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Published On: Jan 19, 2009 02:43 PM
Total entries in this category:
Published On: Jan 19, 2009 02:43 PM
OK - so now I know something about turbulence? Is that all there
is?
Knowing about turbulence is different
than knowing how to fly well when you expect turbulence. Is there more to the
story? What do I do in the first face to face consultation?
As I wrote in the earlier l-o-n-g entry on
turbulence here, many people list as one of their primary
apprehensions the likelihood they will encounter
turbulence.
When I hear that on the phone when I take the initial call, acting as my own intake worker, I usually let the caller know I have made a note of their turbulence concerns and try to convey how apprehension of bumpy flying is common, understandable, and capable of being changed and reduced. I don't go into detail on the phone, but believe it's important to let a caller know I take their concerns seriously even if their friends and family don't.
When we meet face to face in the first session (clients walk in the doorway and the first thing they see are my airplane seats
and
wonder if we will conduct the session there. I direct them to one of the comfy
seats covered in a peaceful blue fabric) I take down the usual biographical
details the law compels me too for the record, and because we have spent some
time on the phone previously, we can launch straight into the current plans to
fly.
Many people have already booked their trip by the time they see me, so I will often ask how they expect themselves to "go" on the flight. All sorts of interesting answers often topple out, including concerns about turbulence. I don't jump straight onto it however preferring to work around it, much like a plane works around thunderstorms, checking out what else may be important for me to know. Such things might include if they have sought assistance elsewhere and who with (often books are cited, the internet less so), what was useful in that process and where they felt it fell short (I always try to remain respectful of other treatments and practitioners clients may have experienced), what has happened between that treatment and their seeking me out currently, and if they are using or have plans to use any medication.
Current medications will also cue me in to understand what other concerns are being treated, such as panic disorder, agoraphobia, claustrophobia, Post Traumatic Stress Disorder, depression, and so on. Some therapists who work by telephone don't make such enquiries perhaps preferring to get moving with interventions, but as a clinical psychologist, I am duty bound to ask about other interventions and medication. How I do that can either add or subtract from the client's belief in the "goodness" of the referral process.
By now you may be reading between the lines to see that each client session is different, and I choose from a broad body of knowledge which questions I will ask and when. Always, I try to maintain a stance of curiosity - Columbo-style
- even
when I am delivering factual information which may offer a competing and
hopefully better explanation for a flying event, e.g. engine
power reduction after takeoff due to noise abatement, often experienced as the plane
"falling".
By constantly seeking assurance that some sense is being made of my alternate explanation, I am remaining curious as to how the client "accepts" this information. Usually I'll ask if "it makes sense", and occasionally I will ask if knowing this information helps them feel any better i.e., less anxious.
The answer is usually "No" and I reflect that is the usual reply. Clients often say it's reassuring to know some factual information about flying even if it's to know that they are not alone in the nature of their fears. However, it soon becomes clear that feelings and thoughts follow different paths of change, and I am always happy to see the "split" occur early so the client knows that domain or map we will cover during our session(s). Occasionally, people describe physical sensations they experience, and of course in the Virtual reality setup these can be more readily accessed and observed than asking people to think about flying. And as a bonus I often get to see their behaviours when confronted by virtual experiences, such as reflexively gripping the airplane seats, holding their breath or breathing rapidly, crying and shaking, and perspiring. On the occasions when I use the biofeedback equipment, I get to see these physical aspects reflected in the readouts on the computer.
Thoughts
With regard to thoughts, clients usually do well learning how their automatic thoughts originated. In a session we will also examine how these thoughts or beliefs are changeable, and require practise to be cast aside, replaced by more accurate thoughts. This is not an easy task, since the automatic thoughts required little or no learning, while the new thoughts feel like it's going back to school and learning math or a foreign language.
I will often ask clients to obtain index cards on which they can write down these two styles of thinking, often for each phase of the flight, so they can readily be pulled out an read. Others find that when a triggering situation happens, they can't focus on the written word, and they require distracting techniques to get through a difficult flying patch. My belief is that clients are best served when they have a variety of techniques to choose from, and once more, in the Virtual reality setup, we get a chance to test out these ideas and fine tune the system before the actual flight.
In that sense, clients find it very useful to leave sessions knowing they have tools they can utilise, and evidence they work, not just in imagination, but in a situation that triggers clinical levels of anxiety. For some this can mean the difference between taking or avoiding their next flight.
Feelings
I always plan with clients for the time when their ability to change their thoughts simply won't work. Their frightening feelings and sensations are simply too overwhelming for clear concise thought to occur.
Some people think they are going crazy because their usual sophisticated grasp on language is failing them, and they experience their situation as a colossal collection of raw emotion.
In the safety of the consulting room, we take some time to explore the normality of this happening. It is important for me to let clients know it is normal to observe this happening. And that there is a workable explanation for its occurrence.
