Phobic space and therapeutic lever

Introduction.- The spatial experience in phobic disorders needs to be better understood in order to account for the pathogenic effect of a local phobogenic situation on the whole subjective world. Such an understanding could be useful for the treatment of resistant phobias which are hampered by therapeutic blocks that require a global restructuration of the subjective world. Objectives.- Three objectives are addressed in this paper: ( 1) a clarification of the experience of space ill phobic disorders; (2) an account of the impact power of the phobogenic Situation; (3) an analysis of levers in cognitive psychotherapy that may help to overcome therapeutic blocks in resistant phobias. To tackle these objectives, we bring in the conceptual framework of representational spaces that proposes some tools to describe a subjective world as grounded in the spatial experience. According to the model of phobic disorders that we build up in this framework, the phobogenic situation behaves like a probe that reveals some strains disturbing in depth the subjective representational space. These strains depend on past traumatic situations that have resulted in the development of phobic cores. Thus, the phobogenic situation materializes some dimensions of the representational space that makes it vulnerable to a traumatic agent. In this framework, a therapeutic lever can be defined as a key-situation that favors a global reorganization of the representational space from it local work on it. Three conditions appear to be necessary to the works of such a lever: (I) the key-situation needs to resonate through the representational space with a central phobic core; (2) the patient should actively grasp the processes of the symbolic structuration of his/her space; (3) the therapeutic lever should only be operated at the suitable time of the therapeutic course by taking account of the subjective defences. Patient and method.- Our model is exemplified with a case study that describes the behavioral and cognitive therapy of a patient that suffers from a phobic disorder since his adolescence. The technical method notably uses a work on the cognitive schemas that starts from the patient story. Results.- The method used to overcome therapeutic blocks reveals some phobic cores that are related to traumatic situations in childhood and adolescence. Therapeutic levers are operated when key-situations relative to the familial story can be addressed and elaborated by an active work of the patient, with a feeling of global restructuration of his psychic space. Conclusions.- The conceptual framework of the representational spaces is interesting to clarify the spatial experience in phobic disorders and to explain the impact of the phobogenic situation. Moreover, in complex phobias, this framework offers some useful tools to conceptualize the therapeutic levers that could be efficient to move the whole subjective world. Such levels can only be used during a long-term therapy. (C) 2008 Elsevier Masson SAS. All rights reserved.