‘Significant Others’ – how friends and loved ones can collude with our beliefs

The following few pages come from the March 2014 edition of  'Cure your emetophobia and thrive'

Significant others

A ‘significant other’ is any person who is important to an individual's life or wellbeing. Sociologically speaking, it is any person with a strong influence on an individual's self-evaluation, who is important to this individual. Therapeutically, significant others are usually the client’s spouse, best friend, or parents. If a therapist, doctor, or other health-care professional is not careful (in avoiding unnecessary long-term treatment), they can become the significant other for their patient or client. In this situation, it is the ‘care’ of the professional that is validating the illness or problem that the client wanted help in overcoming in the first place!

A significant other, understandably, shows love, encouragement and support for their friend/partner/child, they listen to their worries and fears, help and support them through painful, emotional, or other difficult times.  They mop their brow, fetch and carry, take them to their appointments, speak to the doctors and therapists, learn all about their friend/partner/child’s condition, and, importantly, rarely challenge them.

This ‘significant other’ is just what we would all want if we suffered a heart attack, stroke, broke a leg or suffered some other similar setback – who doesn’t want a little tender loving care when they feel lost, in pain, or unhappy? The difficulty is, that there is sometimes a fine line between ‘giving support’ and ‘colluding and validating’ (reinforcing). The significant other can be the person that (usually unintentionally) helps to provide the reinforcements mentioned in the previous section.

Significant others can often help to maintain a person’s fear of being sick. This is particularly true with children – very often the parents (unwittingly, of course) validate the child’s fear and collude with their beliefs. We have already mentioned that, in a study of five emetophobic children who developed their fear after a vomiting illness, ‘attention to the symptoms by others (particularly parents) was reinforcing and contributing to maintenance of symptoms’ (Klonoff et al., 1984). Other research also suggests that parents can unintentionally reinforce their child’s fear, for example:

Michael's reporting of his obsessions to his parents precipitated a circular, homeostatic parent-child loop of reassurances, complaints, reassurances, and so forth. Parental reassurances were never enough to diminish completely Michael's anxiety. The family was organized and regulated by Michael's descriptions of feeling states, which sequentially evoked a series of verbal reassurances by parents. Michael would continue his visceral monitoring, report changes, and parents would increase their reassurance. In this way, the parents' behaviors in finding a solution became part of the symptom-maintaining matrix.

(O’Connor, 2004)

Think back to the very beginning of the book where I talked about belief systems… we know that to maintain any belief takes effort, especially one that isn’t true (being sick isn’t actually terrifying – it’s just a bit unpleasant). You have to keep thinking about your belief, and interpreting events through distorted spectacles, in order to maintain it. If you stop thinking about your belief, then other experiences in life will slowly force you to change it… sooner or later the ‘weight of evidence’ would just be too much for you and you would HAVE to change the way you think.

Every time you have a conversation with your friends/partner/parents/Doctor/therapist about emetophobia and they DON’T gently challenge your belief, they are inadvertently colluding with it.  They have just helped you to add another brick into your ‘wall of belief’. (Remember? – where every brick in the wall is another thought or experience that confirms your belief… the more bricks, the bigger the wall).

Let me ask you a question:  Do you still believe in Santa?

No, I’m not taking the piss, it’s a genuine question.  Do you?  I’m guessing that, if you are over the age of say, 12, you don’t believe in Santa anymore? (If you are under the age of twelve and do still believe in Santa, then please give this book back to mummy and daddy, and certainly don’t read the next few paragraphs! Oh, and sorry about the odd swear word in here, I know it’s neither big nor clever) How did that happen? For ten years or so you believed in Santa, then suddenly you didn’t?!

What went wrong? How did that happen? Why the sudden change of heart?

I’m guessing that, despite the want to carry on believing, the weight of evidence against the existence of Santa (let alone one that can visit every child in the world, and get down every chimney, whilst being towed through the sky on a magic sleigh pulled a bunch of reindeer, the lead one having an over-sized red hooter) soon forced you to realize that it was a bit unlikely.

So, most kids stop believing in Santa by about the age of 10 or 12. Think about children who are brought up in a religious household. Do they stop believing in god by the age of ten or twelve?  Some might, but most probably carry on believing, at least until their late teens.  Why? Both stories are equally unlikely. If anything, the Santa Claus story is actually more plausible than the Jesus one. Santa only has one miracle to perform, and the other fella has loads.  So, why do kids find it comparatively easy to drop the Santa belief, but not the god one? The answer, in a nutshell, is significant others. Your parents stopped colluding with your Santa beliefs, and started to let a wry smile cross their face when talking about leaving milk out for the reindeer, or stopped running out of excuses for the fact you don’t have a chimney… They stopped colluding with you and the weight of evidence overcame your previously held beliefs, and you stopped believing. Not so with the god belief.

If you did grow up in a religious household, it’s unlikely your parents stopped colluding with your god beliefs when you were age 10 or 12, because they wanted you to carry on believing them. When you questioned them about the existence of Santa, they probably said something like ‘ah, you got us, you sneaky little devil, it was your dad in a red coat with a fake beard.’ But when you asked a similar question about Jesus, they probably replied ‘actually this fella did save the world, and his mum was a virgin, and he could walk on water – when he wasn’t turning it into wine, could heal lepers, make the blind see, and come back again once he was dead’. So you carried on believing, because you had people around you that ‘helped’ you to carry on believing. (Please don’t email me complaining about my comparison between the belief in Santa Claus and the belief in god. I’m describing how a young child might think when being told strange magical stories by their parents.  If you do insist upon emailing me about this, can you add in a bit about your despair in relation to my general spelling and grammar issues as well, rather than putting it in a separate email, as it will save us both some time J).

