of society.
Regarding the veteran and my client who systematically faced discomfort, I’m not the reason for success clients achieve. I merely play a role in the psychotherapeutic process.
Truly, it’s doing the work that yields success. When the work pays off for clients my work pays off, as well, because we benefit together. Would you like to know more about how you may be successful through use of systematic desensitization and other helpful tools?
If you’re looking for a provider who works to help you understand how thinking impacts physical, mental, emotional, and behavioral elements of your life—helping you to sharpen your critical thinking skills, I invite you to reach out today by using the contact widget on my website.
As a psychotherapist, I’m pleased to help people with an assortment of issues ranging from anger (hostility, rage, and aggression) to relational issues, adjustment matters, trauma experience, justice involvement, attention-deficit hyperactivity disorder, anxiety and depression, and other mood or personality-related matters.
At Hollings Therapy, LLC, serving all of Texas, I aim to treat clients with dignity and respect while offering a multi-lensed approach to the practice of psychotherapy and life coaching. My mission includes: Prioritizing the cognitive and emotive needs of clients, an overall reduction in client suffering, and supporting sustainable growth for the clients I serve. Rather than simply helping you to feel better, I want to help you get better!
Deric Hollings, LPC, LCSW
References:
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