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Case Studies & Client Profiles

I treat clients from all walks of life helping them through a range of life affecting issues. No one person is a text-book client with ‘off the shelf’ remedies. Because we are individuals and our lives involve differing circumstances, it is vital to explore a range of issues and work together to achieve desired outcomes.

These profiles are based on actual clients, although names and circumstances have been changed to protect confidentiality.

  • June (44), while struggling with a difficult relationship June is diagnosed with breast cancer. She feels lonely, frightened and unsupported and becomes very anxious and avoidant.

Changes in our health rock the foundations of our sense of security. It demands from us high levels of coping and resilience. Therapy with June explored her habitual patterns of response to stress and how we could modify her thinking to keep her in a coping mode. She was also encouraged to seek outside sources of support, and she managed to set up a group of friends and professionals to be there for her. June felt that she benefited especially from changing her fearful and worried thinking to an attitude of living mindfully; taking everyday as it comes and making the most of it. Last time I saw June her hair was growing back and she said that although her diagnosis was an experience she would not wish on anyone she had emerged from it as a stronger and wiser woman with a new sense of her priorities.

 


 

  • Shana (51), is struggling to overcome the death of her beloved husband from an aggressive form of cancer five years ago – she feels as though her life has also come to an end and the only reason she plods on is for her teenage daughter who still needs her.

Bereavement or grief counselling is valuable at every stage of loss, especially if one gets ‘stuck’ in the process. Shana needed time and a safe space to let out all her suppressed feelings of anger, disillusionment and sadness. She also needed support in devising a new life for herself without feeling as though she was betraying her husband. Shana had become caught up in very negative patterns of thinking without realising it and her gradual change in attitude opened up the door to her healing.

 


 

  • Matt (59), a series of bad luck, poor business decisions and ill health has altered Matt’s life circumstances completely. His G.P. has diagnosed depression as he struggles to get through every day.

Matt’s depression was strongly linked to the loss of his sense of identity. In his mind his worth as a human being was linked to his ability as a breadwinner. In therapy Matt explored how his life experiences and the way he attributes significance played a role in how he judged himself. In time he came to understand that his anger and disappointment in himself was contributing to his depression and was blocking him to coming to terms with his circumstances and moving forward in a positive way. Matt had to learn that sometimes the circumstances cannot be changed – therefore the only change that can be made is to your attitude towards the situation.

 


 

  • Joan (24) has been with her boyfriend since schooldays, yet she finds herself attracted to woman all the time. This confuses and frightens her. Phil (18) has known he is gay all his life – but is fearful of the reactions of other people, especially his parents, to this.

More and more, people need to talk about their sexual identity. In spite of a more open attitude towards gays and lesbians for many people it remains an area fraught with difficulty. Joan and Phil attended therapy to help them clarify their own needs and fears and to assist them with ways of dealing with the responses of others. Joan decided that she did not want to act on her attraction to women at this point as she did not want to jeopardise her relationship with her boyfriend whom she loved deeply. Phil decided to ‘come out’ to his family and received great support from them, however he needed help to cope with the hostile rejection of some of his former friends.

 


 

  •  Millie (47), seems to have it all – a hardworking partner, delightful and great kids and a beautiful home – yet she almost always feels restless, sad or angry.

In my office I frequently see both men and woman in their forties, usually when their children are no longer completely dependent on them, struggling to deal with a vague sense of emptiness – a kind of, ‘Is this all there is to life?’ questioning. Almost always they feel guilty about this feeling and yet cannot shake the malaise that comes along with this frame of mind. For some there is a sense of loss about youthful vigour and beauty, and regrets about opportunities not taken. Millie needed help to take stock of her life; what she had already accomplished, and what her attitude was to life in one’s fifties and sixties. She needed to reconnect with old passions and discover new ones. Using Cognitive Behaviour Training (CBT) enabled Millie to discover how her rigid set of beliefs about herself and ‘old age’ was impacting on her mood and behaviour. She also benefited from some assertiveness training to break her out of her submissive and passive aggressive style of interacting with dominant others. Within six sessions Millie professed to feeling like a changed woman!



 

  • Harry (34) has been married for ten years and is in a state of shock when his wife announces to him that the marriage ‘no longer works’ for her. He does not know how to deal with his anger and grief, nor is he sure how to minimise the effect of the divorce on his children.

The break up of a marriage almost always has intense emotional fallout. Apparently sane, rational people can behave in extremely destructive ways. At one point Harry wanted to take his children and hide them away from his wife to punish her. When children are involved managing divorce and custody issues in the most calm and sensible fashion pays huge dividends down the line. Therapy provided strategies for Harry to deal with his grief and feelings of betrayal. He was able to maintain a civil relationship with his ex-wife and as a result their children have coped well with the separation, adjusting surprisingly quickly to dual living arrangements.



