I treat phobias using a modified protocol developed by the BWRT counsel. To briefly outline how the basics work the protocol looks to change the worst memory a client has about an issue and alter the mental association with that image.

To put this in context, when an event of trauma occurs in your life (e.g. loss, sexual assault, verbal abuse, physical assault etc) that leaves a significant emotional impact (fear, pain, anxiety, anger, embarrassment) that memory is saved to the subconscious mind, alongside the attached emotion. Whenever you are forced to confront an issue of a similar nature the emotions associated with this traumatic memory will come to the forefront of your mind and will create a similar sensation to what you felt at the time of the trauma. The subconscious mind does this to protect you and as an effort to steer you away from the thing you have a phobic response to.

Sometimes there are cases where the individual does not have a clear negative memory associated with the phobia, we use the most negative mental construct they have in their mind.

A good example of this is myself. I used to have a terrible phobia of needles created when I was younger. With the only apparent available date being my seventh birthday, my mum took me to have the BCG vaccination. I vividly remember the nurse handing me a jammy dodger biscuit and then her injecting the needle into my arm without me being aware. I had a huge freak out episode during the vaccination and ran out of the hospital with the needle still in my arm. After some coercing (I had climbed up a tree), they restrained me, brought me back inside where it was necessary to have the injection a second time.

As you might imagine that left me with a horrible phobia of injections for a large period of my life. Every time I would be forced to have a vaccination I would be petrified, resulting in a terrible wave of anxiety and severe panic attacks. As a result, I actively avoided any situation where I would need to have an injection, missing out on a lot of travel and job opportunities as a result. I no longer have this issue after working with a BWRT practitioner. My result from that session is in fact what inspired me to become a BWRT practitioner.

The way BWRT works with regards to phobia is to take the most powerful negative memory you have of the associated issue. So in my case this memory of having the BCG as a child. We then have the individual bring this memory to the forefront of the mind. We then repeatedly overlay a positive memory that you have over and over again through a semi-hypnosis process (you are awake for the whole experience, just imaging flashing imagery as I verbally guide you). This process is spoken very quickly as the aim is to communicate directly with the subconscious mind. After the BWRT session is completed, the client is asked to recall the worked upon memory, whereby the emotions associated with the memory should be completely changed.

After an hour of this work I no longer had any phobia of needles, and whilst I don't particularly like them, I am fine to have one at any time for any reason, which is worlds apart from my previous ability to deal with injections. As you might imagine BWRT is extremely effective at resolving trauma. Where it may take months of work utilizing CBT techniques, phobia resolution with BWRT takes just a couple of hours.

I first had CR to bring this negative memory of taking the garbage past the cats. I had her bring the most negative memory she had to the forefront of her mind and then to focus on the worst part of the memory and bring the associated emotions to the forefront of the mind. I then asked her to rate the memory in terms of fear where 0 is no anxiety at all and 10 is high anxiety, she gave it a clear 10. This score is known as the PAL or perceived arousal level. I asked her to then save that memory and titled it the frozen memory (the reasoning for this name will become apparent as time goes on).

We then created what is known as the preferred response. This a memory or a mental construct where the client feels roughly the opposite of how the negative frozen memory makes them feel. In this instant the frozen memory was a memory with associated fear, anxiety and discomfort. We are now looking for a memory where the client feels comfortable, happy and relaxed. This can be a memory of anything, all that matters is there is strong positive association with that recall. In this case, CR chose to use a memory of a few days after the birth of her first born, holding her baby and feeling at ease. This is a very positive memory for CR so it was a good choice.

The final construct created is called the future memory. This is the memory of a simple everyday action. It could be making breakfast, going for a drive, a run etc. In this case we choose making a packed lunch for her kids, which CR did most days. Whilst picturing this future memory I have the client associate feelings of overcoming and tie it with something mantric. In this case lines like 'I am not afraid of cats', 'I have really changed and grown' and 'I don't care about cats anymore'. Such lines embedded into the memory now continue to reinforce the work in the future after the therapy has been completed.

At this point we ran through the BWRT process. In this case when using BWRT with phobia, the experience takes around 10-15 minutes after which I put the client into a relaxed state for another 5 minutes before testing to see what the associated PAL is now with regards to the frozen memory. The initial memory had a 10/10 strength emotional response. The BWRT process involves having the client picture moving between these images among over elements, creating an overlapping effect within the mind. This associated link allows for a change in perceived emotions towards a memory and even towards a mental construct. In this case, cats. This is done through a scripted process, during which the client is awake through the whole experience.

After we completed the BWRT process, I had the client bring to mind the negative frozen memory and test the PAL again. CR said she had no anxiety whatsoever towards the memory after completion and scored it a 0-1/10 for PAL. I consider this to be a positive result. If the client still scores a 4 or higher, it usually means there is some other unresolved element or the trauma is complex in nature.

Working with phobias is very quick when using BWRT. This particular instant took just a single session of an hour and a half. In most cases we can resolve the phobie in a single session. However there may be lingering effects on the personality (such as general anxiety, depression or self-esteem issues) that we then may transition into working on. Some examples of this is Case Three: PTSD related to childhood & self esteem (Client TN) & Case Six: PTSD related to military service. I choose this case as it was aa standalone session focused only on phobia.

What was particularly interesting about this case was shortly after we had finished (it was a house call), I left their house and spotted a cat outside their home. I called the client to come out and to test the work we had just done. We stood around 30 meters from the cat initially and I asked her how she felt. She said she had no anxiety about the cat, although some anxiety around the idea she had no anxiety over the cat. We moved nearer to the cat, with each interval I asked her how she felt. Still she was fine. At around five meters away the cat came towards me, ran between my legs and then ran on. The whole time she was fine and felt no anxiety. Her husband later told me that this was a radical change and she would have previously screamed and cried at the thought of going near a cat. Thus I consider this cat to be a good example of how effective BWRT is both in terms of time and effect.

