Friend with fear of wetting self

This section is for questions relating to therapy, assessment, formulation and other aspects of working with people in mental health services.

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pantsbeforesocks
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Friend with fear of wetting self

Post by pantsbeforesocks » Mon Dec 14, 2015 10:24 pm

Hi there,

I'm a ClinPsyD trainee. My good friend (who has given me permission to talk about him anonymously) has a fear of wetting himself. He finds that when he is at home he can go a normal length of time without needing a wee. However, as soon as he goes out he finds himself anxious about where the nearest toilet is and ends up going to the toilet really frequently. I've known for a while now that he has a bit of anxiety about needing the loo and being 'caught short', but I didn't know the extent of the problem until recently. It transpires that he avoids going out sometimes to avoid the hassle and if he knows in advance he will be leaving the house he drastically reduces his fluid intake. He is constantly mapping where the nearest toilets are and he says his brain never stops thinking about it and he's got to the point where it is 'running his life'. He went to the GP a while ago and they did a urine test and said everything was fine physically. He won't entertain having therapy, mainly because I'm working in the area so it's a bit complicated.

I've spoken to him a bit about maintenance cycles and the links between feeling anxious, sensations of needing a wee, thoughts and safety behaviours. We also spoke about hypervigilance to bladder sensations. He seemed aware of all of this, but he is finding it difficult to make any changes and break the cycle.

I've spent a couple of evenings trying to find some papers or books that might help, but so far haven't found anything relevant. Does anybody know of anything that I could send his way? He is particularly interested in what behavioural experiments he could try. Would really appreciate any input.

alexh
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Re: Friend with fear of wetting self

Post by alexh » Mon Dec 14, 2015 11:11 pm

Reading your account, I wonder at what point helping a friend becomes quasi-treatment? Finding relevant literature, psychoeducation, designing behavioural experiments?

What's complicated about the fact that you work in the area? Do you work in the service he would be referred to?

pantsbeforesocks
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Joined: Sun Nov 04, 2012 10:01 am

Re: Friend with fear of wetting self

Post by pantsbeforesocks » Tue Dec 15, 2015 9:46 am

Yes I work across services, including the one he would be referred to. So do other people from my course with whom he is also friends.

I thought if there was some reading he could look at, it would at least help to normalise the experiences he's struggling with at the moment. There are tons of CBT-style self help books out there so it's not out of the question for somebody to read up and start to think about the sorts of changes they should be aiming to make. I've been thinking a lot about the best thing to do, but I thought this would be better than nothing.

lingua_franca
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Re: Friend with fear of wetting self

Post by lingua_franca » Tue Dec 15, 2015 11:40 am

Have you explained to him that if he's referred for therapy, you won't be the person to deliver it and that he will have complete confidentiality? It sounds like he's imagining that his therapist would be chatting to you about it and that everyone in the psychology service knows what's going on with every client who comes through the door. I think reassuring him that this isn't the case might be more helpful than book recommendations.
"Suppose a tree fell down, Pooh, when we were underneath it?"
"Suppose it didn't," said Pooh, after careful thought.
Piglet was comforted by this.
- A.A. Milne.

reefflex
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Re: Friend with fear of wetting self

Post by reefflex » Tue Dec 15, 2015 6:46 pm

The OP asked for a bit of psyched, not analysis of their helping intentions ;o)

Sue Watson and colleagues have recently written about this - its a reasonably common presentation of agoraphobic anxiety or social anxiety:

http://discovery.ucl.ac.uk/1400718/1/Ka ... hother.pdf

and if you google "fear of bladder control loss" there are other people talking about similar experiences in some of the anxiety forums like nopanic and ocdaction:

https://www.google.co.uk/search?q=fear+ ... gws_rd=ssl

There's also a really interesting new study suggesting that imagery rescripting of embarrasing "near miss" events can be helpful, as per rescripting shame memories in social phobia:

http://www.google.co.uk/url?sa=t&rct=j& ... FO9Sn5tzzQ

Having this kind of problem can be immensly disabling and yet the treatments are likely to be very effective, given the evidence base of CBT for agoraphobia and social phobia. This is where psyched is so important! Your "reassurance" might not be effective simply because you are his friend and he thinks you will always put a positive spin on things to try to encourage him. However finding he is not alone might be the first step to overcoming the fear (and shame) of seeking help, and hearing from a disinterested party (such as the NICE guidelines!) that very effective treatments exist might give him enough hope to try one.

Ruthie
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Re: Friend with fear of wetting self

Post by Ruthie » Thu Dec 17, 2015 2:23 pm

Hi All,

Can I politely remind people that we cannot give clinical advice here. It would be entirely inappropriate to do so given we haven't assessed the person concerned. Your friend can't just pluck out a behavioural experiment to try - they are done as part of an overall therapy where the formulation helps direct the client and therapist to design highly individualised experiments to specifically address the beliefs and assumptions that that client has.

Your friend's presentation is far from unusual and could certainly be seen by an IAPT or primary care psychological therapies service. He would be quite likely to see a CBT therapist rather than a psychologist given it is a relatively straight forward issue (although it may not seem like that to him right now).

The service can put measures in place to protect his confidentiality (e.g. arranging for him to be seen on a day of the week that trainees do not typically work, keeping his notes separate, ensuring his therapist knows not to discuss him with trainees or in group supervision meetings. An alternative option for your friend if he is still uncomfortable would be to see someone privately. However, I know qualified clinical psychologists and mental health nurses who have accessed local NHS mental health services with various arrangements to protect their confidentiality (including a receptionist letting a mental health nurse who was being seen by the service in through the back door and directly up to where she would be seen rather than having to wait in the waiting room).

I think it is really impossible to say we should never discuss our friends' psychological difficulties with them - it is inevitable that as friends we share things with each other and knowing what we do people might ask for our perspective on their difficulties. We might well be able to support them as knowledgeable friends and direct them to resources that can help but we do have to stop at the point at which we start acting like our friends' therapist and be quite clear that we can't treat them. If your friend decides not to seek help, then that is his decision. However, I would suggest that trying a bit of this and a bit of that rather than biting the bullet and going for therapy might just provoke more confusion and frustration for your friend.

I hope that is helpful. Having discussed it with the other mods I am going to lock this thread as giving clinical advice is not what this forum is for.

Ruthie
If God invented marathons to keep people from doing anything more stupid, the triathlon must have taken Him completely by surprise.

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