The Agoraphobic Girl

Agoraphobia is derived from the Greek words phobia, which means "fear," and agora, which means "marketplace." Agoraphobia generally means a fear of public places, perhaps due to social anxiety. But from a family systems point of view, a child's agoraphobia can have a different meaning entirely.

Recently, a mother called me about her 11 year-old daughter's debilitating agoraphobia. The girl, whose name was Cassie, refused to leave the house, even to go to school. Her parents woke her up at 6:00 AM, so that she had plenty of time to get ready, but when it was time to leave for school, Cassie threw herself on the floor and sobbed. She complained of painful stomach aches which felt worse when she was at school. Cassie's pediatrican had said that there was no physical reason for the stomach aches, and thought the cause might be psychological. I told the mother to bring Cassie into my office the next day.

When I spoke with Cassie alone, I asked if she was worried about one of her parents. She admitted that she was worried about her mother. When I asked her why, she mumbled "I don't know." I asked if her mother was stressed out. Cassie replied that she thought her mother was stressed, but she couldn't say why exactly. When she wouldn't say any more about this topic, I moved on. I asked Cassie to write down all of her fears in little notebook. Every time she felt afraid, she was to write down where she was, the time of day, the thoughts that went through her mind, and her feelings. Then I gave her a little paradoxical exercise that is usually very effective. For fifteen minutes each day, she had to sit in her room and conjure up her fears. She was to set the kitchen timer, to make sure that she felt the fear for exactly fifteen minutes. When the timer rang, she could stop being afraid and go about her life. A few minutes before the end of the session, I invited Cassie's mother back into my office and said I would like to see her and her husband at the next session. "Without Cassie?" she asked. And I replied "yes."

At the appointment the following week, only Cassie's mother showed up. She said her husband had a meeting at work and couldn't get away. When I told her that I always see a child's parents to understand the family context of the problem, the mother unexpectedly burst out in tears. "I am having an affair," she blurted out through her tears. After a few minutes of sobbing, she asked me, "Could this be affecting my daughter?" "Possibly," I said. As her mother told me about her affair, I began to see Cassie's agoraphobia from an entirely new point of view. Cassie's staying home had the effect of keeping her mother from meeting with her lover because her mother had to stay home to take care of her.

Suddenly I was struck with the thought that this was an almost identical situation to the case of an agoraphobic young woman that Freud had treated in psychoanalysis. In fact, I had discussed Freud's case in Suffer the Children (p.p. 153-154). The function of the young woman's agoraphobia was to keep her mother home with her so she could not meet with her lover. Freud was unsuccessful in treating the young woman, because when her mother found out that her infidelity was a topic of her daughter's psychoanalysis, she sabotaged the therapy by sending her daughter away to a clinic. Unfortunately, I fared no better than Freud. The mother sabotaged Cassie's therapy. After the session with the mother when she disclosed the affair, I never saw Cassie again. This mother did not want to deal with her own feelings of guilt and pain or stop seeing her lover any more than the mother in Freud's case.

I often wonder if I should have focused on working with Cassie alone for a few sessions to decrease her anxiety. But, from long experience as a family therapist I know that if the family system problem is not resolved, the child's symptoms will not go away entirely.