Ed came to see me complaining of an elevator phobia. At first, the symptom was limited to large office buildings where he was forced to ask creditors for extensions of loans, bankers for more money to build his business, etc. For a while, he suffered almost no anxiety while riding elevators to friends' apartments or to rooftop restaurants; but soon these became phobic experiences as well. Initially, we talked about some ways to cope with the phobia when it arose or threatened to. He gave a stab at these methods, with some success, but then began reporting other anxiety symptoms. After about 4 sessions, we began to discuss what happened to him before and during the kind of business meeting where the problems seemed to have started. With a certain amount of cheerleading from me, since he was not a man given to talking about such things, he described the humiliation and rage he felt but usually kept "tucked away where I don't think about it". To his surprise, he became quite emotional in the telling. The next week he came in and told me the phobia was greatly diminished. He rode elevators all week with only a few brief episodes of anxiety. What happened? 

This man's "phobia" was really a fear of confrontation and of being in a vulnerable position, such as asking others for money. He was, in effect, "lost" with regard to what hurt. He thought he was scared of elevators; in fact he was scared of certain people. Had he known this, he might well have gotten over the phobia himself. Sure enough, once these unpleasant issues came into awareness, the original phobia lost its power and simply evaporated. Treatment continued for another few months because he wanted to "lick this fear thing once and for all" -- he wanted to explore and overcome the fears that had caused his phobia (and other symptoms) so that they would not later rear their heads again in the form of another symptom.

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