The Fear of Exposure Therapy

The Fear of Exposure Therapy

Reframing Our Approach

By Jelena Kecmanovic

September/October 2022

As we approached a bridge, my client Amy started walking slower and breathing faster. “I’m nauseated and a bit dizzy,” she muttered. I encouraged her to carry on and assured her that the actual experience wouldn’t be as bad as she feared. About a hundred feet above the river, I stopped and modeled leaning on the railing to look down as the rowers slid by below. After a pause, she joined me, closing her eyes. More of my prompting led her to open them for a second before she jolted back and threw up all over herself—and me.

Stunned and feeling hot vomit seep through my blouse, I sat down with my back to the railing. I hadn’t realized how tense and anxious I’d been feeling for the past 30 minutes as I’d been doing this in-vivo exposure exercise with Amy—and now it had all come crashing down. Amy apologized profusely through tears and eventually heeded my nonverbal invitation to just sit beside me.

“I’m not going to pretend to have the answers, Amy,” I said. “Anything can happen, and that can suck and be scary. But the fact that anything can happen means that everything is possible, right? And that’s the most wondrous thing in the world!”

The two of us sat there, covered in vomit and baking in the sun. Suddenly, I started laughing at the absurdity of the situation and my assumption that I’d been in complete control of this exercise. Amy looked puzzled—and then joined me in uncontrollable laughter.

That day in the middle of Key Bridge, facing the…

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