THERAPUTIC ASSISTANT'S REMARK

THIS SECTION IS DESIGNED AS A GUIDELINE FOR RELATIVES OR FRIENDS OF SOMEONE SUFFERING FROM AGORAPHOBIA ALTHOUGH AGORAPHOBICS DO A GREAT DEAL TO HELP THEMSELVES. THE RIGHT KIND OF SUPPORT AND ENCOURAGE- MENT FROM OTHERS IS EXTREMELY INVALUABLE AND FOR THIS REASON YOU MAY BE IN A POSITION TO HELP.

-I recently read of support groups with "specially trained staff". Does this frighten you, who are standing by your 'aggie', offering yourself, as you are, with no experience or special training? There are voluntary training courses in a few places only, certainly not producing enough assistants to go around. In S.A. they are called Therapeutic Assistants.
The majority of helpers are relatives, friends or neighbours who have a real caring and empathy (putting yourself in someone else's shoes) towards others with no "special training" other than the teachings and lessons of living and a kind heart. You are a "special person" to offer support to your aggie in the first place and secondly you will be "trained" as you go along primarily by the person you are helping, your aggie. (I will call him/her a friend at this point).
Aggies have been reticent about sharing their inner feelings, partly because of fear of being misunderstood and because the full depth of the fears can never be related others, (they'd rather not discuss them either as the memories are too vivid), so treat what is shared as confidential. If your friend tells you something about the ways and methods of achieving a small goal, listen and respect their point of view as they have thought it out quietly and carefully prior to voicing it and it's a suggestion that will suit the person and occasion at the time. THEY ALWAYS KNOW THEIR LIMITATIONS and you don't. DON'T push or bully - that has happened enough to them in the past. There is no 'magic' about yourself and you are certainly no better than your friend; don't let you "good deeds' go to your head for you will be the receiver in as many ways as you are the giver.
As you work together you will gradually grasp the severity of the condition and have great admiration for the courage and determination expressed in your friend. An aggie friend once said "If a million dollars was waiting for me to collect at the railway station, I couldn't collect it: and this has been confirmed by so many others I've spoken to - try and realise the severity of this condition. Be gentle in words and actions, for your friend has endured much misunderstanding and criticism that has caused much hurt. These personal things will not be told to you, for it happens many times and sympathy is NOT UNDERSTANDING. How often I've heard these words with a smile and a sigh of relief, "They understand me!" You can help explain to others what is needed from the public, this lifts a burden. Carrying agoraphobia is more than enough for anyone but to try an explain it as well !!!! especially if a panic could be around the corner. You relieve the added pressure of that and can slip away together quietly and slowly from that situation.
Carry some information on agoraphobia with you if you wish, then you can leave it with anyone whose help you are asking on behalf of your friend, it saves a confusing discussion. The outings you make together should be done with little or no mention of agoraphobia, once you've built up good communications. Your reliability in your words and actions will produce TRUST which is a vital key to success. FAY

-The role of an assistant is basically being able to understand the needs of the agoraphobe. Because of the nature of their fears, very often they are afraid to go out and sometimes can be stubborn. This is where the helper comes into his own. By offering gently, but persistent encouragement, he can help the person over hurdles that might easily daunt them, or even bring recovery to a stand still. Here encouragement and persistence is most important.
The most useful advice is not to push a person beyond what they feel they cannot do. However that is not to say that advice cannot be given, but the suggestions given are not aimed in criticism and must always be constructive. Above all this is patience. Let the "aggie" progress at their own pace, not what you feel they should be doing. The whole idea of practising is de- sensitisation and to regain self-confidence - this cannot happen if the person feels as though they are pushed beyond their limits. So the helper must be patient and let recovery take its course. On the other hand, the helper should encourage the "aggie" to practise every day (unless ill health prevents) no matter how they feel (good day or bad day). Often "aggies" feel they cannot achieve what they had the previous day. This must be pointed out that it is of no consequence and what is important is what is achieved on the day that counts and even if only a fraction is achieved of what has previously been done on another day. The helper may feel that they cannot gain much benefit from helping an agorapnobic recover - but this is not so!
An assistant does share the satisfaction of achievement when the "aggie" has reached a goal they have both been aiming for, and thought they would never reach. In addition to the satisfaction of helping in the recovery, the experienced gained by the helper makes him a more tolerant and patient individual. Often assistants help others as well. If the person you are helping recover is your wife/husband, girlfriend/boyfriend etc. then you will find your partner a more relaxed happier person, able to enjoy and receive the benefits life has to offer, and that is reward enough in itself. IAN