If you would like more information on how I work with phobia, or would like to schedule a phone consultation, please send me an email at info@ryanmcconnell.co.uk

I asked TN to write down her most anxious memories. I then had TN give each memory a score out of ten where ten is highly uncomfortable anxiety and zero is no anxiety at all. She presented the following memories as causing her the most anxiety:

• TN mother conducting silent treatment on TN for weeks at a time. TN stated her mother had ignored her for an extended period of time (as much as 2.5 weeks) and refused to acknowledge her existence even when she was begging and crying. She did not have a defined memory but a collection of small clips.
• Around age 12 having her mother berate her and reducing her to tears, significantly damaging her self esteem. She had a defined memory for this one.
• Age 16 Seeing a person get hit by a bus and dying in front of her. This she found to be shocking and uncomfortable to recall, but it didn't have any ties to her self-esteem.

We decided the best memory to tackle would be seeing a person die in a bus accident. The reason for this was to demonstrate the efficacy of the therapy with a stand alone event and thus boost encouragement for future sessions

At this point we started to conduct the BWRT. Please note that whilst I will explain in some detail the BWRT process, it will not be possible to conduct the BWRT on yourself just following this case example. Much of the effectiveness of BWRT is in delivery, with nuances that require a certified practitioner to conduct it effectively. Also please note there are multiple different uses and forms of BWRT, the version described here is for traumatic memories.

Also please note for legal reasons I cannot fully write out the BWRT script, only briefly outline the process.

More explanation of how BWRT can be found on my website at this link https://ryanmcconnell.co.uk/bwrt/ and also on the BWRT official website https://www.bwrt.org/

The first step of BWRT involves the creation of small mental movies or mental constructs. These are seen in one's mind's eye and I ask the clients to put in as much detail as possible. When working with memories I ask them to try and remember as many little details as possible. Any smells, details of the individual, what was the client wearing at the time etc. The more fully formed the mental template, the more effective the therapy.

The way BWRT was used in this case requires three mental constructs to work. The first one is known as the frozen memory. It refers to the mental image in your mind of the negative event. This can be a memory or your own mental creation. It can be a memory of a single event, a collection of fragments or a fantasy of the worst case scenario you can imagine. We then test to make sure it is the correct negative construct by using a variety of testing methods. The frozen memory/ mental construct should make the client uncomfortable to dwell on.

We then create what's known as the preferred response. This is another memory or mental construct that is the opposite in nature to the frozen memory. It should be something of the ying to the yang in terms of emotional response to the frozen memory. It is usually highly positive in nature and on recall creates a positive sensation, although the type of preferred response we create depends on the nature of the negative association within the frozen memory. Once again I test to make sure this is indeed an appropriate memory and have the client put as much detail as possible into this memory.

To use this case as an example the frozen memory or seeing an individual get hit by a car. This memory caused TN a great deal of anxiety and distress to recall. The memory we used as a preferred response was her relaxing with a cocktail on the beach in Thailand. This preferred response recalled emotions of relaxation and calm.

The third construct is the future memory/ construct. This is a mental construct that takes place in the future where the problem has been overcome. The reason for the creation of the future construct is to address the issue of how we perceive a problem. We perceive issues in all tenses, the past, present and future so we need to address all three in terms of mental templating. This future construct involves picking an everyday action and modifying how we perceive it. Usually this is a very mundane task, like going for a walk or cooking dinner.

The future memory used in the case was TN brushing her teeth tomorrow. Whilst brushing her teeth I had TN imagine letting go of the death of this individual and having her believe that being emotional over his death would help no one and there was nothing that could be done. It was only hindering her. Instead she would be careful to never run anyone over, but ultimately she would let the shock and fear of seeing this person die go. I had her make this very clear and defined in her mind and tested appropriately.

To give you another example of the application of the BWRT method I will use the example of myself with my childhood needle phobia, I perceived needles as terrifying on a multitude of levels. I had a traumatic experience as a child with needles that made me uncomfortable to recall (frozen memory/past). I had terrible anxiety and cried when having a needle, reinforcing that needles are indeed painful and scary (present). Finally I had terrible anxiety and panic attacks thinking about upcoming vaccinations and would avoid them at any cost (future).

At this point we then ran the BWRT procedure on TN. This is a ten to twelve minute process that involves a mental visualisation journey for the client and involves picturing images and emotions as I direct. The client is awake through the whole process. It involves myself having the client bring up the frozen memory, preferred response and future memory in quick succession in a certain pattern. The purpose of this is to take the emotional response from the preferred response and to overlay it upon the negative frozen memory. This is done several times until the new emotional response begins to stick. When conducted properly the emotion associated with the frozen memory should be hugely reduced to the point that it no longer causes the client any emotional pain to recall.

After the process is completed we then test the negative frozen memory to see if there is still an emotional response. Part of the initial testing of the frozen memory involves taking something called the perceived arousal level or PAL. PAL is a given score out of ten where the memory causes maximum anxiety to zero where the memory causes no anxiety. The initial PAL for TN memory was a nine out of ten. After the BWRT session TN's frozen memory had been reduced to three out of ten. I was fairly happy with this result and usually try to get a score between zero and two. However, given the client's history it was apparent it would take a few sessions of BWRT to really reduce her baseline anxiety to the point where zero and one were a possibility in future sessions. The client was very satisfied with the result.

This concluded our first session of BWRT. I directed the client to spend some time recalling the frozen memory over the week and to write down the PAL generated when recalling this memory as well as some videos to watch.

After pleasantries I had the client recall the frozen memory we worked on last week. She did so and scored the memory as still causing a three out of ten in anxiety. This was expected as the score associated with the frozen memory should seldom rise after the first session (I have never personally encountered this issue) and in most cases decreases. However, given that her baseline anxiety was very high normally it was unlikely to reduce over the week. She described herself as feeling lighter as if a burden had been lifted from her and was very happy with the result thus far.

At this point the next logical step was to work on the other two memories which focused on the relationship TN had with her mother. After discussion we decided on the following goals.

• To remove the anxiety associated with the verbal judging and silent treatment. She suggested she would like to just let go of the hold these memories have over her and to just feel neutral about the memory in a similar manner to the BWRT conducted earlier.
• To adjust the way she sees her mother, giving her a more neutral association. She was not interested in forgiving her but she did not feel comfortable allowing these memories to have a hold over her either. In TN own words she just wanted to move on.