 

  • Rob and Linda at their wits’ end dealing with their difficult, oppositional and wilful teenage daughter, Tiffany. Their marriage is buckling under the pressure and their other two children are becoming problematic to deal with as well.

All teenagers have their difficult moments, it is part and parcel of becoming your own person, but some teenagers leave the realm of the real world and go into a parallel fantasy existence of the ego. For a period of time they are blind to the wishes, needs and demands of ordinary society, and will frantically put up a knee jerk reactive fight to every expectation of school or home. The exhausting tightrope parenting dance then begins ; providing enough secure and appropriate boundaries while maintaining connection. Getting some adolescents to understand that rights and privileges come with responsibilities and the adherence to basic rules can take years, and be a frustrating and draining experience. On the other hand, adolescents who are confronted by permanently hostile and punitive parents who can’t or won’t allow them an opinion and some freedom to explore the world will disengage from the family unit as soon as they can. For Rob and Linda’s family we arranged a series of sessions, sometimes including Tiffany and/or the other children. I wish I could say there was a dramatic turn around but the truth is it took a many months for hostilities to diminish between Tiffany and her parents, and not before she got into serious strife and needed their help. Therapy did however help Rob and Linda to work together and to focus on providing a happier family atmosphere for the younger children.



 

  • John (23), is a competent tradesman, but finds himself overwhelmed with anxiety when he has to deal with the public and his employees. His strategies of avoidance, e.g. letting others make appointments and handle financial transactions is impacting on his business. From time to time he explodes in anger and frustration.

Anxiety comes in many guises – at its worst it may morph into debilitating panic attacks. People become anxious at the perception of threat. That ‘threat’ may be physical, as in fear of dogs or flying, or less tangible; such as the fear of humiliating oneself, incurring the wrath or displeasure of others, fear of failure, fear of death and loss of control. Once the ‘flight or fight’ system has been activated it is hard to rein in the biochemical spiral of anxiety. So all therapy involves exploring what thinking and belief system sits behind the anxiety in order to manage it before it starts. John was not confident about his ability to communicate effectively with others and he had a fairly rigid set of internal standards of perfection. Perfectionism and anxiety often go hand in hand as individuals strive to keep external factors in control so that they do not have to deal with their own emotional response to confrontation and difficulties. Using Cognitive Behaviour Training strategies, enhanced communication skills and a programme in which John slowly tackled areas he had avoided in the past  he managed to get on top of his anxiety.



 

  • Jill (32) cannot control her two children, aged 8 and 5. They are demanding and non-compliant and yet also very clingy and unsure of themselves. She feels unsure of her own parenting and finds herself being very inconsistent as she tries to meet their needs.

Children need both love and boundaries to flourish. Some parents find it difficult to know what they can expect from their children and how they should discourage bad behaviour without damaging the relationship with their child or the child’s own self-esteem.  So they land up giving in to the point of frustration and then trying to influence their children’s behaviour by shouting and threatening. This does not work in the long run as kids quickly work out how far they can push their parents before there are real consequences.

 By not setting consistent rules and routines for her children Jill made them feel insecure and out of control. This situation was exacerbated by the fact that her husband, who was rarely home on weekdays, would undermine her attempts to enforce basic good manners, consideration and responsibility on the weekends when he was home. Several sessions involving both parents resulted in a planned programme to which both parents adhered. Their mantra became; ‘kind, firm and consistent,’ putting into place real and immediate consequences for inappropriate behaviour and lots of rewards, such as praise, for good behaviour. At first Jill’s children fought the system by becoming extremely challenging – but because the parents had been warned that this might happen they were able to stay calm, model appropriate emotional modulation and stick to their guns. Their home is now a (fairly) calm and ordered place with much less confrontation and more cooperation all round.



 

  • Tony (28) has been smoking dope since high school, Maria (38) has a bottle of wine every night, Dave (46) has been smoking cigarettes since his teens, and Felicity (56) has been struggling with her weight all her life. All these people need help with ‘substance abuse’.

In order to crack this problem a client needs, firstly, to understand what keeps the addiction going on a deeper more sub-conscious level. Every one of these clients knew that what they where doing to their bodies was wrong. All of them had tried many times to give up – some with other organisations. So it was only when Tony found other strategies of dealing with his anxiety, Maria started dealing with her nervousness and feelings of inadequacy and Dave with his stress that they could start putting into place behaviour modification programmes that worked.

Felicity is a comfort eater – she imbues food with supernatural powers of soothing and reward. Limiting her food choices takes away her primary source of gratification, setting up a situation where she feels more and more emotionally deprived resulting in a huge backlash of over-eating. Only when she can hold onto this insight and feel she is nurturing herself by replacing unhealthy food with healthier food choices, and also non-food rewards,  does she manage to maintain her weight at a comfortable level.

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