In extreme moments of perceived danger, so I tell clients, there is a moment of immediate decision making needed to survive the next few moments. Asking them to consider the plight of the lone descendant in caveman times confronting a sabre tooth tiger in his vicinity, I ask if what they believe the poor caveman options might be. Most agree the caveman stands little chance in a fight, and without weapons, his options are few. He can either flee immediately, running as fast as he can, or he can freeze, holding as still as possible without breathing, in order to avoid being noticed by the tiger.
We usually then discuss how animals who are prey have stereotypical responses to these situations when confronting predators. But those who have survived are usually the ones which have a variety of responses they can moderate depending on the situation. On one occasion they may freeze, on another they may sprint, freeze, then trot back into the herd where they can cloak themselves.
To bring it into contemporary times, I usually describe crossing the road having not noticed a bus bearing down upon me. We usually share a chuckle when I say there won't be enough time for me to bring out my calculator to derive an estimate of how long it will be before the bus strikes me based on current speed estimates and distance from me.
As Bill Cosby
once said in
a comedy routine, it's the time when the brain says,
"Feet - do your
duty!"
Indeed, this is the time for "Act now, ask questions later" or "Better a live coward than a dead hero".
In other words, under extreme provocation few of us can think our way out of danger, and our body's inherited evolved protection mechanisms kick in. After we have survived, there may be a time of pondering about what's happened, and it may require quite some time for the rush of adrenaline to return to normal levels, and for that shift to be reflected in our behaviours, thoughts, and feelings.
In this acute refractory period, we can either deal well or deal poorly with what's just happened, and set ourselves up for how we handle similar, but less dangerous situations in the future. In other words, our early warning radar may be reset at this time, such that we become more sensitive to hints of danger, and respond more strongly in preparation, so we won't be caught out again. We may even find our sleep and dream patterns temporarily shifted, as we deal with our close call.
Of course, those who face "close calls" for a living receive training at getting their thoughts to kick in rather than relying on the brain's inherited "quick and dirty" danger management system. Police, emergency workers, paramedics, nurses and doctors, and firefighters all receive training and repeated retraining in such emergency drills, as do pilots and cabin crew.
The rest of us blithely go about our lives, reading about others' tragedies or near misses, or watching them fictionalised on TV or in film, and hoping inside we never have to face such immediate no-second-chances decision making.
Do fearful flyers need to know all this to handle their fears better? Some do, some don't. I always like to have this information ready to go for those I conclude would do well to have a better understanding of their fear mechanisms. For some, it is the prelude to some of the physical work, like rebreathing training, and muscle tension reduction exercises I may recommend. Actually, with breathing, it's something I always recommend and spend time retraining.
(more to come)
When I hear that on the phone when I take the initial call, acting as my own intake worker, I usually let the caller know I have made a note of their turbulence concerns and try to convey how apprehension of bumpy flying is common, understandable, and capable of being changed and reduced. I don't go into detail on the phone, but believe it's important to let a caller know I take their concerns seriously even if their friends and family don't.
When we meet face to face in the first session (clients walk in the doorway and the first thing they see are my airplane seats
and
wonder if we will conduct the session there. I direct them to one of the comfy
seats covered in a peaceful blue fabric) I take down the usual biographical
details the law compels me too for the record, and because we have spent some
time on the phone previously, we can launch straight into the current plans to
fly.Many people have already booked their trip by the time they see me, so I will often ask how they expect themselves to "go" on the flight. All sorts of interesting answers often topple out, including concerns about turbulence. I don't jump straight onto it however preferring to work around it, much like a plane works around thunderstorms, checking out what else may be important for me to know. Such things might include if they have sought assistance elsewhere and who with (often books are cited, the internet less so), what was useful in that process and where they felt it fell short (I always try to remain respectful of other treatments and practitioners clients may have experienced), what has happened between that treatment and their seeking me out currently, and if they are using or have plans to use any medication.
Current medications will also cue me in to understand what other concerns are being treated, such as panic disorder, agoraphobia, claustrophobia, Post Traumatic Stress Disorder, depression, and so on. Some therapists who work by telephone don't make such enquiries perhaps preferring to get moving with interventions, but as a clinical psychologist, I am duty bound to ask about other interventions and medication. How I do that can either add or subtract from the client's belief in the "goodness" of the referral process.
By now you may be reading between the lines to see that each client session is different, and I choose from a broad body of knowledge which questions I will ask and when. Always, I try to maintain a stance of curiosity - Columbo-style
- even
when I am delivering factual information which may offer a competing and
hopefully better explanation for a flying event, e.g. engine
power reduction after takeoff due to noise abatement, often experienced as the plane
"falling".By constantly seeking assurance that some sense is being made of my alternate explanation, I am remaining curious as to how the client "accepts" this information. Usually I'll ask if "it makes sense", and occasionally I will ask if knowing this information helps them feel any better i.e., less anxious.
