a case study by Ivan Tyrrell
SARAH, a single mother of two boys under five, shuffled dispiritedly into my consulting room. She was completely lacking in confidence and her voice was almost a hoarse whisper as a result of what she termed her nervous breakdown. She lived on a council estate in a flat too small for herself and her two children (one of whom had behaviour difficulties), and had had to let her children go to live with her parents because she couldn’t cope with them in her present circumstances. A year previously her ex-partner, the father of her sons, had thrown a brick through the window of her flat, broken in and assaulted her. A new relationship had just recently gone wrong because the man, himself depressed, was too possessive and overprotective of her. She was in despair, missing her children desperately, and, knowing she needed help, had accepted the chance of free therapy sessions which were to be filmed for training purposes.
She told me she was unable to sleep properly and felt utterly exhausted. Since her parents had taken over responsibility for her sons she rarely left her poky flat, had let herself get overweight and spent her time depressed about her life and the loss of her boys, or worried about her debts. In answer to my questions about her life, she told me she hated being on welfare benefits and that, when she was 17, she had loved her work as a care assistant in an old people's home. I also found out that she had used to enjoy going swimming and had joined a gym before her 'breakdown' but had rarely gone there.
When I asked her what, realistically, she would like to have happen in her life, she said she would like to move, and mentioned for the first time that she was now 'priority' on the council's waiting list to be allocated a house and garden. She was actually expecting to hear about a move within a week or so. She also wished for a job, although she saw many obstacles to this.
As we talked, I countered her negative comments about herself, inviting her to see herself as caring, loving, independent, someone with initiative and so on, and explained how endless worrying turns one inwards. What would help her most, I suggested, was to direct her attention outwards, so that she could find solutions to her problems instead of just worrying about them, and regain her interest in things outside of herself. These ideas were new to her.
I suggested she close her eyes and relax
while, one by one, we went through the things she had said she needed to
sort out in her life and she imagined herself dealing with them. For instance,
I asked her to imagine herself enjoying going swimming regularly again,
and going to the gym; to imagine herself looking at local papers for possible
jobs, perhaps in the care field, or finding out about courses she might
want to take; and to imagine herself in a new house with her boys back
When Sarah came back to see me a few weeks later she was looking bright and alive. "I feel really well," she said. "You gave me a lot to think about, a lot of positive things." She told me she was swimming regularly and had already started losing weight. Although she hadn't gone back to the gym, she was using an exercise bike at home in the mornings. She now had her children back staying with her three or four nights a week and planned to have them home full time very shortly, as she had now been offered a three bedroom house. She was doing a parenting course, which she found really useful in helping her handle her sons' behaviour, and had been in touch with an agency which helped single parents back into work. She was also "getting on top of" her bills and announced she had felt low only one day in the last month. "I actually feel in control of my life again," she said. "I felt like it was being taken over by, I don't know, I just felt like it was being taken over."
Shifting her focus on to solving her problems
had stopped her negative introspections, normalising her sleep patterns
as a result. Her voice was also back to normal. When I commented that she
seemed to have everything pretty much under control and probably didn't
need any further help from me, Sarah herself said, in amazement, "One session!
I think that's probably all it took, really; it gave me a push in the right
direction. Whereas if I'd gone to a different kind of counselling, I might
still be back where I was."
The video "In control again"effective therapy
in one session for clinical depression (the first in a series
of practical therapy demonstrations made for MindFields College) can be
purchased with full transcript and commentary for £49.00 from Radical
Psychology Television on +44 1323811654