Graduated exposure therapy explained
Make a ranked list of urination locations from easiest to most difficult. For example, most people with paruresis find it easiest to urinate at home alone. The hardest location is usually a crowded and noisy public toilet. The idea is to start with the easiest locations and work your way up in degrees to the most difficult.
Have a ‘pee partner’ to support you. This could be a family member or trusted friend.
Ask your pee partner to stand as close to your home toilet as you feel comfortable while you are trying to urinate. Urinate for a few seconds then stop for a few minutes.
Have your pee partner stand a little closer to the toilet. Go back into the toilet and urinate again for a few seconds, then stop.
Keep practising, with your pee partner getting closer and closer to the toilet. This may take several sessions over a period of time.
Try to make as much noise as possible while urinating. Deliberately splash your urine into the toilet water. Do this with your pee partner nearby.
Pick a quiet public rest room (once you are comfortable with urinating at home) and then, with your pee partner standing outside the toilet door, practise the same way you did at home.
Use your pee partner and work your way up the ranked scale of difficult locations until you can successfully urinate in a crowded and noisy public toilet.
Graduated exposure therapy is more successful if it is practised often, perhaps three or four times per week.
Drink plenty of water before your practice session to make sure that your bladder is full.
Avoid any negative self-talk while trying to urinate. Remember that paruresis is a common social phobia. You are not abnormal or ‘the only one’.
Take it slowly, step by step. Don’t pressure yourself. You should see considerable improvement after about 12 sessions or so.
I never knew about this, but I used a very similar method. Where are you right now? Can you pee in public restrooms (stall or urinal) if nobody is in the room at all?
Build up from where you are now. Maybe first use the stall with nobody in the room, then go for the urinal. Then try using the stall/urinal when someone is washing their hands in the room (with no one using a urinal), then build up to using a urinal when someone is using a urinal that is 2 or 3 urinals down from the one where you are. It’s all about being comfortable, and that usually doesn’t happen over night. It happens with experience.
As soon as you can pee in a stall with people in the room, you are set. Then you can choose if you want to try the urinal over the stall if the conditions meet your level of comfort. Plenty of people use the stalls to pee, I actually prefer it. Just relax!
