A Guiding Hand : Therapist Helps Agoraphobics by Making House Calls

The trim, 42-year-old secretary stops short. Her heart is racing, her palms sweaty. She wants to buy a mirror.

But at an antiques marketplace, she is caught in a maze of narrow alleys and can’t see the exit.

She clutches the arm of her psychotherapist, Judith A. Allen, who remembers exactly what the mind-freezing panic feels like. Allen, an ex-agoraphobic who now makes house calls to other agoraphobics, also walks them through the daily trappings of life.

“[Allen] knows exactly what you’re feeling,” said the secretary, who did not want her name used for fear of being stigmatized. “She can see it in your body language. She can see you’re not breathing right.”

Step by step, Allen coaxes her clients out of their homes. Over and over again, they practice going outside. They practice getting in the car. They practice driving down the street.

One of Allen’s clients, a 60-year-old mother of six, had not left her house in 30 years and had never been inside a grocery store until Allen took her.

“We got to an Albertson’s store, and we stood outside while she watched the automatic doors,” Allen recalled. “She had never seen those before. . . . I tell you, I had tears in my eyes.”

Few psychotherapists visit agoraphobic clients at home, experts said. It is easier and faster for psychotherapists to schedule only office visits, which in itself can cause anxiety to the clients, said Shirley Green, director of Agoraphobics Building Independent Lives, a coalition of 40 support groups based in Richmond, Va.

“I wish there were more who did it,” she said. “There are an exceptional few that do it, and they’re the most successful in getting people out.”

Agoraphobia is a fear of open or public spaces. The cause is unknown. Agoraphobics panic when they leave a “safe place,” such as a home or established driving route; some feel they are going crazy or dying. About a million people in the United States have agoraphobia, according to the National Institutes of Mental Health.

For Allen, the disorder struck like lightning.

In the summer of 1973, she was taking a bus home when she became disoriented and shaky. She thought she might have the flu.

But the feeling didn’t go away. Soon, Allen hardly ever left home.

After nearly two years of therapy, she started to venture out on her own and volunteer at the counseling center that had helped her. Meanwhile, Allen decided to go back to school. She wanted to try to help other agoraphobics.

She got a master’s degree in psychology at National University in Anaheim and began making home visits to agoraphobics in 1989.

Now, Allen has three such clients, whom she charges her regular rate of $90 an hour.

“To see these people’s faces, to see the change in them . . . that is very rewarding,” said Allen, who is divorced with no children. “It gives me such a thrill to see them do something.”

Three years ago, Allen’s secretary client barely made it to Allen’s second-floor office in Fountain Valley. The two practiced going up and down the stairs.

These days, the secretary can drive to work on a route she feels safe. She can go to a local restaurant with her husband. She is chatty and articulate, and shows no signs of anxiety. She dreams of being able to fly, to go on vacation some day.

But fear still grips her during everyday tasks.

Some days, she and Allen go to a mall and practice riding the escalator. First, the secretary determines exactly where the exit is and where the escalators are. Always, she wants to know how to escape to the safety of her car. Allen holds her hand if she’s feeling vulnerable.

Now, she drives on short trips but carries a pair of scissors in her car. That way, if she feels trapped by her seat belt, she can cut loose.

She is a careful, both-hands-on-the-steering-wheel driver. She makes it to the antiques mall with no problem.

Just inside the door, she stops.

“I already don’t like this,” she says firmly in the middle of an aisle crammed with old plates and furniture.

Allen walks ahead of her and peeks around the corner. Allen explains the layout and points out the exits. Together, arm and arm, the two walk in a square through the marketplace.

They make it to the exit, and the secretary gives Allen a hug.

“I’m going to come back by myself!” she promises.

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Phobia Facts

Phobias are a persistent, strong fear of a certain object or situation such as arachnophobia, fear of spiders, and claustrophobia, a fear of enclosed spaces. Phobias are classified as panic, or anxiety, disorders. Nationwide, more than 23 million people suffer from anxiety disorders each year.

* Agoraphobia is an abnormal fear of being in open or public places.

* The root, agora, is an ancient Greek word for marketplace.

* Treatment may involve psychoanalysis, behavioral therapy and medication to control symptoms caused by anxiety.

* Systematic desensitization involves gradual exposure to the phobia.

County and National Mental Health Resources

General health information, (714) 834-4722

Behavioral health care, (714) 834-6900

National Panic Disorder Information Line, (800) 64-PANIC

Sources: World Book Encyclopedia, Orange County Health Care Agency

Los Angeles Times