Emetophobia is very similar. It’s actually pretty difficult – for a child at least – to maintain a significant fear of being sick, without at least one parent or caregiver colluding with them.  It’s obviously much easier to collude with someone if you share their beliefs. Many, if not most of the people I have helped overcome emetophobia had at least one parent who was a significant other. Often, the mum had emetophobia as well, or was at least quite obsessive. An obsessive mum (or dad!) is likely to collude with many of the obsessive, black and white cleanliness and hygiene-related behaviours and beliefs that the average emetophobe holds.

Nowadays, when treating kids and teenagers at my clinic, I always work with at least one of the parents as well as the poor kid with emetophobia. If mum (or dad) stops colluding, and instead starts to gently challenge their child’s beliefs, they can help reduce the number of pro-belief thoughts that their child has by hundreds if not thousands of thoughts PER DAY. Sometimes, stopping colluding is alone enough to help the child overcome their phobia. Let me say that again: if the parents stop colluding, and start to gently challenge their child’s beliefs, then this alone can be enough to enable the child to challenge their limiting beliefs and overcome their phobia.

Some adults may gain validation of their symptoms from online support groups, where other sufferers tend to back-up and support their unhelpful thinking, rather than providing some perspective (I don’t know whether you had noticed, but online support groups and forums always seem to be run by people who still have the problem or symptom?). If partners, friends and family know about an emetophobe’s fear, they may collude with them by, for example, helping them to carry out avoidance and safety seeking behaviours, providing reassurance that the person will not vomit, or supporting the idea that the fear is external and uncontrollable. Many adults do not, however, tell anyone about their fear, so significant others cannot collude directly with their emetophobia. They do, however, often validate or collude with their partner/friend’s desire for control and powerless beliefs generally, which indirectly helps to reinforce their fear.

If you are reading this from the perspective of someone with a fear of being sick, you may realise that you have a significant other(s), who is in some way helping you to maintain your problems. There is a copy of this ‘significant other’ section right in the back of this manual, just before the references. If you are a teenager, tear these pages out and give them to your parents, friends and teachers to read. If you are an adult, tear these out and give them to your partner, therapist and anyone else whom you talk with about your emetophobia.

If you’re reading this from the perspective of a significant other who is perhaps unwittingly providing some reinforcements for a loved one’s symptoms, you may be feeling somewhat uncomfortable (especially if you have some social anxiety!). You probably don’t want to think that you may have been contributing in any way to your loved one’s problems, even if inadvertently. Think of things this way…

You are probably very close to your loved one and you obviously care for them a great deal. This has undoubtedly provided many benefits for them. BUT, it may also have validated their problem or illness and perhaps provided reinforcements or gains for maintaining it. As someone who loves a person in distress or difficulty, it is often very difficult to not be concerned, worried and sympathetic. And equally, if you had instead ignored them, been really unsympathetic, judgmental or negative towards them, this would likely have caused problems too (Research by Walker, Claar and Garber (2002), for example, has shown that in addition to positive attention being reinforcing, negative attention, also, helps to maintain illness symptoms in children with low self-worth and low competence beliefs).

Ideally you want to be able to take a step back, maintain some perspective and support your loved one, without validating their negative beliefs. Gently challenging any limiting beliefs that a person may have, whilst still showing your unconditional love for them, is much more beneficial than just being sympathetic. So how do you do this?

Colluding vs. Challenging

When we love, or even just care for someone, we don’t want to see them upset or in pain. We empathise with them, we can feel sorry for them, we can feel guilty because we believe their situation/symptom is somehow our fault, we can even feel their pain. When they say ‘I’m so terrified of being sick, it’s the worst thing in the world’, it’s really hard to not let your emotions get in the way and be 100% supportive: you’re human. Trouble is, if you are blindly supportive, then you are supporting both the emotions/pain your loved one is going through, AND also their beliefs about it.  In the above example, you’d be saying ‘I’m really sorry you’re frightened sweetheart, being sick really IS the worst thing in the world’.  What you want do you is be loving, supportive, to ease their pain and suffering a little WITHOUT agreeing to their belief about WHY or HOW they are suffering.  So, for the above example, you could say something like ‘I’m really sorry you feel so frightened sweetheart, we’re doing something to help, this should be over soon’, or maybe even better still ‘I know you are really suffering at the moment sweetheart, but we are going to beat this thing and help you to feel great again. Remember that this thing isn’t happening to you, all we need to do is just help train you out of it’.

Another example could be if your loved one said something like, ‘I’m so anxious about tomorrow, I don’t think I can cope’. Rather than responding with something like, ‘You poor thing, this must be awful for you, can I do anything to help?’ a better response might be, ‘I’m sorry you’re feeling anxious, but this is all about how you are thinking, you can cope. You’re creating that anxiety and you can change it. Let’s look at what you have been thinking in order in wind yourself up.’

Remember: you want your loved ones to support you, love and care for you, WITHOUT colluding with your beliefs about HOW and WHY you need their love and support. They want to help you to realise that this phobia isn’t happening to you (external cause) but is in fact something you are unintentionally doing to yourself (internal cause) and that you are in the process of training yourself out of it. It might feel like hard work, but everyday you are making some headway.

Here is a link to a presentation given at our 2014 Annual Conference, by Jane and Maggie.  Jane talks about how she overcame her emetophobia (after 5o years!) and Maggie talks about what it was like being her 'significant other':


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