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  1. #1
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    Default Disagreeing with therapist about over-exposure

    Hello! I have emetophobia and social phobia. For the last year I've been seeing a therapist. CBT seems to work really well when it comes to the social phobia, but the emetophobia is as present as ever. I constantly worry about germs and bacteria, monitor other people to check if they're OK, wash my hands until they bleed, am seriously underweight, and worry, worry, worry, panic, freak out and so on.

    The therapist says I can be cured if I expose *and* over-expose myself to the scary things. She wants me to touch things in public restrooms without washing my hands afterwards, lick/eat things that have been on the floor - stuff like that - and I just won't do that. Actually, since our last conversation about over-exposure I keep thinking I'd rather keep the phobia. It also seems to me that the therapist doesn't know how germs are spread, she talks about them as if you randomly catch things no matter what kind of hygiene habits you have ... and it makes it hard for me to trust her.

    I just want to be able to have a normal life, do normal things, eat normal amounts of food and wash my hands 5-10 times every day instead of 50-100. Exposure seems hard and terrifying enough and over-exposure is simply unthinkable when I'm not even able to touch my food or my lips when I washed my hands only seconds ago. But at the same time ... disagreeing with the therapist feels silly.

    Any thoughts? Is over-exposure really that important? When the therapist's suggestions terrifies me and makes me want to hold on to the phobia, is it just the way it is when the phobia is severe or should I try to find some other therapist?

  2. #2
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    Default Re: Disagreeing with therapist about over-exposure

    She sounds a bit of a rubbish therapist to me. Exposure is widely used in the treatment of phobias for the usual suspects of spiders and pigeons etc where you start off looking at a picture in a book, then look at one in a cage then eventually touch one, and some people do use a similar sort of exposure therapy for emet where you look at pictures, words and then maybe videos but to suggest you lick things that have been on the floor, not to wash your hands after usig a public loo etc is just downright weird and vergeing on irresponsible imo. And i'm not sure of it's effectiveness with emet anyway as i'm convinced it often has more deep-rooted causes than just disliking v* such as loss of control issues etc.

    What if you followed her advice then got noro? - in what way exactly would that be helping your phobia when it would be something you were totally unprepared for, unequipped to deal with and is proven not to cure peoples emet in the long term anyway?

    obviously your hand washing is over-excessive but i think your goal of 5-10 times a day is sensible and achievable, but it's not going to happen overnight. Why not try and cut down gradually? it may also help you to know that if your hands are dried and cracked they actually harbour more bacteria than soft skinned hands?! That was what helped me to cut down on obsessive washing and sanitising. Also treat yourself to a really nice hand cream, one that costs more than you would normally spend - you won't want to be washing it off all the time.

    Any therapist that tries to force you into something you are not ready for isn't worth having and forcing someone into looking at v* or inducing them to v* themselves can do more harm than good. Find yourself another therpaist is my advice.

  3. #3
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    Default Re: Disagreeing with therapist about over-exposure

    People eat food that has been on the floor and leave bathrooms without washing their hands everyday. Millions of times a day and manage not to fall down dead from it. The problem is that you are very fearful of germs to the point that it overwhelms you. What your therapist is trying to do is make you expose yourself to these 'threats' so you will learn that you can do it and survive.

    It seems safer to keep the phobia than try such 'risky' things right? That is a normal feeling. We have so much built up in our brains as life threatening that it is hard to simply expose ourselves. It's like if I was scared of getting hit by a car and someone suggested I jump in front of one to cure it. I would see that as life threatening, risky and stupid. This is how emet feels. We equate vomiting with dying and to risk it is the same as jumping in front of a car. This is our incorrect and flawed thinking because it is actually not the same.

    Talk to your therapist about everything you have said here. You should not be forced or pressured into an activity, this will do nothing to help overcome your fear. Tell her that although over exposure might be something that is helpful to you in the future, for right now you need to work on being able to even consider it because that is how deep rooted your fears are! You guys are working together on a cure for you.

    Although your therapist might have the knowledge and the tools to help you, you have to be ready and willing or nothing will help. Don't feel badly for not being at that stage yet, just discuss it with your threrapist and work on something that you can push yourself on. Never stop pushing the boundaries of your fears but don't be ashamed if you have to start small like only washing your hands 95 times a day instead of 100. Good luck!
    Last edited by hippychick; 02-15-2010 at 10:50 AM.
    Be courageous, believe in yourself, and be the best woman you can be. I'm with you all the way.

