There are many ways to conceptualize and deal with fear in the therapy office and only the outcome determines effectiveness. A positive outcome means that irrational fear does not continue to be pervasive and life disrupting. However, it doesn't mean that the client loses all sense of fear. Rather, over time, it provides the client with a way of approaching fear in daily life.
In addition to the various ways I may choose to discuss it, irrational and historically based fear takes many forms, all of which are de-stabilizing and result in life being survived rather than lived. For example, a woman with a phobia related to leaving home (agoraphobia) is literally imprisoned by her own emotion. Likewise, an individual with an eating disorder such as Anorexia Nervosa (a disorder which is manifest by fear of and obsession with food), experiences fear sufficient to force self starvation to the point of death. Facilitating healthy change means no longer being captive to the imprisoning fear.
These examples and countless others have one thing in common; they illustrate that irrational fear serves as an unhealthy and maladaptive response to the world. One of my therapeutic objectives with each client is to find the ways that s/he can move past the fear and develop healthy responses to the world. This results in being able to make choices rather than rigidly adhering to self defeating behavior. Since an individual's early life serves as the foundation for dealing with fear, it may be necessary to learn new approaches to potentially threatening life events. What may have been adaptive during childhood or adolescence may not be an adaptive response in adulthood.
To facilitate change in dealing with any form of fear, a number of approaches can be used. For example, I frequently use a visual image of a fog bank as a metaphor for anxiety. Using this image facilitates the verbal exploration of fear. In addition, it becomes clear that the most effective way to be rid of this form of pain is to go through it. Ongoing acknowledgment of the presence of fear is the start. This is followed by actively visualizing the image ofwalking through it (as if it were a fog bank), which tends to facilitate moving through the dreaded experience or fearful event. I have found this simple image, in conjunction with other therapeutic approaches and techniques, to be very helpful in combatting the stifling effects of conditioned fear experiences and responses.