A frequently asked question is whether phobias can be treated within one session. For example, at the time of writing a recent needle phobia patient that I worked was indeed resolved within 1 session. They needed to have blood tests on an ongoing basis through pregnancy and did not present with underlying anxieties. A non-complex phobic can therefore be treated in one or a few sessions, sometimes within a single session as was the case in this instance.
Equally, some phobics, such as those presenting who co-present with eg generalised anxiety, panic, panic disorder, depression, trauma / PTSD or social anxiety; are somewhat more complex to treat with one symptom reinforcing and contributing to other symptoms. Clearly in these instances an expectation of a single session resolution is wholly unrealistic.
The challenge with the more complex phobics is not necessarily the removal of the phobic response, but ensuring that the phobia resolution persists and that the phobia is not just displaced into another behaviour, which may well be more damaging. That is the implicit risk of using some of the faster “quick fix” techniques available to therapists which blindly target change within one session.
Additionally, some types of phobia are more complex than others eg Covid vaccination due to additional underlying vaccine anxieties, or emetophobia due to the underpinning fear of disease / death / making others ill. Whilst some phobias such as needle or dog phobia generally present as a simple phobia, underlying maladaptive beliefs can complicate matters substantially, especially if the beliefs are held unconsciously or where there is an unwillingness to vocalise them. This can impede the process of desensitisation.
Desensitisation is simply the process of moving from being sensitised ie avoidant / fearful to tolerant. From a therapeutic perspective there are many different ways of approaching the concept of desensitisation, with techniques available from the disciplines of hypnotherapy, REBT / CBT, NLP, EMDR and more besides. Possibly the most well-known techniques are hypnotherapeutically delivered systematic desensitisation, which facilitates desensitisation using a graded hierarchy of stimuli, with exposure facilitated in the imagination and the fast phobia “cure” from the NLP world.
A small number of phobics experience a very rapid onset of anxiety when physically exposed to their phobic stimuli with no anticipatory anxiety being reported. This rapid ramp-up can complicate the treatment process. With simple phobia cases there is generally some measurable perception of anxiety in anticipation of the eg injection and / or in presence of visual stimuli. That is part of how phobias are defined. The possible absence or unawareness of that response, simply means that additional steps need to be introduced into the treatment process to determine what is happening and when, or perhaps that a more non-standard desensitisation approach may be required. That takes time to determine and consider.
Effective therapy is also based on rapport and the capacity to relax in the therapy room and these factors can also take time to develop. Where underlying anxieties are present these can impede the process of learning to relax which from a neuroscience perspective maintains the nervous system in a non-plastic state that inhibits the change process.
In terms of estimating numbers of sessions required my website states: “There are a variety of approaches with substantial change typically in 1 to 5 sessions, with an average of around 2 sessions. Change can however be very rapid with complete resolution in a single session.” [About phobias and fears]
On the following page a very rough indication of complexity and therefore the possible number of sessions is provided via Low Medium High (LMH) indicators in the complexity column. [Issues that can be treated using hypnotherapy] (Phobias are listed as LM).
Apart from single session Smoking Cessation I do not seek to resolve an issue within a specific number of sessions. I will however always seek to facilitate change within the smallest number of sessions possible. As a therapy lecturer with many years of experience teaching at post graduate MSc level with the UWL, I insist that students do not attempt to promise resolution of issues within a pre-determined timeframe, and I refuse to enter into that debate beyond mentioning the broad ranges described above.
In terms of expectations, prospective clients should understand that clinical hypnotherapy treatment is not the same as stage hypnosis which is the origin many false unrealistic expectations. I would argue that stage “hypnosis” does not make use of hypnosis at all, quite the reverse. It is a mentalism act at best. They deselect anyone they perceive as being able to go into a deep trance state too readily (about 5% of the population) since they are far too immobile. I take the view that there is no form of trance state present at all in fact. Stage “hypnosis” relies on peer pressure, group dynamics and paid “plants” that give the rest of the group on stage an example to follow. The stage “hypnotist” selects those that 1) want to perform, 2) have friends with them they want to impress, 3) went to the bar before the performance, 4) are highly compliant ie do exactly as asked and 5) are highly extroverted individuals with a strong desire to perform.
The therapeutic approaches that I use seek to accelerate the change process as much as humanly possible, with short term quick fixes reserved for emergency situations. During the course of the first session, I very quickly I get a sense of what approaches work best for you as an individual by a process of experimentation and feedback. If there is slow response, we consider what might be underpinning that and change the strategy accordingly. Regressive or psychodynamic based hypnotherapeutic techniques may be needed to facilitate deeper change or to release emotion, before returning to desensitisation-based approaches to facilitate behaviour change.
Response to therapy does clearly vary between individuals. What I can say is that with the right level of motivation, clearly agreed goals and a high level of compliance with homework tasks (including deliberate behaviour change) substantial levels of change are possible, often quite rapidly. However, we are all different and excessive analysis of the process, negative expectation, anxiety, lack of compliance with techniques in the therapy room and back at home and / or an unwillingness to change behaviour; all contribute to a slower rate of change. So to answer the question: “Can phobias be treated in one session?” the best I can say is perhaps “where possible”.