  4. #4
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    Default Re: Disagreeing with therapist about over-exposure

    To be candid that's the exact advice my therapist gave me.

    I've gone out and done all those things, and my emet is pretty much gone.

    I know it sucks at first, but it really does work. Just start out small... eat a meal without washing your hands before. Then you can do the things you find scarier.

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  5. #5
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    Default Re: Disagreeing with therapist about over-exposure

    I think if she makes you uncomfortable you should find a new therapist. Over-exposure therapy is supposed to work but emetophobia is a hard phobia to cure (along with all the other phobias that may come with it such as being afraid of germs). If she's telling you to pick things up off the bathroom floor and lick them she sounds insane. A normal person wouldnt even do that. Yes she sounds like a nut.

  6. #6
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    Default Re: Disagreeing with therapist about over-exposure

    Thanks guys for sharing your thoughts, it means a lot to me since I'm quite confused right now

    I'm thinking ... since I feel comfortable with both the CBT and the therapist when it comes to the social phobia. I'll talk to her again about the emetophobia and try to explain how I feel and then decide what to do. Maybe she hasn't yet fully understood how very fearful I am. It's like we're on completely different levels when she's talking about not washing hands after using public toilets while I struggle with cooking and eating in my own home even after washing my hands like crazy. Being able to handle and eat food in my own home without fear would be fantastic and improve the quality of my life tremendously and maybe that's where I need to start.

    At this point I guess I'm not really interested in being able to do all the scary things - I doubt that I will ever eat something that has been on the floor, because eating things that has been on plates would be good and normal enough for me - but I think I'm ready to take some baby steps in the right direction.

    paulinek – thanks for the tip about cutting down the obsessive washing. These last weeks the washing has been pretty much out of control – the only way to stop it seems to be staying at home and starve myself (which is not a good idea) – and I really need to start taking better care of my hands or I won't be able to cook or type or anything.

  7. #7
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    Default Re: Disagreeing with therapist about over-exposure

    I have had CBT twice now with different therapists and i still very much have emetophobia and believe i always will. It has helped me with being able to control my panic attacks a little bit more then before but thats about it. I have also seen a hypnotist recently too and that didn't cure my phobia either however it helped me understand where the cause of it may have come from. I think a lot of therapy is down to the person having it. I think the reason that it didnt work for me is because im scared of not being scared of it as mad as that my sound.

  8. #8
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    Default Re: Disagreeing with therapist about over-exposure

    You're welcome re the handwashing

    I find it so interesting that we all have such differing views on stuff, like i think she's absolutely crazy to suggest not washing your hands after going to the loo and other people think it's fine because millions of people do it every day and get away with it - so i can see why you are confused lol

    I think what you have said yourself is the best bet and that is to take the middle ground such as being able to prepare a meal in your own home without re-washing your hands 20 times - and if you can get to that stage in a gradual and controlled way, then it's not really going to be necessary to go to the lengths of licking things that have been on the floor, which i think even non-emet handwashing-dodgers would draw the line at!

    I can see everyones point who agrees with the therapist, but i still don't think encouraging bad hygiene habits such as not washing your hands after using a public loo then eating is necessary to help, just because someone else sticks their fingers in the fire doesn't make it right and doesn't mean i'm going to do it

  9. #9
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    Default Re: Disagreeing with therapist about over-exposure

    haha I know what you mean Pauline. I don't think she is suggesting to never wash your hands after using the bathroom, just to do it once to see that the world wont end right away. (which it wont)
    Be courageous, believe in yourself, and be the best woman you can be. I'm with you all the way.

  10. #10
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    Default Re: Disagreeing with therapist about over-exposure

    This is what will happen next: We will continue working on getting rid of what's left of the social phobia for a while and then we'll talk about the emetophobia again.

