Are there therapists that join you in exposure therapy?
July 8, 2024 6:17 PM   Subscribe

I have agoraphobia and I'm interested in finding a therapist or other mental health professional who will join me in person for exposure therapy. Honestly I have only ever seen this level of dedication on tv, and searching online hasn't gotten me anywhere. I live in Northern Virginia. Has anyone ever found this type of therapist or is it really rare?
posted by juniper to Health & Fitness (6 answers total) 2 users marked this as a favorite
Yes! I am not one of them, but I know this is something people who specialize in phobias do. It's not a weird thing to ask for or expect.

Actually I recently attending a really impressive training on OCD treatment that specifically talked about doing exposure therapy in person with clients who have phobias, that was run by this organization: NOCD. They have a directory of therapists in different states. If there is not someone on their directory near you, they might still be able to give you referrals if you contact them.

Best of luck to you!
posted by EllaEm at 8:02 PM on July 8 [8 favorites]

If you can't find a therapist in your area, try looking for a coach who will do that. We found some for my sister, a long time ago. They were willing to accompany her to school, stores, doctors, any place that scared her. They were skilled in handling anxiety or panic and good at motivating people. Maybe you could have a therapist devise a treatment plan and help you process between sessions, while the coach provides you the support you need on your trips outside?

Good luck.
posted by toucan at 8:04 PM on July 8 [5 favorites]

Yes, ERP therapists do this, but they generally are people whose entire practices are dedicated to ERP for anxiety disorders and not just people you find on PsychologyToday who say they have expertise in anxiety and exposure therapy. ERP stands for exposure and response prevention and is the most common standardized form of exposure therapy, but many people use the general principles of exposure and provide “exposure therapy” that is not as intensive and therefore less likely to go the full “let’s get in the car you’re terrified of and drive” mile (something I’ve also frequently known ERP therapists to do).

He’s not in your area, but Marty Franklin is someone I know does this; his office was at one time above a subway station and he would frequently take clients there for exposures. In general programs focusing on OCD have a lot of ERP trained therapists who often do exposures with clients out in the real world, so it may be helpful to reach out to an OCD based program in your area for referrals.
posted by brook horse at 8:28 PM on July 8

I’m a trauma therapist in private practice in the PNW. I think this is going to be easier to find than you might imagine, though agoraphobia isn’t my area of expertise. Many therapists who meet with clients in person would be willing to do a variety of things that might suit your needs. For instance, someone who offers in-home sessions might be able to start with in-home work and build up to accompanying you out of the house (depending on what exposure would look like, walk-and-talks are super common, but there are plenty of other activities I could imagine doing—therapists might have different policies around driving with you but a taxi or bus trip would be doable for many, or walking to a nearby restaurant, library, mall, wherever). I’d be shocked if many (if not most) therapists specializing in agoraphobia don’t offer sessions that include going outside, not just literally outside their offices, but into the community. I don’t know how a therapist would really treat agoraphobia without taking sessions beyond the office (unless someone else on the client’s care team was doing that). So, if you’re in an area where you can find an agoraphobia specialist, you should be able find what you’re hoping for. If you’re in an area that’s more rural or just doesn’t have that type of specialist for whatever reason, I’d look for anxiety therapists who do in-home, or nature/hiking therapy first just because they’re already doing therapy outside the office and might be able to work with you more easily. But even just anxiety therapists who see clients in-person and by Telehealth would potentially be able to work with you.
posted by theotherdurassister at 8:36 PM on July 8 [1 favorite]

Jelena Kecmanovic, PhD (Arlington, VA) treats phobias, offers exposure therapy: "Conducted in the office and in the world. For example, I might join you on a drive or flight, walk together to a Metro stop or a bridge, visit stores, cafes, or your home." And, "see my Washington Post article about exposure therapy" [maybe this one, gift link]. Dr. K also wrote "The Fear of Exposure Therapy," which describes an outdoor session, for Psychotherapy Networker in Sept. 2022.
posted by Iris Gambol at 10:42 PM on July 8 [6 favorites]

Hey there! I have a agoraphobia. It’s great that you are looking to get help. Also great that you are looking practically to get the best help for you.

I have found that, unlike with OCD, therapists who frequently work with agoraphobic patients tend to be reluctant to join them during exposures. I think it depends on the specific person, but for many people with agoraphobia, myself included, the phobia is not necessarily staying inside 100% of the time, but instead, the phobia is directed at leaving the house or safe area alone.

I am somewhat in remission now, but when my agoraphobia is bad I find it much easier to get out of the house if I have someone with me.

The most successful therapist I had was hugely helpful and, again, and for me personally, I think he would not have been as helpful if he joined me when I was doing exposures.

That doesn’t mean that you’re just like me, but I would suggest that if you can find a therapist who seems to be a good fit that it might be worth seeing if you can make progress even if they’re not able (or willing) to accompany you. It may be that having someone go with you would be hugely motivational and helpful, so I’m not saying to give up on that, just very gently suggesting that it’s possible to make progress independently if you have support from the right therapist.

Good luck – this is a rough condition and again, I am really impressed that you are seeking help!
posted by knobknosher at 2:13 PM on July 9

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