-As a wife suddenly thrust into being a "helper" to, at last recognised agoraphobia, it was rather an awesome role! Once the problem was recognised as agoraphobia, it was the opening door to healing and as a helper I realised I could be part of that healing Being a new helper and support, it was important to read and study the manual for "aggies" and the helper's manual as well. Both these manuals gave me an insight into the problem and also lots of points that were invaluable when we seriously and consistently began our program of practise, in the battle of acceptance and de- sensitisation.
The words, apprehension, fear, anxiety, panic, flashes sensitisation and acceptance have taken on a deeper meaning for me and learning to know the best way to help when these emotions happen to my "aggie". My husband is very patient and explains how they affect him, mentally and physically. A "helper" requires a great amount of stamina, lots of Avon Foot Cream for the hardening of the soles of the feet! - new concept of what a sense of humour really is, otherwise we tend to get hurt by our "aggies", unintentional unkind remarks to our encouragement, otherwise it's a challenge.
To help my "aggie" walking in many diverse areas of the City of Adelaide, Rundle Mall, the dreaded King William Street, all the floors of the large retail stores and all types of luncheon eating places etc. were required. It was great fun, educational and interesting. Haven't put on excess weight from the lunches, I am a great deal fitter and not so shy, showing definitely being a helper has its beneficial side. The assistants in John Martin's Bass outlets have become very helpful and friendly, when asked for seats by the door, on the aisle and not as yet upstairs in the Festival Theatre. My husband had become quite a relaxed "aggie" now, at live shows or at the pictures; it has been worth all the effort of stepping out and trying new challenges. We have known relapses, the most recent being quite devastating. We went back to our basic principles learnt when we started on the road to recovery, going back and recovering goals already that had been achieved, having sub-goals, taking time to stop and rest and being determined the feelings were not going to beat us. He has a new saying now, "relax and accept" .(shortened R.A.A.) Agoraphobics are a great group of people. To know them is a privilege, my "aggie" of course being the greatest !!!! They usually have a great sense of humour, courage and determination; all very necessary as they set out to achieve their sub-goals, goals and full recovery. Keep at it helpers! MARY

-Hi, Fellow Helpers. After being an Aggie Helper for some time I would like to pass on some of the things I have learned. Being a helper, as you now, can be tough going at times. S o much hinges on you and your ttitude. We must be kind, patient, understanding, confident, re-assuring, positive, cheerful and encouraging. It is no use calling on someone you wish to help if you feel 'lousy' yourself . Imagine how the "aggie" would feel if you knocked on her door and when he/she answers, youl ook a mess. Big bags under the eyes, suffering from a hangover, shocking headache and complaining about how you feel. Remember how negative feeling rub off onto others.
A good tip before you go visiting is to pretend you are member of the royal family making a public appearance! If you are smiling, relaxed, confident and self-assured this will rub off in a positive manner. Of course you don't have to overdo it! No "aggie' wants to see you trip up the stairs because you are so confident OF running up them three at a time!! "aggie" can be very perceptive. O.K. so you are there and spend some time chatting and making him/her feel at ease. Now you are wondering just how you are going to get the person out of the door. Use your imagination. I once picked a flower and invited my friend to come and look at some more. It took some persuasion but once outside we looked at the plants, trees, clouds and anything that was pretty. We smelt the fresh air and listened for sounds. There is so much around if only you look. Once you can manage your friend to go ouit with you, think of things to do - watch the planes take off or collect pine cones for the fire, visit the beach and watch the water moving and the light dancing on the waves.
If you find your friend starts to panic at any time, give him/her a sharp pinch on the arm, bottom or wherever you can reach. When they exclaim loudly about the pain, just grin and say, "I just wanted to see if you were awake!" Chances are they will laugh and forget about the panic. I've heard it said that laughter is the best medicine and I believer this to be true. See; the fun side of life, get your "aggie" to laugh at him/herself and others. Develope a good sense of humour and you will laugh at failures and enjoy successes. Get used to telling each other off occasionally (in a friendly way), it bulds confidence and makes you more assertive. There will be times when you think you have done all you can but nothing seems to be working. Don't give up! because its usually at this time that everything you have done suddenly clicks into place and you will start to see advancement. Don't forget to keep going over what has been achieved and working out new goals, you will be surprised at the progress and how proud you both feel. Cheerio for now GLORIA