    I really don't know if I can be OK with the fact that the therapist talks about germs as if they were little green men who only exist in my head. I understand that the danger I feel when I look at a scary picture or try to watch a scary video (you all know what I mean ... not Saw XIV ... more like Jackass The Movie ...) is not "real", it's just me thinking scary thoughts. But ... let's say I use a toilet at the office where I work (amazingly enough I do have a job) and don't wash my hands ... then something bad *might* happen, especially during those times when a lot of people complain about themselves and their families having stomach bugs. The therapist says she's sure nothing bad will happen, but I don't believe her. I mean, how could she ever be sure? She just can't. If her point is that I will survive even if get a bug, I already know that and the thought doesn't comfort me. A few years ago I got a horrible bug - the first one in 20 years - and obviously I survived, but it sure didn't cure me from the phobia and I was miserably underweight and weak for months.

    Good thing: My hands feel and look a little less cracky today. Yesterday was my "worst bug ever anniversary".

  11. #11
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    Default Re: Disagreeing with therapist about over-exposure

    I don't really want to say this, as it might be an unpopular opinion around here, but here goes: to get better, you have to do things that make you uncomfortable.

    I view it like this: when I want to get in better physical shape, doing the workouts and running the distance that I always do won't help. I have to make it more strenuous.

    To get over emet, doing the routines and avoiding the things I always do won't make me better. I have to go out and face my issues head on.

    I'm not saying you shouldn't wash your hands after using the toilet. That's a little gross. It won't necessarily make you sick, but it's inconsiderate to others.

    I'm saying you should go out to eat more or let other people cook for you. Don't overcook every single type of meat you make. Do you have any weird rituals or things you avoid because the last time you did that, you v*? I did. I avoided salmon like the plague, since that was my last meal before I got sick. Well just yesterday I had salmon and I didn't get sick, so I'm not worried about having it again.

    As far as the whole germs thing go, my philosophy is the famous "a little dirt doesn't hurt." When you don't let any germs get into your system, your immune system goes to the tanks. I'm not saying you should try to ingest as much bacteria as possible, but the more you focus on avoiding germs, the more likely you are to contract a virus.

    So I realize that people will disagree with me here, but it's the philosophy that has cured me.

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  12. #12
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    Default Re: Disagreeing with therapist about over-exposure

    Guess what DJEskimo....I totally agree with you! Different things may work for different people but having the same philosophy that you just described has helped me overcome a lot of my emetophobia fears and anxiety. Its amazing the confidence that I get from being terrified of something, and doing it anyways, so I say try it Amone!

  13. #13
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    Default Re: Disagreeing with therapist about over-exposure

    Quote Originally Posted by DJEskimo View Post
    I don't really want to say this, as it might be an unpopular opinion around here, but here goes: to get better, you have to do things that make you uncomfortable.
    You're right. I need to do things that make me feel uncomfortable. I just wish the therapist would admit there's a slight risk I might catch something and help me figure out how to cope with that (instead of saying there's no risk at all) and while eating at a restuarant or at a friend's house seems to be a good (but scary) idea, I don't think I need to "go too far" (eating stuff from the floor) in order to fell happy and normal ... and you didn't suggest that, but the therapist did.

    Just wanted to clarify myself Happy to hear about how you recovered!!!

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    Default Re: Disagreeing with therapist about over-exposure

    I can see why this would bother you; some of the things she told you to do are things that a lot of people who aren't phobic wouldn't do anyway. A friend of mine is a teacher and she makes the kids sanitize their hands many times a day, etc. She is not an emet or a hypochondriac. Touching a dirty restroom, not washing your hands and then eating isn't really the brightest thing - never mind because of emet worries, but even with the whole overblown swine thing this past year.

    Something "normal" to start with would be eating without washing your hands after you've been home all day, something simple like that - which would be hard for you to do because you say you don't touch your mouth seconds after washing. Or yeah, you can eat something that has fallen on your own floor in your own house. You just don't really need to be that extreme with things, at least not yet.

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    Default Re: Disagreeing with therapist about over-exposure

    Quote Originally Posted by alexikiss View Post
    Touching a dirty restroom, not washing your hands and then eating isn't really the brightest thing - never mind because of emet worries, but even with the whole overblown swine thing this past year.

