Scope of the Problem

A phobia is a persistent, excessive fear of a particular object or situation that causes avoidance, distress, and life interference. Specific phobias are among the most common psychiatric disorders, with 11% of the population meeting diagnostic criteria for specific phobia at any time in their life (Kessler et al., 1994) and 5.5% of the population meeting diagnostic criteria for specific phobia within a 30-day period (Magee, Eaton, Wittchen, McGonagle, & Kessler, 1996). There is little debate among clinicians regarding the most straightforward way to treat phobias, as most clinicians accept that treatment involves some sort of systematic exposure to the feared object or situation in order to achieve reasonable success (Antony & Barlow, 2002). In fact, very shortterm treatment (one to five sessions) is associated with clinically significant, long-lasting changes in up to 90% of cases (Öst, 1989; Öst, Brandberg, & Alm, 1997). Despite the fact that specific phobias are so common and that well-articulated treatment protocols are readily available, practitioners often experience uncertainty when they encounter a client with a specific phobia. For example, specific phobias are common in the general population, but rarely do individuals with specific phobias seek treatment for this problem (Kessler et al., 1999). Thus, clinicians are infrequently called upon to provide treatment. When individuals with specific phobias are indeed in treatment, it is usually for a psychiatric problem that is judged to be of greater severity (Sanderson, DiNardo, Rapee, & Barlow, 1990). It would follow that these particular clients are likely to present with a complex array of psychiatric symptoms that may or may not complicate the course of standard treatment for specific phobia. Clinicians often operate under the assumption that specific phobias are less severe than other psychiatric disorders. Indeed, this is often the case, as the fears are circumscribed enough that most individuals with specific phobias can arrange their lives so that they can easily avoid encounters with feared objects or situations (Antony & Barlow, 2002). Nevertheless, it is important for clinicians to be aware of the potential for pervasive life interference that can result if specific phobias are untreated. The consequences of specific phobias often manifest themselves more saliently when an individual experiences a major life transition where he or she can no longer avoid the phobic object or situation. For example, an individual with a driving phobia might suddenly spend hours to avoid certain highways or bridges when she takes on a new job at a different location. A dental phobic might develop major dental problems because he avoided routine maintenance for several years. There is very little research and discourse on the effects of specific phobias on relationships and family functioning. However, our clinical experience suggests that specific phobias can take on a profound role in a relationship culture or family system. Many of our adult clients with specific phobias describe conflicts with their partners over avoidance of phobic objects or situations. In extreme cases (e.g., a housebound agoraphobic woman whose husband assumes the role of care provider), a power imbalance can emerge which enables the partner of the phobic individual to assume substantial control in the relationship and the phobic individual to continue his or her passive avoidance under the guise of being “cared for” by the partner (Jackson & Wenzel, 2002). Many families of children with specific phobias have created elaborate, time-consuming rituals to structure the phobic child’s environment so that the child either successfully learns to deal with the phobia, or so that the family can avoid a “scene” involving the phobic stimulus. Thus, a specific phobia in any one family member has the potential to complicate family interactions, roles, and dynamics. Following is up-to-date information about the nature, assessment, and treatment of specific phobias, with consideration of the manner in which specific phobias affect close relationships and can be addressed from an interpersonal approach.