-Unlike a disease agoraphobia always depends in part on things that other people do, often with the best intentions. People with agoraphobia often have to depend a lot for getting out on others (this is not by choice on their part), in fact it makes them feel guilty to put others out. In some cases it could be very difficult to encourage a dependence on others in the early stages, but it is necessary if the situation is chronic. To the agoraphobic it can be reassuring to know that there are dependable people to help them get out. There are many ways the people can encourage the sufferer to improve- and that means helping the problem and not hindering it. In the beginning agoraphobics feel safer with familar people - others can encourage self- help. Many things that people do can be helpful. To be really helpful means finding ways to help one's self-efforts of getting out even if the gains are small. Encouragement and understanding from others after a set-back are important. Helpers shouldn't make suggestions, assuming the answers for the agoraphobic. Reassurance that nothing too awful can happen is more important, but best of all is DOING THE PRACTICE rather than talking about it and AS OFTEN AS POSSIBLE. At each step in the plan there are some particular points where other's help can be beneficial. a. Suggesting targets that are being overlooked. b. Discussing which target seems right to begin with. c. If a goal has been started, others can help gradually to move towards it being achieved. d. Every day practice needs to be discussed, not forgetting the effort the agoraphobic is making. e. Others help the sufferer to do thing one step at a time in practising going out every day, In the long run it is the people who are close to the agoraphobic that can help the most. KAREN

-Hi there! One question that pops up early in discussions concerning the roll of the helper is, 'Will 'aggies" become too dependant? Will they like the regular support and not rely on their own strength?" I have spoken to many 'aggies' over the years and seen many come through the steps of recovery and can assure the helpers they need have no worries about this. I personally have not met one who wishes to stay restricted, needing to be dependent. Firstly all 'aggies' were very independent people, going about their daily work, enjoying their independent freedom of choice at all times, before the agoraphobia showed itself. Secondly they can't wait to return to their life as before and have searched from all sources and have never given up trying to find the answers, inspite of the fear. No, helpers need not worry, "aggies" want to be free to 'fly' again. Can you imagine what a relief it is for them to stop searching for answers and can now turn to an empathetic helper, whether in the family or a trained volunteer, or a neighbour or friend who is prepared to learn and lend a helping hand? What a relief for the "aggie" to find someone who cares and has time and patience and can help lead them to recovery in a gentle but strong way, reassuring the steps and confirming them as well as sharing life's dramas and humour of everyday experiences. In the early days of the support programme there is the necessity to be in close, constant contact (perhaps daily) to build up trust between you. Remember, there has been so much disappointment and rejection because of not understanding the problem, that it will take time for the 'aggie' to fully trust you personally, that you do understand the problem. You will need to be very sensitive to your "aggie" because of these past experiences and remember, there have been many, so never allow lack of trust to develop. Being trustworthy is the first goal for you to aim for, to prove to your "aggie" you won't let them down in a panic situation, as they learn to retrust their own bodies. 'Aggies' often feel guilty to have to rely on you so do all you can to help relieve this feeling; reassure them that you have chosen to help them and want to! Your roll as a helper draws on qualities of optimisim and encouragement so be prepared to give your best and don't think you'll run out for you have many unexplored qualities still. As you journey along the course of recovery you may find the rolls have changed. You will be the one who has been enriched, because all along you will be receiving while giving; many sincere friendships have formed this way. 'Aggies' have rich qualities of perseverance, loyalty and genuine sincerity that you will benefit from through sharing in their lives. Whether you are a T.A . or a helper, remember we must at all times be teachable as well as being a teacher. You may find that your values have changed as you help lift the weight off the 'aggie', some of those weights have been put upon them through no fault of their own. Helping an 'aggie' is really just aiding a friend. All the best. FAY