    .
    Just to clarify the OP never said she was to touch a dirty restroom, not wash her hands and then eat! That would be insane.
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    Default Re: Disagreeing with therapist about over-exposure

    Quote Originally Posted by hippychick View Post
    Just to clarify the OP never said she was to touch a dirty restroom, not wash her hands and then eat! That would be insane.
    Oh, yes! I see now. My imagination ran away with that one. But that's just poor hygiene to begin with. I know there's something to be said for curing one extreme with going the other extreme, but I guess it depends on what we're talking about...

  17. #17
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    Default Re: Disagreeing with therapist about over-exposure

    That makes no sense whatsoever- even most non-emets with a brain wouldn't do that! Exposing yourself to things such as eating out etc is fair enough, but doing something that is highly likely to cause you to be ill could make your phobia a lot worse. I've v*ed a few times from illness and every time just reinforces in my mind why I have this damn phobia.

  18. #18
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    Default Re: Disagreeing with therapist about over-exposure

    the therapist CAN NOT guarantee you wont be ill if next time you say dont wash your hands. personally i think it is irresponsible of her to say "she's sure nothing bad will happen" - she cant be sure at all.

    djeskimo - you make good points espec about food. i too have avoided things and recently ive started eating prawns again! not tons but once or twice the last month. i havent done so for years. and they havent made me sick.

    but yeah, not washing ur hands after going to the loo is not good hygienic practice imo!

  19. #19
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    Default Re: Disagreeing with therapist about over-exposure

    I agree that to overcome this phobia you need to take yourself outside of your comfort zone, but it needs to be in small steps and in a way you can still feel in control, for example, maybe start by reducing the amount of times you wash your hands (only do it when advised to do so ie before eating, after using the toilet etc. I think for someone who washes their hands 50-100 times a day and very "aware" of germs to eat something from the floor is more likely to be ill from it than someone with a built up immunity from not being so aware...? (I am not a therapist, but I think small steps)

  20. #20
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    Default Re: Disagreeing with therapist about over-exposure

    She's right, to a degree. That's what I did in my therapy. What I did was set up a hierarchy of fears, a list of things I was afraid of from least afraid to most afraid. I started out with writing out the common words for v. My last step was watching videos of people v'ing. Then, you need to slowly, at your own pace, work your way through the list until you can do each item with no anxiety. Talk to your therapist about your concerns re: exposure, but remember that exposure/de-sensitization is about the only way to get the emet monster under control.
    Ultimately we know deeply that the other side of every fear is a freedom. - Marilyn Ferguson

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  21. #21
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    Default Re: Disagreeing with therapist about over-exposure

    You definitely don't build up your immune system by contracting noro... you can't gain immunity to noro and it really wipes out your body. You don't make a car run better by smashing it with a sledgehammer either.

    You should try to make your house, though, your "safe area". So when you are in your house you don't need to be constantly washing your hands. Believe me, there are tons of germs even in your nice clean house- you will still get plenty of exposure to regular old germs to make the "hygiene hypothesis" folks happy. Exposing yourself to noro doesn't help your immune system though, so common sense about bathroom hygiene and washing before you eat should still prevail.

  22. #22
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    Default Re: Disagreeing with therapist about over-exposure

    Try another therapist - that's just crazy. I would never ask my phobic clients to do something like that.
    Click on the link in my signature and go to the "diagnosis and treatment" section and read about how therapy should work and how to find a good therapist.
    All the best!
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    DISCLAIMER ~ Any advice I give on this forum is well-intentioned and given as to a peer or friend or for educational purposes. It does not in any way constitute psychotherapeutic or medical advice. Please discuss anything you may learn from my posts with your doctor and psychotherapist prior to making any decisions or changes or taking any actions.



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  23. #23
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    Default Re: Disagreeing with therapist about over-exposure

    I agree that you need to push yourself out of your comfort zone. I never use milk on the "sell by date" ever....That is a big no-no for me. Yestrday, I did it and I was fine! Now, I am more comfortable with that. Unless you do it, you will never know!
    I do think what she is suggesting is slightly crazy though, who eats off a dirty floor?Actually, I did drop a cookie last week in my room and ate it anyway. And I'm sorry, but not washing your hands after using a restroom is just gross, even for non-emets. Anyway, in a way she is right, but I aslo think it's too extreme. Like others said you need to start out slower, like not washing your hands before you eat or eating a food that you deem "unsafe"
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