We chose the worst memory of her mother's negative behaviour and selected it for the frozen memory. In particular I wanted to look at memories of shame and embarrassment that TN's mother had caused her.

The memory we used for the frozen memory was on her mother calling her worthless and a failure, telling her to sit on the trash can. It was just the two of them. TN remembers sitting on a trash can and hearing this. Recalling the memory caused TN to cry and it was very apparent this was a very traumatic memory to recall. She gave the memory a clear 10/10 in terms of anxiety inducing and was visibly shaking.

Please note when working with BWRT it is not necessary that we discuss the memory or even that you tell me the memory. The only thing that matters is that you can visualise a negative image in your mind's eye. If you would like to keep the details of the event to yourself you may do so.

For a preferred response we used the same preferred response as before and picked a different future memory of TN walking her dog. We conducted the same process as before and afterwards we again tested the level of anxiety associated with the memory. The score this time was a two out of ten. I was happy with the result.

We concluded the session there. I set her some further tasks and preparation for level 2 BWRT. The next session would be focused on improving her damaged self-esteem which was the last key issue TN stated she had wanted to tackle. Since the poor self esteem was mainly around how her mother had treated TN, it was important for us to first: understand her mother's behaviour as best as possible; remove the barriers of her mother's control with BWRT and to convince TN on both a conscious and subconscious level that it was possible to change her personality.

At this point I had been working with client TN for some time and now knew a great deal of her past. When dealing with past trauma it is important for the client and myself to work together to draw an accurate picture of how the client's past was and what is the correct mindset by which to now view these past events. This is why I did not attempt to improve TN self esteem until we had: made progress over accepting and overcoming her past; taking steps to improve her career; taking steps to improve her health and working on her relationship with her family.

Through my conversations with TN we had established the following about her self image:

• TN mother was controlling and displayed narcissistic tendencies. TN suggested they got considerably worse after TN mother had found out about an affair between TN's father and a woman he worked with.
• After finding out about the affair, TN's mother's had become increasingly more abusive and paranoid. She distrusted other women and became controlling over her kids as a coping mechanism. As a maladaptive method of control she had become overly judgemental and critical. This manifested as an abusive parenting style which TN had sadly had to bear the brunt of.
• The effects of this abuse were permanent on TN due to the duration of the abuse (all throughout childhood), the frequency of the abuse (most days) and the respect she gave to these criticisms due to them coming from her mother.

This abusive attitude towards her had left lingering effects on TN. These had manifested as low self-esteem, anxiety, fear of failure, distrust of others, paranoia and depression.

For this version of the BWRT process, we have the client take the negative self-image the client has of themselves and then overlay a positive hero image over on top of this negative self image within the mind's eye.

I asked TN to picture herself looking into a mirror and seeing a version of herself displaying all her most negative traits. For TN's negative self-image she imagined herself as being: weak, unworthy, unlovable and boring. Her mirror self looked old, tired and sad; a miserable version of herself. I asked her what primary colour this negative self image brought to mind and see said a dark grey. This negative self image reflected how she thought of herself repeatedly throughout the day. It was a filter by which she viewed all of her actions and behaviours. As a result she continuously felt she was not good enough to be in the presence of others and constantly doubted her own opinions and decisions. This false self image had affected everything in TN life, from her approach to relationships, to her career and even to the way she stood. At this point I asked her how the image felt to her. She was clearly uncomfortable and said it made her feel very sad to picture.

At this point we created the positive superhero imagery. I had TN imagine herself still looking in the mirror but this time seeing a powerful wonder woman version of herself standing tall. This wonder woman version of her was filled with confidence and happiness. I asked her what positive colour she associated with the image and she replied gold. When asked how this image felt, TN was smiling stating it made her feel happy, hopeful and proud.

Finally I had her create what is known as the future memory. This is an ordinary event that a person does everyday. In this instant she picked brushing her hair, but it could have also been making breakfast or going for a run etc. During this future memory I had her imagine leaving behind her past self and really acknowledging she had changed. I then had her add some details to this mental image of her brushing her hair. Within this future image she was a changed woman, who was more relaxed and confident in herself. imaging herself as a changed woman, thus ingraining it in her subconscious. We tested accordingly until she said she could clearly see this imagery in her mind's eye.

At this point we ran through the BWRT process. This involves her visualise the negative weak version of herself transforming into this more powerful version of herself and then directing her mind to the future memory where she had changed as a person. This is done repeatedly, very quickly whilst the client had their eyes closed. Afterwards I put TN into a relaxed state for a few minutes, whilst her mind adjusted. This whole process, including creation of mental images and the relaxation period, takes around 40 minutes.

We concluded the session and I asked TN to give it a couple of weeks before seeing me again, allowing her some time to notice the level 2 transformation, which unlike BWRT level 1 work can take some time to take effect.

After this session I continued to work with TN further alongside her husband for some marriage counselling and on and off in the future that doesn't need to be written about. However if you would like to know how TN therapy was concluded, TN received a job offer a month after sending out her CV and was very happy with the move. After some marriage counselling her relationship with CN greatly improved and CN decided to abstain from alcohol for the foreseeable future. The BWRT removed a great deal of her anxious tendency and allowed her to function without being plagued by memories of the past. Her personality became noticeably more upbeat and confident, and hopefully will remain as such.

We continue to maintain occasion contact and I am satisfied with the results from the counselling.

The information provided in this case example is more than enough information for you to know for us to conduct a successful session of BWRT. In fact very little information needs to be explained for BWRT to work. Indeed the client does not need to reveal any details of the memory if they so choose. This includes any details about the negative event they wanted to change the template of.

BWRT is very versatile. I have used it in some manner on the following issues to very successful results:

• Addiction including alcohol, drugs, cigarette and binge eating.
• Sexual assault cases
• Phobia (as demonstrated in case 1)
• Traumatic events both associated and not associated with PTSD.
• Speech impediments
• Letting go of a loved one.