-A helper's important role is listening. Listening to communicate is most beneficial to you being an agoraphobic 'support person' as well as in your everyday life situation. In general people feel that to communicate or to be a good communicator one has to speak, but this is not so. If you don't listen to what is being related to you, you cannot carry out your role effectively.
There are many ways of listening, you can listen and not hear, this means, a) you can be thinking of other things while your 'aggie' is speaking to you, b) you may not be looking at the person while they are talking, c) you may not indicate by your expressions or body language that you are listening. These non-listening attitudes can stop communication between you and your 'aggie'. The 'aggie' can be put off wanting to talk to you or lose his/her train of thought by your attitude; this can have a drastic affect on the 'aggie' and of course when used in your personal life destroy relationships with friends and relatives.
Increase your communication by 1. First of all look at the person when they are speaking. 2. Concentrate on and of what is being said, even if you feel tired, change your attitude and you will become interested. 3. Use good body language, don't fiddle with things in your hands - lean towards the person and add small words of acknowledgement to show you are sincerely interested. Just because you are the support person it doesn't mean your 'aggie' doesn't have any good interesting ideas or subjects to talk about. Remember the statistics read that they have a high I.Q. They may be confused for a while because of the condition of agoraphobia but that does not mean their plans and ideas are non-existant. Listening is an attitude. When you put good listening into the situation it will increase your communication; listen to the 'aggie's needs; listen and you will get all the details right; listen and you will understand your 'aggie' better.
Remember, your 'aggie' may have something exciting to say, something to share that they have achieved. . Don't assume you know what another person could be thinking, this causes bad communication. Best Wishes VERA

-I would like to give a list of the attitudes that encourage progress the most 1. A hug goes further than words. If your partner becomes anxious, hold his/her hand, Your touch has twice the power than a lecture on why he/she shouldn't be afraid. 2 . Like you, your partner wants understanding rather than advice. 3. Encourage practise with rewards. e.g. "When you can handle restaurants, let's have lunch together somewhere special." 4. The road to recovery is rough. Our partner will have set-backs but do be sympathetic towards them. He/she is in the process of changing, patterns that have built up over a lifetime. The patterns don't change easily or overnight. Your understanding can help your partner through times of trial. 5. Although you can be available to help run errands you can't do the practice for your him/her. Don't run an errand for him/her because of his/her anxiety but offer to accompany him/her and promise to complete the errand if he/she cannot. 6. Periodically help your partner to re-evaluate hi/her goals. A good goal is one your partner finds exciting. Assist him/her to set up goals that have meaning, rather than what is expected of him/her. 7. Don't allow your partner's distress to rattle your own sense of calm. Reason isn't present in panic attack. If your partner panics, quietly lead him/her to safety. Though panics are extremely distressing and uncomfortable, they do not do permanent damage. 8. Appreciate your partner's small achievements. This is a good time to 'make mountains out of mole hills' ! 9. Be prepared to make changes in your routine. You may have to adjust your plans to facilitate your partner's practice sessions. Eventual freedom will more than compensate for your change of plans now. 10. Know your limits. If your capabilities to be supportive has been stretched to the limit, take a breather. Your partner needs honest communication about your feelings. Factually say what has been done or said that might have upset your feelings; he/she won't ' break under your disapproval. Honest discussion of feelings strengthens your working partnership. Remember also that your partner has the same option to tell you about his/her feelings. 11. Don't expect yourself to be perfect. Being a support person isn't easy, so be gentle with yourself. 12. Do not place any extra guilt onto your partner; he/she knows very will your role isn't easy. 13. Make sure that you and your partner have effected a plan that will be supportive to both you and your partner. 14. Remember you are no better than your partner and your partner no better than you. 15. Do not be devastated if your partner doesn't give you perfect results. 16. Remember you are a support person in the relationship, not a business partner. A support person is just like a friend and your partner is more than likely a friend to you. Successful travelling to all. CLIVE

