Cognitive behavioural Therapy
Fiona Matters
“Nothing I do will ever be good enough.”
40 years old with a moderate combined family income, living in a 4 bedroom detached home; on the face of it, Fiona’s friends and family thought everything was ok. But this couldn’t have been further from the truth.
Fiona was held back by excessive levels of worry and anxiety, a lack of confidence in her ability to protect her loved ones and ensure their happiness.
And, after a major disagreement with a work colleague, who she considered a friend, Fiona was left feeling devastated and overwhelmed most days.
She just wanted to relax and enjoy the company of family and friends but was sabotaged by various fears; worrying things wouldn’t get done properly if she didn’t do it, worried about the safety and wellbeing of her family, worried about not coping during social events and situations involving more than a handful of people.
All this worry affected Fiona’s sleep, ability to regulate her emotions, and her concentration levels at work. Fiona also experienced intrusive thoughts;
- “Everyone else copes ok”
- “I’m so selfish for getting annoyed!”
- “I need to double check my kids are safe and happy”
- “I must do everything for Mum because she can’t manage herself”
- “People will expect everything to be perfect, what if I have a meltdown and embarrass everyone”
Fiona needed help, and so we started working together and I provided Fiona with cognitive behavioural therapy as part of our work together.
So how did iCBT help Fiona?
A full assessment of current and previous experiences
Primarily, we discussed what kind of things Fiona loved doing before her issues started. And, specifically, how she imagined herself, and her life, to be if the distressing symptoms and issues magically disappeared. This helped us set goals for therapy giving us a specific target to aim for and a way of regularly checking treatment was effective and refine our strategy if need be. It also allowed us to set small, joyful activities to re-discover good emotions and feelings, create a little balance again and start to re-build self-confidence.
Secondly, we did a full assessment of her distressing symptoms and issues, considered alternative causes, such as, underlying medical issues and historical information including what Fiona had tried previously. This helped us set a starting point for our regular reviews and allowed us to collaborate on a ‘working theory’ of what was causing and maintaining Fiona’s issues. From this we could agree an initial therapeutic strategy including what psychological information, techniques and skills would likely work best to get her feeling better quickly and moving towards her goals.
Got clear around Fiona’s values, strengths and other commitments
We made sure our therapeutic strategy was realistic and manageable around Fiona’s existing lifestyle. As well as attending sessions, Fiona needed to have time to practice and test out new ways of seeing and doing things.
By clarifying and aligning our work to what she was already good at, and making good use of the support around her, learning new skills and coping strategies was easier for Fiona. This helped rebuild her self-confidence, her feelings of self-efficacy and hope. She also felt more engagement in our work.
As well as her goals, we designed therapy to honour the things that mattered most to Fiona. All therapy consists of experimental work. You have a theory about what will work and sometimes the outcome isn’t what you’d expect. But, as everything Fiona did was line with her core values, she noticed she enjoyed trialling new skills irrespective of the outcome. If her theory was proven she kept using the new skill. If not, she had enjoyed the exercise and what she’d learned gave her a better idea of what was likely to work. Win, win!
Provided psychological education
Providing factual, psychological information on how the mind and body work reassured Fiona that her distressing symptoms were normal human reactions to perceived threat. So, she wasn’t broken or flawed!
I gave Fiona additional educational material, which provided a rationale for the treatment. It also gave Fiona hope that with a little time and practice she could become self-reliant at overcoming issues and achieving her aspirations.
Understanding and noticing the connection between mind and body helped Fiona become aware of thoughts and behaviours which were maintaining her issues. Particularly her lack of self-compassion and her self-critical commentary. And to recognise physical sensations and emotions she could use as cues to behave in more helpful ways.
Acquired new skills and techniques
Fiona learned effective ways to maintain good sleep patterns, to relax, to focus her attention when and where she chose. She was able to take a more objective view of life, maintain a more realistic and positive attitude towards her span of control and deal with unexpected events more calmly and assertively.
Fiona used the time she previously spent feeling worried and anxious to do things she enjoyed which promoted her physical and mental health. She finished therapy feeling confident of dealing with current issues and other problems which could occur in future.
Best of all Fiona achieved her aspirations. She reduced her feelings of stress and anxiety to healthy levels and is spending lots of time relaxing and socialising with family and friends. And she takes, guilt-free, ‘me’ time too!
Top 4 Light Bulb Moments
1.
“I really thought there was something wrong with me….my personality. Nobody teaches you that you can learn to manage how you’re feeling and thinking better. I just thought if you couldn’t cope there was something up with you!”
2.
“All these beliefs I have about what I should do, how everyone should be. Just stories I’ve made up on the back of what other people told me, what I thought. But they’re not true. So, I can choose to drop all of them…stop hurting myself.”
3.
“If someone spoke to my daughter the way I speak to myself I’d be mortified! I thought it was what I should do. But it was just making me even more anxious and hopeless!”
4.
“Stopping going out and avoiding people prevented anxiety attacks short term. But I just spent more time worrying about the future. Now focusing on what I’d love to do, how I’d love to be again….and doing small, fun activities…. I started to realise what being happy felt like again …..made such a big difference to my self-confidence.”
Ready to Matter?
Your action creates your outcome. You can choose to MATTER