If you would like any information on BWRT and what it can be used with send me an email at info@ryanmcconnell.co.uk

I started by asking MV what she was looking to achieve in these sessions. MV stated she wasn't sure and that she had no idea how to make herself feel better or how to enact a plan. She stated that she was hopelessly lost. At the time she had very little motivation and it was apparent that just the conversation with myself was draining for her. It was also apparent MV had been depressed for sometime as she talked with some blasé on how she could not be fixed. According to her this was the way life is supposed to be and though she has tried to do everything others had recommended she had never really felt any better.

With this in mind for the first session we discussed the nature of her depression, where she believed it came from and why it had become a problem now. Of course the fibromyalgia played a large part, however aside from this she did not have any clear idea of why she was depressed. According to her, work at her company was fine, and she seemed to fit in well there. She was happy with her relationship and with its progression so far so she did not consider this an issue either.

I then asked if she had any traumatic memories that could be causing her to feel depressed. Whilst she could produce some negative memories that had occurred in her past, she did not believe they caused the depression. The passing of a grandfather the previous year had been hard on her, but again she did not believe that it was the primary cause. When delving into the history of her youth there was no particular event which struck me as being traumatic, at least to the extent that would cause depression further in life.

When asked why she felt discontented in her life, a reoccurring phrase was 'not living up to expectations' and 'letting herself and others down'. We completed the Hamilton Depression Index together (a test which measures the severity of a client's depression and in this case suggesting she had a moderate depression scoring) and then moved on to a discussion about other areas of her life she thought might be lacking. Throughout this period the client divulged details of her life and made some note on feeling like she was missing on fun and on her career.

Throughout the conversation It became apparent that MV's life goals were poorly structured and she had little direction. She had no real idea on what she wanted to achieve with her future. She also didn't have a daily routine structure. As a result she had little to motivate her each day and found herself just going through the motions of living.

At this point we had spent an hour together and wrapped up the session. I set her a goal orientation task to do for homework, a life wheel tool to complete and a video on Wim Hof breathing to practice (this is a breathing technique that boosts mood and energy, I usually teach it to clients with depression or anxiety at the end of our first session, see the breathing page on the website for more details). I also set her a series of basic stretches to do in the morning and encouraged her to go on at least one walk per day outside and to go for a walk when she found herself in a low mood. Given MV's fibromyalgia this exercise routine was designed to be stimulating but not excessive.

MV returned the following week having completed the goal orientation tool and practiced the Wim Hof breathing a few times. She stated she felt a little better and had found some motivation but very sporadically. I asked her what thoughts had triggered the depressive periods throughout the week. She said her thoughts had been mainly around her negative self image, feelings of hopelessness and a general difficulty caring in having a quality life.

At this point we went through the goal orientation tool, where it was apparent that the client felt lost at what she wanted to achieve and didn't have a single focused goal to move towards. They were vague in nature from 'just be happier' and 'care less about the judgment of others'. Given the vague nature of these goals within her head and a lack of steps taken to achieve them, it was obvious why they had not come to fruition.

We sat and brainstormed some things she might want for herself. In general I try to set thematically goals based on duration rather than concrete ones. For example instead of saying, I will lose 10kg of weight, instead to say I will make these next two months the theme of healthy living and where possible and comfortable I will make healthy choices. The reason being such goals are less likely to dissuade you if you start to fail or fall behind. We can further add some concrete goals like 20 minutes of exercise per day or only one piece of junk food per day to give some more understandable direction. Also the reason we choose a small duration is we want the goal to feel present and achievable (hence why it's one/two months of the healthy theme and not a year, as a new years resolution might be).

In terms of bettering one's life, there are several things humans need to be satiated and what said things are is of course highly debatable. However there is unanimous agreement on some things. We need:

• Our health: so one should focus on the power of healthy living and exercise.
• Personal growth; we need to feel we are progressing with our career or our personal development.
• Love: we need the love of those around us and to feel comfortable in who we are.
• Social; we need interaction of some others to have pleasant conversations.
• Creativity: we need something we can be passionate with that is just for our own sake that we can develop. This would be a hobby.
• Self acceptance: To accept who we are, with an unbiased understanding of our flaws and their origins.

With this in mind we decided to keep her goals relatively small in nature so as to keep them obtainable within a small period of time. These were to:

• Spend the next week making more decisions that result in bettering herself. This would involve doing something constructive when she had the energy and to make healthier eating choices for the week. When posed two choices, MV would attempt to take the one that was more beneficial to her physical and mental health whenever possible.
• To write about events from his life that she feels affected her, for the purpose of identifying themes, mindset changes and triggers.
• To knit a pair of socks over the next month (a hobby she had wanted to try)

We also created a daily routine that MV was happy to follow. This included:

• Some form of exercise/ yoga each day. This only needed to be for 10 minutes but what was important was that she did this every day.
• Wim Hof breathing process at least once per day, but with an aim of three times per day (morning, noon and night)
• Hot and cold showers turning the water drastically between hot and cold temperature for a duration of 10-20 seconds several times (this technique has shown marked improvement in depressive symptoms)
• Some time for learning something new if possible. This was to take somewhere between 10 – 60 minutes depending on how MV felt that day and could be regarding anything she so chooses.

I also advised her to devote some time into a creative hobby if possible. She didn't have a creative hobby but decided she would give something new a try, and suggested knitting. Knitting being a constructive hobby with growable skills made a lot of sense as a way of fulfilling a creative outlet.

The difficulty in maintaining a routine is that it must be something that feels both challenging whilst being enjoyable. It should never be so difficult that you resent it and want it to stop. The very best routines are ones that you are excited to do each day and you feel effectively boost your mental health.

We concluded the session with MV feeling pretty determined to give the routine a go, given that she considered it to be manageable and exciting..

MV came describing mixed success but happy with her progress so far. She suggested certain elements had been easy and others less so. Whilst she had managed to complete the Wim Hof breathing and the hot/ cold showers each day, she had spent less time knitting than she had hoped, as well as completed 3 days out of the intended 7 for yoga practice.

However as mentioned she was happy with the result stating it was her most productive week in years. She described herself as also feeling disappointed initially at her lack of progress at the start of the week, but decided to not guilt trip herself and to just do what she felt she could. After accepting this she said her productivity had started to climb as the week continued. I was very happy with this attitude and whilst we didn't hit all the targets MV was clearly enjoying the routine.