-To begin with , the helper must realise that the only reason why an 'aggie' cannot go out is because they believe their fears will come true. The basic idea of recovery is to change this thinking! An 'aggie' who is not scared to go out is no longer phobic. There are several ways of changing this thinking, however to date the most effective method is situational de- sensitisation. To those who are not familiar with this - it involves setting goals and then working in steps towards them. Seeing panic through, with the right attitude and realising that it is no more than a release of tension and fear, is the only way to recovery. To many this may seem far too much - however as they progress and they will find confidence will grow more and more. As an 'aggie' recovers and their goals become larger, their previous goals will seem easy in relation to the present ones. It is hard for a helper not to be sympathetic to an 'aggie's' avoidance habit, however they must realise that too much procrastination will prolong recovery. It can be hard to help someone into a situation they dread. It is the helper who at times find it hard to make someone do something they are really scared of doing. You are likely to meet with "I can't". The most important aspect of being a helper is to see the happiness and delight expressed when the 'aggie' returns from achieving a goal as well as rationalising why a goal was fled from and then encouraging them towards further goals. The agoraphobic behaviour pattern of avoidance is changed by encouraging the 'aggie' to face their fears. Once faced the 'aggie' will see him/her fears as thoughts and feelings of no consequence. It is not true to say that ''aggies'' lack the will to recover, merely that their fears are so great that they shrink from the irrational thought of them materialising. This is one of the roles of a helper, to encourage the 'aggie' to face their fears and help them rationalise the situation. When a goal is being postponed temporarily by an 'aggie' both the helper and the 'aggie' must look carefully into the reason and determine whether it is valid or merely an agoraphobic avoidance. "I can't" is not an excuse. All this may appear to the 'aggie' to be hard and unsympathetic but it must be realised that an agoraphobic fear is cyclical, so until this cycle is broken it will continue. New small goals, controlled breathing and knowledge of conditioning etc. breaks the cycle and takes you forward towards full recovery. My girlfriend has been agoraphobic for 7 years. We have tried many forms of recovery (mainly avoidance!!) however after being convinced to face her fears, in the short time of 4 weeks she has progressed from being housebound, to doing things such as - staying in a large Westfield shopping complex for 2 hours alone, spending the day 70 kilometres away, and surrounding areas and other things wonderful, but too numerous to mention. IAN

-I have been with 'aggies' over the years and personally felt the hurt when this condition has not been understood by the public, but this story is a 'turn around' and tops the lot. How often we helpers have heard sufferers say that they would 'not wish this on my worst enemies' (personally I don't believe that 'aggies' have any enemies, only those who don't understand and become intolerant). During one of the visits we had to the dentist, who by the way is one of the most understanding and interested professionals we have met, told us how she could empathise with agoraphobics. She always asked what would help most with this condition and would keep up a running commentary on the dental process which helped with distraction and made it easy for my 'aggie'. The dentist needed some medication for a certain illness she had and her doctor prescribed some with adrenalin in it !!! Does this ring a bell with you 'aggies' ? Yes, the poor woman experienced a shocking panic ! Now don't laugh you readers, as you have so much sympathy for those with this condition, but it is amusing to know that one can actually plan a panic by taking such a tablet!!!. This again proves that this condition is not "psychosomatic" (in the head) it really is a fact and you are not going mad as you may have thought when there was no information about it. Don't drop your bundle when the panic sometimes tricks you and shows itself, when you think it is behind you. That annoying adrenaline gland WILL return to its normal state just like a broken bone always restores itself naturally. The body is a wonderful creation with inbuilt recovery properties. Keep looking ahead, the best is yet to come. FAY