The answer is usually "No" and I reflect that is the usual reply. Clients often say it's reassuring to know some factual information about flying even if it's to know that they are not alone in the nature of their fears. However, it soon becomes clear that feelings and thoughts follow different paths of change, and I am always happy to see the "split" occur early so the client knows that domain or map we will cover during our session(s). Occasionally, people describe physical sensations they experience, and of course in the Virtual reality setup these can be more readily accessed and observed than asking people to think about flying. And as a bonus I often get to see their behaviours when confronted by virtual experiences, such as reflexively gripping the airplane seats, holding their breath or breathing rapidly, crying and shaking, and perspiring. On the occasions when I use the biofeedback equipment, I get to see these physical aspects reflected in the readouts on the computer.
Thoughts
With regard to thoughts, clients usually do well learning how their automatic thoughts originated. In a session we will also examine how these thoughts or beliefs are changeable, and require practise to be cast aside, replaced by more accurate thoughts. This is not an easy task, since the automatic thoughts required little or no learning, while the new thoughts feel like it's going back to school and learning math or a foreign language.
I will often ask clients to obtain index cards on which they can write down these two styles of thinking, often for each phase of the flight, so they can readily be pulled out an read. Others find that when a triggering situation happens, they can't focus on the written word, and they require distracting techniques to get through a difficult flying patch. My belief is that clients are best served when they have a variety of techniques to choose from, and once more, in the Virtual reality setup, we get a chance to test out these ideas and fine tune the system before the actual flight.
In that sense, clients find it very useful to leave sessions knowing they have tools they can utilise, and evidence they work, not just in imagination, but in a situation that triggers clinical levels of anxiety. For some this can mean the difference between taking or avoiding their next flight.
Feelings
I always plan with clients for the time when their ability to change their thoughts simply won't work. Their frightening feelings and sensations are simply too overwhelming for clear concise thought to occur.
Some people think they are going crazy because their usual sophisticated grasp on language is failing them, and they experience their situation as a colossal collection of raw emotion.
In the safety of the consulting room, we take some time to explore the normality of this happening. It is important for me to let clients know it is normal to observe this happening. And that there is a workable explanation for its occurrence.
In extreme moments of perceived danger, so I tell clients, there is a moment of immediate decision making needed to survive the next few moments. Asking them to consider the plight of the lone descendant in caveman times confronting a sabre tooth tiger in his vicinity, I ask if what they believe the poor caveman options might be. Most agree the caveman stands little chance in a fight, and without weapons, his options are few. He can either flee immediately, running as fast as he can, or he can freeze, holding as still as possible without breathing, in order to avoid being noticed by the tiger.
We usually then discuss how animals who are prey have stereotypical responses to these situations when confronting predators. But those who have survived are usually the ones which have a variety of responses they can moderate depending on the situation. On one occasion they may freeze, on another they may sprint, freeze, then trot back into the herd where they can cloak themselves.
To bring it into contemporary times, I usually describe crossing the road having not noticed a bus bearing down upon me. We usually share a chuckle when I say there won't be enough time for me to bring out my calculator to derive an estimate of how long it will be before the bus strikes me based on current speed estimates and distance from me.
As Bill Cosby
once said in
a comedy routine, it's the time when the brain says,
"Feet - do your
duty!"Indeed, this is the time for "Act now, ask questions later" or "Better a live coward than a dead hero".
In other words, under extreme provocation few of us can think our way out of danger, and our body's inherited evolved protection mechanisms kick in. After we have survived, there may be a time of pondering about what's happened, and it may require quite some time for the rush of adrenaline to return to normal levels, and for that shift to be reflected in our behaviours, thoughts, and feelings.
In this acute refractory period, we can either deal well or deal poorly with what's just happened, and set ourselves up for how we handle similar, but less dangerous situations in the future. In other words, our early warning radar may be reset at this time, such that we become more sensitive to hints of danger, and respond more strongly in preparation, so we won't be caught out again. We may even find our sleep and dream patterns temporarily shifted, as we deal with our close call.
Of course, those who face "close calls" for a living receive training at getting their thoughts to kick in rather than relying on the brain's inherited "quick and dirty" danger management system. Police, emergency workers, paramedics, nurses and doctors, and firefighters all receive training and repeated retraining in such emergency drills, as do pilots and cabin crew.
The rest of us blithely go about our lives, reading about others' tragedies or near misses, or watching them fictionalised on TV or in film, and hoping inside we never have to face such immediate no-second-chances decision making.
Do fearful flyers need to know all this to handle their fears better? Some do, some don't. I always like to have this information ready to go for those I conclude would do well to have a better understanding of their fear mechanisms. For some, it is the prelude to some of the physical work, like rebreathing training, and muscle tension reduction exercises I may recommend. Actually, with breathing, it's something I always recommend and spend time retraining.
(more to come)
Posted: Thursday - July 08, 2004 at 09:59 PM |