She described herself as being eager but still lacking in motivation on some level. We had at this point discussed life philosophy in some depth. In order to have the motivation to reach one's goals one needs to be able to present reasons why they should bother trying to obtain any goal in the first place.

In MV's case the goal to improve herself mental health and feel overall happier should be a high priority goal. Therefore not being motivated for this means there was a issue of personal philosophy that was blocking the way. It was important we explored all avenues of why this might be the case.

MV had spoke about her working in only passing before but when I asked her about it she had said the company and work was fine. Clearly not something she felt motivated about but not something that seemed to be troubling her either. When we spoke about her work in a little more detail she said the company was prestigious and was a pleasant place to work in general. Her job was a sales woman for hoteliering. She had taken this job after leaving her previous sales job which she had held for a few years. She had been with the company for 4 years and promoted twice, so there was an established career path. MV had a fairly good rapport with her management and considered some to be good and some to be mediocre. In general whilst she was not overly complimentary of the company, she was not overly negative either.

However, during the conversation it had become apparent she had an issue with the type of work. MV had been in sales for around 8 years and said she had not intended to go into sales, but was good at it and found it to be initially an exciting challenge. She had enjoyed seeing her hard work pay off and collecting a pay cheque that was only limited by her ability. When I asked her about selling in general she found it now to pointless and manipulative. She didn't feel like the product was bad, but the job encourages individuals to bend the truth to make the sale. MV felt like this had been somewhat corrupting to her soul and felt this was now a bad career choice for her. When I asked about her career's future she was pessimistic, saying this because s what she is now pigeon-holed into this profession and would most likely just go from sales position to sales position with the aim to get the most money possible.

It became apparent at this point that work was perhaps the main source of her depression and if MV was going to feel more motivated in life, it would be necessary to switch jobs. This would mean leaving sales entirely. This prospect seemed to both motivate and frighten MV. She felt at this point she had been too pigeon holed into a career type and that leaving at this point would mean she needed to start from scratch again. She also had no idea on what she wanted to do and was worried it could be a financially poor decision. However we agreed we might as well talk about some other career potentials.

To her help come up with some sensible career change options I set her career orientation tool to complete, advised her to maintain the routine for the next week with the additional caveat of 5 minutes of silent mediation with a notepad (I ran through the basics of this process with her then).

I also asked her to start a journal of her thoughts and specifically around her job. This didn't need to be completed daily only when she felt she had an interesting thought and wanted to write it down.

MV came in a positive mood and seemed optimistic for the session. We started by going through the career tool. For brevity sake I won't write out all the questions, but some example are:

• What are some of your strong skills
• What are some of your average skills
• What are your weakest skills/ things you want to avoid?
• What elements of your current career do you enjoy?
• What elements of your career do you not enjoy?
• What previous roles did you enjoy and why?
• What previous roles did you not enjoy and why?
• What are some traits you would like in your new career to have? (e.g certain hours, certain amount of responsibility…)

This resulted in quite a lot of further analysis which we spent the session discussing (for brevity sake again I will not write out all but just some of the key dialogues here).

In general it wasnt that she was necessarily opposed to any form of sale, rather that she didn't want to be selling anything she didn't believe in. When we discussed the prospect of her running her own business she seemed excited, but again quite nervous. She described always wanting to do carpentry and laughed off the concept. I asked her if she was interested in making it a business and did she have any talent. She showed me some previously made products, which were to be honest were good, but not outstanding. Whilst they could be sold for money, they could do with some improvement and she acknowledged this. However there was some potential in this business idea if done right.

We discussed this business idea in more detail and spent some time working out the cracks. The two most sensible options seemed to be to work on carpentry in spare time, improve her skills and then sell the products whilst she makes the transition. Alternatively to join another carpenter, to shadow them and learn some of the trade, then perhaps create her own business.

Some other opportunities included working in operations where she had previously had a job and enjoyed it. Alternatively, she said she would like to work as a florist (although we both agreed this wasn't likely to make her a great deal of money in relation to the passion she felt for being a florist).

We discussed whether she would want to go on to do further education. Whilst there were a few potential courses she would be interested in, given that she had a BSc and another diploma already, it would only make sense to go and do a masters course. Given that she didn't have a clear MSc course in mind, nor needed an MSc to carry out the job transitions she had in mind, we decided not to keep this as an option.

We decided that in the short run we would focus on a shift to operations manager or a projects manager, either in house or a move to another company. This would be an interesting new challenge for her. In the meantime she would work on her wood working ability and try to improve her skills whilst deciding if this would be a career path she would be interested in.

We then did a form of BWRT that focused on motivation. For brevity I will just write the basic details of the approach.

For more details about the mechanism of BWRT, see case example one and three. Also see my page on BWRT https://ryanmcconnell.co.uk/bwrt/).

To do this I first ask the client to conjure up a mental image of themselves, feeling highly de-motivated and overwhelmed. This image should be uncomfortable and tiring to picture.

We then overlay a superhero version of themselves that feel positive, highly motivated and proactive. This is done many times until the positive sensation for the superhero image to imprinted on the negative image. This imagery change services as a basis of a more proactive subconscious mind. After completing the BWRT we tested the BwRT which provided a satisfactory result. We then concluded the session.

We continued to meet in the coming weeks where MV slowly transitioned her career. She eventually left her job to join a woodwork company in her home country. She was happy with the move and when we last spoke she felt inspired to keep up this new momentum in her life. Since much of her personal philosophy had been adapted by the culture of aggressive sales, this less target, more creativity focus had really impacted her life philosophy.

There are of course many reasons why an individual might be depressed and most likely it is a combination of factors. All clients are treated as individuals and several tests and measures are put in place to help find some of the root causes of the clients depression.

Please note: some forms of depression have a root in a chemical deficiency. Some examples of this might be post drug addiction withdrawal recovery or a biological impairment of certain feel good neurotransmitters. In such cases I may recommend you consult a psychiatrist in tandem to our sessions.

Thank you for taking the time to read this case example.