-The helper must never believe they are more important or superior than the 'aggie' they are helping. It is even more important for the 'aggie' to choose the helper. The helper learns a lot from the 'aggie' that perhaps a helper would not have otherwise known. Also the 'aggie' knows who they are comfortable with and who they could trust. The helper must always remember the 'aggie' wants to be helped - not pushed! Previous to helpers, the 'aggie' had all their trust in tablets, now the helper does get the 'aggie' back to a normal life style. That is a very big step to take. A helper should never get discouraged if the two can not somehow get along with each other. It just means that it is a very big step that the 'aggie' has now chosen, and perhaps sometimes they are just simply not in tune with one another - it is important that they at least share one thing in common other than the supermarket. All people are different in many ways, attitude, temperament etc.. Sometimes the 'aggie' will know herself, how to go about achieving a certain goal and the helper should not be in conflict with that decision. The helper may have read a lot but there is still room for variation for each 'aggie' that they are helping. In the same way, the helper must be thought of as an important person - especially chosen to do very special work - to help others reach a new horizon in their life. Feelings are very important. A helper should not be embarrassed to help, nor should the 'aggie' feel embarrassed or guilty to have a helper. The helper should not broadcast the fact she is helping an 'aggie' unless she knows the 'aggie' very well and knows she doesn't mind if you tell some one else. Both should keep criticism to themselves but both share in the pleasure of progress. In many cases helpers and 'aggies' do end up with very special; friends. A helper should never increase the negative when helping; if the 'aggie' is hesitant, this is where the skills of positive communication from the helper would be needed; encouragement and rationalisation not agreement with the negative. A helper must learn to see her way around the negative way of the 'aggie' in a particular situation. Also helpers should realise that as an 'aggie' does progress and become more independent, sometimes anger from the 'aggie' might show and is taken out on the helper - this needs special understanding also. Just keep in mind the more confident the 'aggie' gets the stronger a friendship is likely to come about. Don't be shocked to find an 'aggie' is the same as anyone else and you will see the true person coming through during the progress of their recovery. If the communication line is not open between the 'aggie' and the helper and both have tried, neither party should take it personally if each need to work with someone else. DOROTHY
-HELPERS should always remember that within all people there is an inbuilt 'survival kit!" There are some amazing stories of 'incredible achievements' people have made in a crisis, showing at that time the strength needed to handle an extraodinary situation e.g. In the Darwin cyclone (Tracy) a father lifted a concrete block, far heavier that he could normally lift, to release his wife who was pinned underneath. We say this is superhuman strength, but this potential is within us all. I am not talking about muscles in the case of agoraphobia, but the fact of this untapped resource. Sometimes helpers get impatient when they cannot see progress made, and lose sight of this potential within; the desire to recover is always there and the power to recover. Instead of expecting things to flow in place one after the other, a helper must coast along sometimes and be patient. Do you yourself like impatience from others, especially while waiting for something to change or achieve? RECOVERY STARTS FROM WITHIN AND IS NOT SEEN AT FIRST. Keep on being patient and you will see an expression of your support in time. Admire your 'aggie' facing firstly, this devastating problem and then asking for help ! Some younger people may not understand this comment as I belong to the era when people ignored and buried their problems and suffered alone, unaided with no help and suffering much despair. These days there is so much help and support available to the helper to understand agoraphobia. Aim to show optimise in the situation faced, that can reasonable be understood and rationalised by your 'aggie'. A helper must always be balanced in their optimise, and try not to cloud the situation with their own personal problems at the wrong time. It is a very difficult subject to understand, as the 'aggie' looks so well and healthy, so it is easy to look past the inability to do one thing in one practise session and not again the next session. Do not expect the same pace each time ! This is very important to the end result of recovery for you 'aggie'. Also do not expect to always to have practice sessions - bring in a social time, e.g. lunch or coffee in a nearby cafe. Helpers should know and realise that the 'aggie' does want to put the problem of practising at the back of their mind and enjoy daily outings. This brings confidence, the same as a desensitisation programme. REMEMBER THE PRINCIPLE OF THE 'TORTOISE AND THE HARE'!! HELENA

