I was watching an episode of Modern Family recently: Fizbo, Season 1, Episode 9.
Phil is throwing his son, Luke, a birthday party and his uncle, Cameron, offers to dress as a clown for the party as a birthday present for Luke. Cameron transforms into Fizbo, “a classically trained Auguste clown,” (Peacock Episode Timestamp 6:42) and arrives at the party. Turns out, Phil is deathly afraid of clowns.
We find out Phil has never shared that he is afraid of clowns with his family and is unsure why he fears clowns. “I am not really sure where the fear comes from. My mother says it’s because when I was a kid I found a dead clown in the woods, but who knows?” (13:46).
When Phil sees Fizbo at the party he is trying to calm his nerves, but repeating to himself, “It’s just Cam. It’s just Cam,” and shares with his brother-in-law, Mitchell, that he has a complicated relationship with clowns. (14:10-14:17). It’s evident throughout the rest of the episode that Phil is having difficulty functioning whenever he sees Fizbo (14:48, 15:10, 19:48). The first timestamp shows Phil with a slight freeze response then moving slowly to remain unseen. The second timestamps has Phil slowly walking backwards away from Fizbo and mortified at Fizbo’s trick of pulling ribbons out of his mouth. Lastly, Phil is having difficulty breathing and needs to bolt from the room.
I started to think what I would do if Phil was a client of mine, and began creating the Phobia Protocol in my head. We are taught in Basic Training that when it comes to Phobias we should assess for First, Worst, and Last/Recent events. When was the first time the client was aware of this phobia? When was the worst experience? When was the most recent? For Phil, I would write the protocol this way:
First & Worst: Finding a dead clown in the woods
Last/Recent: Seeing a clown at Luke’s birthday party
Based on the limited information I received throughout the episode it seems the first experience and the worst experience would be the same. This is true for your clients as well. Some clients may even have all three of those categories be the same event. Examples could be: their first and only panic attack, their first and only visit to the hospital, their first and only time encountering snakes. EMDR works wonders for single episode events and I have often found these events are successfully reprocessed in one session.
EMDR also works wonders for phobias, both simple and process ones. A simple phobia would be like Phil’s: clowns. A process phobia would be something that involves going through a process such as, flying on a plane. You would need to pinpoint when the anxiety spikes the most: packing for the trip, driving to the airport, waiting for the plane, boarding the plane, takeoff, turbulence, landing, taxing? This is generally addressed during Phase 3 when finding the target image and EMDR is able to generalize the whole process. However, sometimes the client requests breaking down the process into more manageable reprocessing and it’s okay to follow the client.
Side note: With my studies of EMDR and working with Dr. Dobo he was able to teach me how EMDR addresses complex phobias as well. That’s when the phobia isn’t really about the phobia. For example, I had a client who had a phobia about bugs buzzing by her ears. During reprocessing it linked how her father would “buzz” his fingers by her ears and she hated it. Even though she told her father she didn’t like it he kept doing it because he thought it was a funny joke. This left her feeling unheard and like she didn’t have a voice.
Interestingly enough, one of her symptoms when a bug would buzz by would render her speechless. Even when we were setting up the Phase 3 protocol she was having difficulty talking about the buzzing bugs. EMDR helped her reprocess the bugs and her father’s teasing and she found her voice. Now, instead of running to get her husband to kill a bug in the house she captures them, holds them, and sets them free outside.
Back to Phil. A seemingly simple phobia. (We never really know for sure what kind of phobia it is until reprocessing begins. That’s one of the beauties of EMDR: it makes the implicit explicit. So no, you didn’t break your client if an open-and-shut case of phobia turns out to be complex. Be prepared for this and know that if a new channel/target opens up, and you don’t have enough time in the session to fully reprocess, you can always contain it and target it the next session.
I have usually found most clients are relieved when they are able to identify where their phobia came from. Thank you, Dr. Siegel’s Name It to Tame It explanation! I would ask Phil which target image he would like to start with: the dead clown in the woods, or Fizbo at the party. If he left it up to me I would probably go with Fizbo because past is present. Phil is presently presenting distress when he sees Fizbo, and his explanation of the dead clown in the woods doesn’t seem to bring as much distress. If we choose a generalizing negative cognition such as, “I’m in danger/I’m not safe or I can’t handle it” then processing may link to the dead clown in the woods. This way, I am helping Phil reprocess all of those events with clowns: first, worst and last in the same session.
Again, we could begin with the dead clown in the woods since that seems to be the touchstone, but Phil does make a joke in the episode as quoted above that he doesn’t know if finding the dead clown in the woods is the reason why he’s afraid of clowns so that memory may not be very activating for him. His defense mechanisms may have helped him compartmentalize it to help him cope and survive. This may be a challenge with EMDR. Going with Fizbo is recently, currently, activating and would be a better starting point to link to the dead clown in the woods and help Phil adaptively shift to knowing he can handle it when clowns are around.
It’s always good to clear out any anticipatory anxiety as well. I could advise Phil to ask Cameron to dress as Fizbo again to test out his response. We could target seeing a clown in the future to help Phil know he can handle seeing a clown in the future instead of feeling anxious and running out of the room. I would make sure Phil understands that his body may still need time to know that he is safe since it has been conditioned for years to respond with fear whenever he saw clowns. This is why targeting anticipatory anxiety is important as well as addressing body sensations in Phase 6, and explaining first and second order change in Phase 7.
I hope this helps! I’m off to treat another fictional character now.