If you would like to know more about the treatment process or would like to book a consultation, please send an mail to info@ryanmcconnell.co.uk

For our initial session I spent some time gaining some understanding of GK as a person as well as some insight on the nature of his addiction.

GK stated he viewed pornography several times per day nearly always relating to BDSM, domination and shame. When asked why he said he enjoyed the feeling of being controlled by a woman and wanted them to humiliate him. I asked him why he might want them to do that, he replied that he didn't know but he nevertheless had an attraction towards these ideas.

I asked GK if these fetishes were acted out with his wife (named BK). He said no, as he didn't like the idea of her preforming such acts and didn't want to have have her associated in his mind with pornography. When asked why he said that he didn't like the idea of her doing that to him and already felt criticized enough by her. He wanted the woman to shame him to be different each time. I asked him if he would like to feel differently about this association. He said no, at this point he would rather just not have the fetishism. In terms of sex with his wife he wanted to be more satisfied with more vanilla encounters. It was clear there was a wide separation between his desired sex life and the sex life he had with his wife.

GK mentioned his wife BK had threatened to leave many times, including saying she would leave him if the therapy with myself was a failure. GK said her behaviour was understandable given how many times he had broken her trust and let her down.

GK stated that he had lost interest in having sex with his wife some time ago as their sex was not satisfying his kinks. In turn she had become somewhat reluctant to engage with GK after discovering about his fetishes and sexual behaviour. At one point GK had frequented a prostitute to perform some such kinky acts with him. GK's wife had found out about this some time later and confronted GK. As a result the relationship between them was becoming increasingly strained. In addition these fetishisms had become known by members of his and her family/ friends and the embarrassment of the situation had caused further strain on their marriage. After talking further we agreed that if he didn't discountinue his use of pornography then his wife would most likely leave him in the coming year. GK said he wanted to avoid this if at all possible.

Please note: I have no judgement or opinion on a client's fetish and I understand that fetishism is a mechanism outside of conscious control. It is in many ways a manifestation of the subconscious mind and whilst it can be managed, it cannot be ignored. We do not get to choose what we are attracted to. I am however also aware that most people do not view fetishism in such a manner. This can cause individuals with certain fetishism to have social, cultural and familial issues which may need to be resolved.

At this point we discussed the treatment plan and we outlined some goals GK could work towards. These goals being to:

• Understand his pornography usage and the subconscious mechanism influencing his use.
• Reduce his pornography usage.
• Understand and manage his kinks.
• Repair his relationship with his wife as much as possible.
• Improve his career.
• Improve his self esteem.

We discussed his past use of pornography and where he believed these fetishes came from. Whilst not having a clear idea, GK stated he believed this kink came from an experience with an ex-girlfriend from his younger days. She had frequently been abusive to him and much of their sex revolved around some element of BDSM, shame and pleasure denial. GK stated he thought about this time a lot and although it had been an abusive relationship he had found his sex life to have been the most enjoyable with this ex.

He also said that he had a friend of his sister who was older and frequently tied him up and would play fight with him. This was when he was around 7 years old. Whilst this was not a critical turning in his sexuality GK believed this may be influential. In addition, GK said he had slept with quite a lot of women throughout his life and he spent a great deal of time fantasizing about past sexual encounters with them.

I asked if he would want a similar relationship with his wife as he did with his ex. He said no as it would hurt the relationship he had with his wife. In addition he was not happy in this past abusive relationship and was not interested in turning his relationship with his wife into something that resembled that abusive relationship. It was more the affect her behaviour had on his sex life that he missed, not the rest of the relationship.

We further discussed his history with pornography. He has found some of his father's porn at age 12 and whilst frightened was curious and his appetite for its use had been continuous since then. GK said there was no particular memorable moment with regards his use of pornography, although his mother had lightly scolded him a couple of times after finding his pornography.

We then spoke about how GK's pornography use was also tied to his self esteem, creating a continuous negative cycle. This started with him feeling aroused, using pornography, then feeling guilty in terms of its use, but taking some joy in breaking the taboo. This process affects his self image a little. As he took some joy in using he will use again. Later on when GK becomes aroused again he will return to porn as he received some joy from it, thus starting the negative cycle again. The more this pornography was supposed to be restricted to him, the more he craved it's use, given that it breaks the taboo even more.

I asked him if any sexual or physical assault had happened to him. He said no trauma of any real significance had happened whilst he was growing up.

At this point we had talked for some time and I set him some homework in the form of a life wheel tool (this is a tool that looks at all areas of your life and helps determine which elements are the most important to work upon).and a goal orientation tool.

In addition I asked GK to observe his pornography use this week. This being to record how many times he would used pornography over the course of the week as well as to identify what it was that he felt attracted to, writing it down in detail. I had some idea of what this was already but I wanted GK to really start thinking about his porn use and trying to manage it as a problem in his life, rather than simply something he did when he was bored.

Finally, I had him start watching the first episode of Dr. Carran series on understanding addiction. This is the link if you are interested https://youtu.be/-kpOod1xlb0

Upon our next session GK was in a positive mood. Having done the homework set, we went through each part. The life wheel measures several areas of the client's life but for brevity sake we will focus on the areas GK wanted to improve the most. These being; his career (2/10), personal growth (3/10) and his relationship (3/10). He wanted all of these to be an 8/10 if possible. These would be the areas of his life we would first focus on working on.

In terms of notes about his pornography use GK identified the following points:

• He found himself having the desire to use porn mainly when he was either angry at his wife, bored or disappointed about something.
• He had felt more self aware of his kinks and started to find them stranger in nature.
• As a result he seemed a little less interested in the kinks (although he was still turned on by the same fetishes).
• Having sex with his wife didn't seem to help with porn use. He found himself thinking about porn whilst having sex with his wife. Also he said he has felt awkward having sex with her and could tell she did not find that she could relax during sex.
• He was not particularly interested in initiating sex with his wife.

Throughout the last week it had become apparent to GK that his marriage was in far worse a state than he had previously thought. Whilst he did love his wife he felt distant and disconnected from her. His boredom of his sex life had lead to putting in little to no effort in maintaining their friendship and romance.