-I must emphasise to helpers and friends, particularly in the beginning, to take a very strong passive role! Firstly as a helper, realise you know very little about the subject or perhaps nothing at all - unless you are a member of the family - even then you may only know a quarter. Maybe you are one of those who have studied the Recovery steps already. The sufferer has always been reticent in explaining the subject in detail because in the past they have always come to a 'dead end', with no answers. So they kept most things to themselves as it seemed easier and brought less misunderstanding and confusion. Realise that it is a time of learning for you (use your ears more than your mouth) as well as your 'aggie'. We helpers must understand that in life there are times to impart knowledge to others and times to receive knowledge - to be students as well as teachers. Listen and Learn are the two L's for you, no matter what stage you are at, in your role as a support person. It is imperative to learn the recovery steps in the right order so you know you are going the right way. I myself have been associated with helping 'aggies' for many years and there are still aspects that can catch me 'out of sink' with my 'aggie'. So remember the two L's. Getting to know your 'aggie' is important to begin with. Allow the trust to build between yourself and your 'aggie'. It is a privilege to be a support person as you will find out or already have, to experience the positive side of achievements made on behalf of the 'aggie', sometimes with your help or without your help. Trust is vital for all but even more so for your 'aggie' because firstly the trust they had in their own body had constantly let them down, then trust in themselves (because of confusion and bewilderment ) and last but not least, because of trying so many avenues for help and answers without getting results; this has created distrust. It is very important to share everyday, simple pleasures of life, and realise that the 'aggies' have a desire - built in determination and courage, to recover and find answers. Be sensitive - don't think you must push, they have their own motivations and ambitions, but encourage and be trustworty. Encourage your 'aggie to keep a diary, this is most important for them, they get the benefits as they-read of their progress over time. Your help is needed ! Always remember that ! When graded - exposure is practised your co-operation and influence helps more than you may think! Also realise they do not like to be in the position they are in. Agoraphobics do not like to be dependent on others, they remember their previous lifestyle when they were independent, so at times it is hard for them to accept your help. Those who are living close to the agoraphobic can help more than a busy professional person in the practising of graded-exposure, for help is neaded, sometimes daily. Many people, in many different ways can help in the recovery of an 'aggie'. Thank God that so much more help is available to sufferers. FAY
-What you have read or already know about agoraphobia, you may think everything can be done by the sufferer alone, or you may think a helper has to be a qualified social worker, community nurse, doctor etc.. This help is needed to begin with and occasional support if the first stages are already conquered. In the long run it is the people close to an agoraphobic person who has the time to help more! If there are no conflicting problems to be dealt with, your help is needed. Often there are special difficulties connected with situations at home, or journeys from home, which you may know about, but other people don't. When treatment is done away from the home, e.g. in a hospital, any improvement might disappear when back home again. This is why your help is needed - practise is necessary and best done from the home and familiar surroundings. Because it is where the unlearning of the conditioning is to take place, as this is where the sufferer became chronic (ex) like not reaching the letter box. Agoraphobia, unlike a physical illness or mental disease, always depends in part on things that occur in everyday life, which everyone has. Sufferers often have to depend a lot on others for getting out and starting their programme of graded exposure, because of the avoidance pattern created (not by their own choice). You must also tread carefully as the sufferer is aware of this and often feels unnecessary guilt and will not ask for this little help. They wish to be independent, but must recognise the need for help first. To be really helpful, its not doing the shopping for them, but to find meaningful ways to help their efforts of getting out, even if the gains seem small that way - it is easy to feel impatient for both the sufferer and the helper, even more so if a set-back occurs. But this is when your help is most needed. Reassure and rationalisation play an important part. More important, is, instead of spending time talking about practice - DO IT , and as often as possible, because this is the way a sufferer becomes de- sensitised. AT DIFFERENT TIMES, IN DIFFERENT PEOPLE, ALL HAVE THINGS THAT CAN PLAY A PART IN MAKING AND HELPING AGORAPHOBICS BECOME INDEPENDENT AGAIN. JILL

-Making it too easy for the 'aggie' to stay at home just makes the pattern of avoidance and the fear grow stronger. It is easy to feel impatient if things seem to be moving slowly and even more so after a set-back, this is when a helper will be most needed - understanding is important too, but that does not mean that it helps to talk too much about the unpleasant feelings. since that is a hindrance. Acknowledging the effort that an 'aggie' puts into graded exposure and the reassurance that nothing too awful can happen, is much more important. If the 'aggie' managed to get to a shop that they have been avoiding, tell him/her to acknowledge all efforts and several attempts may be necessary for success. He/she may not have succeeded in getting there but the helper should remember that the attempt has been made and that too should be acknowledged. Avoiding the shop for too long may increase the fear of it and certainly won't make it any easier the next time it is tried. Do not check whether he/she felt any strange panicky feelings as this will cause him/her to think about any unpleasant feelings going on longer. Before deciding on which shop, discussion may help to find items that you both agree would be useful. You may be able to help with shops that have been avoided for so long, but remember that in the end he/she must choose the shop themselves. When working together to overcome a shop problem, it is important to find out which shop is right to begin with - it should not be too easy or too difficult but somewhere in between. Also it is a good idea to start something that you can both enjoy together. SHARON

