Sarah* and the Fear of Losing Control
I just received an urgent call from Sarah, a 35 year old married mother of three children. Yesterday, she watched a news broadcast showing a “perfectly normal mother” who snapped, went beserk and drove her car into a nearby river, drowning herself and her three children. Sarah was horrified.
Over-Identification and Personalization
She imagined what it would be like for one minute to be normal, and the next minute to snap and “go over the edge.” She identified with the surviving family members, husband and grandparents, picturing how they must feel. Sarah could not get that horrible image out of her mind. She imagined, “What if that happened to me?” and the picture of having a nervous breakdown and being locked up in a mental ward kept flashing through her mind. Sarah began to feel “not herself,” spacey, disoriented, there-not there, outside of herself, out of body, and was convinced these symptoms were a sign of an imminent nervous breakdown.
Obsessive Intrusive Thoughts
All night Sarah desperately tried to rid herself of these thoughts. The more she tried to push the thoughts out of her mind, the more the images of snapping and falling apart pierced into her consciousness. The terrifying images interrupted her sleep. She was convinced the constant preoccupation and persistent image of losing her mind meant she was on the verge of psychiatric hospitalization.
The Paradoxical Rule and Obsessive Thinking
I told Sarah that she was experiencing fearful obsessive thoughts of losing control. The images were so horrifying because they were the last thing she would ever do. She would be the last person on earth to ever harm her children, in any way. She was over-giving, overextending, excessively empathic and always in control, taking care of others. The fears represent the exact opposite of who she is and are so repugnant, they stay prominently on her mind.
The Written Guarantee
I told Sarah to let the thoughts stay in her mind as much as possible and recognize what they represented. The fears represented a loving overly conscientious, caring mother who could not even accept the idea that she would ever think she would hurt her children. I told Sarah that her fears were very common with many of my patients and had nothing to do with having a nervous breakdown.
At the 1975 June Institute in Behavior Therapy, Dr. Joseph Wolpe provided us with the opportunity to witness him, live, administering Behavior Therapy to a patient on a closed circuit TV. Then, he would hold a case conference right after he finished the session. With a patient like Sarah, who fit Patient Profile 1, he would offer a written guarantee that she was not going crazy, having a nervous breakdown and would not be hospitalized. Recognition that the obsessive thoughts have no validity takes the fearful sting out of the thoughts and they gradually fade away. In my own practice, I always offer Patient Profile 1 patients a written Guarantee.
*References to real persons, places and events are made in a fictional context, and are not intended to be in any way to be libelous, defamatory or in any way factual.