At this point it became apparent that I would need to speak with GK's wife BK and indeed after this session I scheduled to speak with her (I go on to work further with GK and BK in case eight with regards marital counselling).

When looking through the goal orientation exercise, the key goals he listed were:

• To improve his relationship with his wife and have her be proud of him again.
• To feel like he is achieving something with his career and not wasting his time.
• To not be a slave to his pornographic usage.
• To improve his sex life.
• To feel better about himself as a person.

After some discussion we decided that we would approach the problem on three fronts:

• To work on his relationship with BK and in particular to work on rebuilding trust and respect between the two of them. In addition he would prioritize working on his friendship with her.
• To minimise pornographic use and create a list of alternatives actions to porn use. Some examples being to: go on a short walk, do wim hof breathing (see breathing section of website), exercise, sex, playing an instrument, working on a skill etc.
• When masturbating I advised GK to minimise his pornography use for some time (2 weeks) and to monitor its affect on his relationship and the attraction to his wife.
• To work on his physical health with an exercise routine and to work on his mental health in the form of a journal.

These goals were considered to be moderately difficult and achievable. GK was satisfied with this approach and endeavoured to work on these three items over the course of the week.

GK returned having worked on the routine throughout the week. He described the routine as being good although he was still struggling to find the motivation to make changes as well. He suggested he had some success but not as much as he would have liked. He had watched porn several times and had found it very difficult to resist using. However in other areas of his life including his relationship he felt was starting to see some improvement.

At this point it was important that we try to understand why GK had the fetishes he had, as well as how we were going to attempt to manage them. To do this we then spent some time discussing what most likely would have created his fetishism towards shame and abuse. After some discussion we agreed one of the reasons why GK was using pornography so frequently as well as why he wanted to be shamed was due to his poor self image and inability to accept himself as well as lack of responsibility taken to rectify the situation. GK stated he had spent much of his time feeling ashamed of himself but had never seen an alternative lifestyle that he would be comfortable living.

As GK life had progressed he had become continuously motivated by short term pleasures and instant gratification. This could in some ways be attributed to his career choice. GK was a musician and had had some success in touring. During certain parts of his career the band he was touring with was selling out venues with relative ease. He had played to tens of thousands. At this time GK said he was on something on an emotional rollercoaster and greatly missed some of those highs. He had kept much of this thrill seeking nature and indulgent attitude from this time and felt motivated to get back to this same life in some form or another. This was of course never going to happen. Not that GK could not play to such numbers again, but the lifestyle was never going to be the same as he was older now. He was also married and had some health issues. Such unattainable goals had left GK in a state of depression along with the development of some narcissistic tendencies and bitterness.

In addition, he had heavily used recreational substances during this time as well as slept with many women. GK said he often fantasized about the past and previous sexual encounters. When asked GK opening admitted to wanting to relive these days. He considered these experiences to have occurred at a better time in his life. I asked if he had been happy at the time, he says he was conflicted and had struggled with himself, but having sex with woman and being high had been when he felt most comfortable. During this time he had been heavily abusing short term gratification to the point where he was prepared to ignore his self-respect and societal norms. His pursuit of pleasure had ultimately cost him many relationships and lost him many opportunities.

There was a clear lack of self-actualisation done by GK over the years, which GK openly admitted to, stating he repeatedly made poor decisions and was often beareated for it. However arguably GK was not given any method so far of redeeming himself for his shame nor a path on how he should change. Criticism is not useful if it does not provide a possible and plausible alternative. He knew what he needed to do to be a good husband, but could not do it due to subconscious drivers

It was clear that this repeated need for self indulgences had left GK with some warped views on how to live and how to be happy. This may explain why GK fetishized shame. For example, in a scenario where a person is shamed for some manner the individual either has to accept the shame and admit to it, resolve the shame through debate or deny the shame to themselves and others. In the beginning an individual will try and resolve their shame. If this is not possible however they are forced into going into denial over the situation. This is because we are often further shamed if we admit to wrongdoing. In addition an acknowledgement of wrongdoing forces us to change and work harder on improving ourselves for others. Indeed, it is possible for a person to be in so denial over their behaviour that they refuse to accept it had occurred at all, even to themselves. I believed some semblance of this had manifested in GK personality.

GK wife BK had shamed him many times over his use of porngraphy and his affair. GK of course did not want to make his wife unhappy, but at the same time could not alter the sexual fantasies he had. At first he had tried to deny his use and hide it from his wife. When he could no longer deny this was a problem BK had forced him to confront it by threatening to leave him if therapy didn't work. This shame had become something GK was used to and even comfortable with to some extent. BK's use of shame to motivate GK to change had been largely unsuccessful and in some ways the wrong approach.

There is a counter argument that suggests GK should feel a constant sense of guilt over what he has done, especially with regards to the affair. However the key issue with this is GK will not be able to accept himself, as living with guilt can be overwhelmingly oppressive on an individual's mental health. This causes a great deal of stress and negative rhetoric within the mind over who he is and how he should act. As GK could not correct negative rhetoric in his head he had to go into a form of denial whereby either other people are wrong, or it's okay to be shamed. To be around something who is depressed and uncomfortable in themselves is an unpleasant experience for those around them. GK poor mental health was making BK mental health worse and in a cyclical manner they were both making life worse for each other. For guilt to be used effectively it needs to be used as a catalyst for change, rather than an endless form of punishment. Part of the therapeutic process would be a change in the behaviour BK displayed towards GK (see case eight for details).

There are some other factors which may have influenced this fetishism. For example GK was often made to feel ashamed of masturbating and so had some association between the two sensations. Whilst it was an abundance of shaming placed on him by his mother, he said he does remember it vividly and being told several times. In addition, often individuals who suffer for sex addiction are exposed to sex at a young age. This was the case with GK who had his first sexual encounter at twelve years of age, with a girl who was fifteen. He said he had greatly enjoyed the experience. Thematically this would fall in line with GK's desire to be controlled by women. All of these points in combination are most likely the cause of GK's shame fetishism.