-To keep you in touch with practise that he/she does alone, it is very important that a diary is kept (if not doing so already) to note down every day how long the practise time lasts and where he/she went. If you keep a list of agreed practice targets, then you can check them off every time the record shows it has been achieved. Once the target has been managed several times, you could ask how he/she feels about trying something more. Don't complain or be impatient if progress is slow or variable - remember the first aim of practise for an agoraphobic is to learn how to cope with the unpleasant feelings that keep it going, and these will alter quite a bit from day to day. Pay no special attention to failures other than encouraging him/her to try again in a different way next time. Perhaps with your help or after taking a tranquilliser (if you are on them). Once he/she achieved the planned item, he/she should practise it again, repeat and repeat to check it and this will increase His/her confidence. Suppose you are out together when suddenly he/she says that he/she feels frightened by some strange feeling or situation. Do not immediately take the agoraphobic home. Try to find somewhere to rest, sit down and rationalise the feelings and encourage controlled breathing; walk back a little way or do anything that will help him/her to stay in or near the place where the feeling started. Do not keep asking how he/she feels or get involved in very lengthy discussions of the panic feelings since this might worsen the situation. Find something else to talk about until you judge that He/she is feeling better. In time the feeling will die down and although then you could both go back home, it would be better still to go on practising for a little while before doing so. For unfortunately once panic has come and gone it is unlike to come again for a while. The golden rule is try not to leave a situation until the fear is going down. Telling him/her to 'snap our of it' will have no effect. If it could be done that way, he/she would have already done so and not be in the cycle of avoidance and fear. Helping he/her to get home immediately might make avoidance more likely next time (depending on how severe he/she is at the present time) because he/she has learnt by conditioning that by going home the fear goes down. i.e. back to a safe place. The unfamiliar places can eventually become safe places too. Going to another shop might help, provided it is nearby. There is a danger, however, that he/she will learn to avoid the factor which would regain confidence that was lost. IF IT IS POSSIBLE TO HELP HIM/HER STAY UNTIL THE FEAR GOES DOWN, WHETHER IT IS THE SAME PLACE OR NEARBY - THIS MAY QUICKEN THE REMOVAL OF THE AVOIDANCE PATTERN CHRIS

-Helpers can help in distraction and the control of negative thinking in those in their care. Agoraphobics often make their condition worse and even bring on panic attacks by the manner in which they think. Helpers should become aware of the negative ways in which they think and learn to help change these in order to stop them adding to their fears. The way they think often controls how they feel and can therefore make them anxious or calm. Thinking can be divided up into types: 1. NEUTRAL THINKING This is thinking which is concerned with relatively unimportant minute by minute decisions and has no particular consequence for us. e.g. "Where did I leave my shoes?" "Should we watch this program or that?" 2. POSITIVE THINKING This is a form of thinking which makes it more likely that with your help the agoraphobic will achieve some significant goal. e.g. "If you just do your breathing exercises and practice all you have learned to stay calm you shall succeed in taking the bus". " Remember your body is working with you." 3. NEGATIVE THINKING This is a self-defeating form of thinking which makes it less likely that they will achieve some significant goal. e.g. "I hope you don't lose control when we go out today" " I wish they would hurry up - you can't stand in this queue much longer!" It is easy to see that if you talk negatively much of the time, an agoraphobic, who already thinks the worst, will feel very anxious and probably fail in what you are doing. In order not to undermined the one you are helping, you must learn to recognise your own negative thoughts, and then how to change them into positive thoughts that enable you to help plan for success, not failure. Write down every negative thought you recognise in your agoraphobic and change it into a positive thought when practising.DAVID

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STATE WIDE AGORAPHOBIA GROUP (AUSTRALIA) INCORPORATED
Email address: swag@tne.net.au Phone: 08 8294 6543 Mobile: 0412 226 117
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