At this point it has become apparent that GK needed to improve his self image if he was going to have a mental shift in what he believed was an acceptable way to be treated. The primary method I use to raise a client's self-esteem is to change the mental template they have in their mind of themselves. This can be done through the BWRT process.

Please note for brevity sake I will note go into a full explanation of BWRT. If you would like information on how BWRT works, please see case one (regarding phobia) and case three (regarding childhood trauma and self-esteem) for more extended details.

Also please note before doing self esteem work we will use BWRT to remove the negative emotional association from any highly anxious memories the client has. These anxious memories being any memory that creates a highly uncomfortable sensation to recall. GK had no such memories that scored high enough to work on so we did not conduct any level 1 BWRT on anxious memories and instead moved directly on to level 2.

For my work with GK self-esteem I used the same methodology highlighted in the self esteem case with some slight modifications. Firstly I asked GK a series of questions to determine what is the most negative image he could think of about himself. What are his worst characteristics and actions. I then asked him what does he consider to be his best characteristics and what would the best version of himself look like in his minds-eye.

For the BWRT process I had GK bring to mind and picture a sad caricature version of himself. It was sad, pathetic, sex addicted and miserable. I had him imagine looking into a mirror and seeing a small video playing of him seeing this negative version of himself. To picture this image should make the client feel uncomfortable to picture. I then had him freeze this image overlaying a more happy and responsible version of himself over the top. A superhero version of themselves. The BWRT method involves taking this positive imagery and layering it repeatedly over the top of the negative imagery within the clients mind eye. This is done multiple times until the negative self image has the negative emotional response removed from it. After the BWRT process was completed I then put GK into a relaxed state for a short time and then tested the strength of emotional response of the negative image of himself to see if there had been any reduction in its uncomfortableness. GK replied he felt much better and the frozen negative image had little to no emotional response anymore.

After the BWRT process was completed we concluded the session. For homework I had him complete the BWRT level 2 worksheet which involves self reflecting on the negative image.

In addition I had him work on some other self esteem exercises and a guide on how to manage negative intrusive thoughts.

GK came to the session quite spirited and motivated to improve his life. He felt much better about himself and had a strong desire to continue working on himself. However we had yet to alter his kink preferences and his fetishism towards shame. At this point the most effective course of action was to use BWRT to remove the mental template GK had in his mind of BDSM and dominatrix fetishism. We would now work on removing the sexual allure of the kink and replacing it with one of neutrality or of disgust.if necessary.

Please note once again for brevity sake I will not go into a full explanation of BWRT. If you would like information on how BWRT works, please see case one and case three for more extended details.

This requires a delicate touch as we are not trying to remove the desire to have sex only remove the desire for embrassment and shame as a motivator for sex. The apparent issue was the fetishism GK had in his mind could not be replicated by his wife, thus splitting his desired sex life from his actual sex life.

In terms of using BWRT with regards to fetishism management, the methodology involves taking the image of fetish into the minds-eye and bringing to mind making it as alluring as possible. To play it as a short video within his mind. I asked him to picture this imagery as vividly as possible. We then freeze this sexualised image. Then a negative image is then overlaid on top of this fetishsized image within the minds-eye. This image might be one that creates a nauseous or bored feeling to recall, an emotion that would be the opposite of arousal. Given that GK addictive image was strongly rooted and he had tried to treat it several.times before we used a previous memory of GK throwing up from alcohol (one of nauseous). We overlaid this imagery many times using the BWRT process until the original arousing image no longer created a sense of arousal. The idea is to remove the attraction to the fetisihisized image, thus dulling the fetish.

Please note that couples can be happy without one partner needing to fulfill all the fetishism of the other. However for most individuals in a coupling to feel satisfied there needs to be a mutual attraction for one another and mutual desire to please one another. This should in some ways present itself as a desire to better themselves for one another, both physically and mentally. In addition a drive to become more symbolically involved, to grow together. Without this feeling couples find themselves feeling bored in the relationship believing they are wasting their time on someone who does not fully fulfill them. To keep this sense of desire couples need to be open with one another about what they want and how they want it, as well as why they feel they want it. Excessive use of pornography in a relationship if often a symptom of a couple's poor communication.

In this case GK did not want to feel aroused by such fetishized imagery and did not want to bring the fetisism into his relationship either. Not did he want to be repeatedly shamed and to continue having a low self-esteem. For this reason we both considered BWRT to remove the fetishized image to be the more sensible solution. I won't necessarily approach other cases regarding porngraphy addiction in the same manner.

After this BWRT work we concluded the session. I told him to reflect on the fetishized frozen memory we used. He said he now didn't find the imagery to be sexy anymore and didn't feel any strong emotional response to it.

For homework I told him to spend a bit of time recalling the frozen memory each day and check how it made him feel.

In addition I gave him a variety of CBT activities to work on. I asked him to spend the week working on his career. He wanted to continue to work in music, but in a different manner so I told him to look into some new careers he might enjoy as well to come up with a list of prerequisites.

At this point the main issues affecting GK was the relationship he had with his wife and the future of his career. He said his porngraphy use had decreased significantly since conducting the BWRT. However there was still a great deal of work to be done on improving the relationship GK had with his wife given the cumulative past damage caused.

In case eight I work with both GK and BK to help manage and resolve their marital difficulties. I suggest reading case eight for how sessions with GK were concluded.

However, to briefly summarise case eight and the end of this case, after working on GK and BK communication and respect for one another over the next few weeks, GK porn reduced further and he felt more comfortable in sharing his preference with his wife and started incorporating more roleplay. Aside from improvements in sex life we also worked further to build GK career and give him a life he could be satisfied with. In addition I used several tools including the Gottman method to identify the mistakes and successes both individuals were making.

In addition GK decided to go back to university with the idea of reinventing his career. He wanted to go into sound design and needed a short degree to do so. Given that he already had some experience in this area and he was passionate about sound design it seemed like a sensible option. GK was very happy and motivated with this move.

Whilst GK could of course still cheat again the motive to do so has been greatly reduced and when I last spoke them, they both seemed genuinely happy.

If you would like more details on this case or would like to schedule a free consultation. Please send me an email at info@ryanmcconnell.co.uk