Fiona came across as a well-polished lady in her mid 40s who spoke softly and appeared outwardly calm. However, midway through our first session, her voice began to crack. She had been in a long-term relationship with her partner of nearly ten years and had been engaged for four years before finally breaking up. The emotions that she had suppressed for so long could not be contained anymore.

She met her partner John through a business acquaintance. They exchanged contacts and what started as a casual friendship soon grew into a relationship. He was a gentleman in all respects and Fiona soon fell in love. John told her he was divorced with two children but was still attached to his ex-wife with whom he had started a business nearly twenty years ago. Over the course of time, things seemed to go well between them although a few times John had cancelled doing things together because his ex-wife had suddenly decided to meet up and discuss something. At first, it didn’t bother her that much and she dismissed any suspicions as her own insecurities. Although very attractive and always smartly dressed, Fiona admitted that underneath it all she was very insecure and had trust issues.

We worked together for nine months to help her find closure from her relationship with John as well as work on some of the underlying insecurities around trusting men and fear of abandonment. Her relationship with John had finally terminated for good a few months prior to seeing me. She said one day after lies after lies, she found the courage to look him in the eyes and tell him she was never going to be romantically involved with him again. She still couldn’t believe the courage she had found and how empowering that was to face him, while not shedding a tear or getting overwhelmed with emotions. Yet it had taken a lot for her to get to that stage and it was clear he did not believe her- and why should he, it was not the first time, yet this time she knew it was final.

John was a controlling man and Fiona noticed that from the beginning, but in her defence, she felt he was just a little bit jealous, and didn’t mind. However, within two years he had managed somehow to isolate her from her entire social life. Her life revolved around him. He planned their holidays, concerts and activities, and even the gym timetable, so that there was very little time, if any, for her to socialise with other people. Friends complained but she thought they were just jealous. Yet, three years into their relationship she knew very little about John’s other side – she was still to meet his children and friends.
This became an issue and he always told her that he loved her dearly but had to be careful how he introduced her because upsetting his ex-wife could end up in him being forced to sell the family business as well as lose years of hard earnings and pension rights.

Of course, Fiona didn’t want things to come to that so she believed him. John also travelled a lot on business and now looking back, she believes she travelled with his ex-wife as well as going on family holidays while pretending to be on tour of duty. Five years on, and still no introductions or anything, John finally proposed and bought Fiona a beautiful diamond engagement ring which she could not believe. This helped her put her doubts to one side. John promised that he would be selling the company within three years and they would be free at last to marry and, possibly have one or two children.
John took her and his children on holiday and they spent a week away and things seemed to be fine. By now she was sure he was sincere and that she just needed to address her own insecurities.

At the age of eight, her father had left for a much younger woman and Fion’smother never recovered from the betrayal. She was bitter and years after his death, she still resented Fiona’s half sister and brother. Growing up with her mother, who demonstrated narcissistic tendencies, Fiona had to put up with being reminded that all men were untrustworthy and would only break your heart. Finally as a young woman, her first true love had cheated on her, and this only served to confirm what her mother had forewarned. Fast-forward, it turned out that John’s ex-wife had changed her mind and wanted to work on their marriage for the children’s sake. Two years before breaking up John had changed a lot. He would spend more time travelling and Fiona started to feel very lonely as she had been isolated from everyone, and pride stopped her from reaching out to old friends and family. In her own words, she felt depressed and when she was not working, she would lie that she was busy when all she did was spend a lot of time crying and sleeping endlessly.

John was still not being completely honest and she sometimes wonder if he was oblivious to the pain she was going through because he would lie while looking straight into her eyes. The motional toll was becoming intolerable -with having to be blamed that somehow it was all her fault and need to apologise for all the time for the critical impasse that necessitated John having to decide between her or his ex and children. Clearly, it was a case of a gas lighting. One critical incident stood out when she had to undertake anurgent errand at John’s house and found his ex-wife present. The shock and panic between them was palpable. She met John the next day and was clearly made to her feel it was her fault. On reaction, Fiona could point to other numerous subtle ways she had been subjected to emotional blackmail, whether it was challenging John on his version of events or been accused of flirting with men in the gym or just socialising in general.

Fiona needed closure and through talk therapy, she found the space to let all her repressed emotions spill forth in a safe environment. Her intuition had proven correct. She had been dealing with a ruthless, successful businessman who had manipulated her kind and gentle nature to control, indeed, gas light her; while emotionally blackmailing her each time she wanted to end the relationship. Her case was definitely one of psychological abuse, albeit a subtle one. She could not believe that she had allowed herself to live like that for nearly a decade. During therapy, we also spent time exploring her childhood as the trust issues stemmed from long before both her relationships with John and her first boyfriend. After nine months of Psychodynamic and Mindfulness CBT to help with practical issues, like setting targets and having realistic goals about getting herself back in shape,and regain her lost self esteem, Fiona was ready psychologically, to leave John behind and find closure over the wasted years and her dream of being a mother by now. She was going to take it easy, pay attention to her spiritual growth and travel more while nurturing good relationships with a few old friends as well as meeting new people.
In all our work, I felt very humbled and I learned a lot from Fiona’s resilience and strong will. It was her determination not to end up bitter like her mother which helped steer her away from bitterness towards a life of peace again.

Luisa, aged 30, had been in a number of dysfunctional relationships with men who abused her from the age of 14. She liked her job as a nurse but was spending too much time on sick leave due to depression. She struggled with comfort eating because food was her best friend when she felt depressed – which was often. Her GP had put her on Paroxetine which she had been on for two years prior to seeing me. She was desperate to stop taking the anti depressants but scared that she might end up worse and not coping.

Luisa wanted to address everything and said she was ready to do what it took because she was not happy and hoped to meet someone and start a family.She knew that she was possessive and that didn’t help in relationships because she always feared being abandoned. She was too scared to confront her abandonment issues but knew it impacted on her relationships – especially with men. She had been in five relationships over the years. The first one had lasted for over five years. Even though Gary was verbally abusive in that he called her names like ‘fat cow’ and told her that no other man would ever look at her, she still stayed with him convinced that she would never find another boyfriend.

We explored her childhood issues during the first few sessions and how being abandoned was still affecting her as an adult. I used a Psychodynamic approach which enabled us to link the present with the past. This was never easy because Luisa got angry and a few times had walked out before the end of a session. She had so much anger bottled inside and even though she was never a threat to me physically, I sometimes wondered if she would come back and to my surprise; she always did!

Luisa told me how she pretended to be confident at work but deep inside could not even look herself in the mirror because she believed she was ugly. Using Cognitive Behavior Therapy and some lifestyle coaching skills, I encouraged her to look herself in the mirror and to replace the negative perception with a positive one. A few months had gone by and I was encouraged that even though I knew there was still a lot of work to do, Luisa was starting to relax more and allowing silences during sessions. She still got angry but not to the extent of walking out and I encouraged her to express herself more. We decided to focus on practical issues around her self esteem and confidence. It was hard work but slowly she mastered the concept of replacing negative thought patterns with positive thinking. On occasion I would encourage her to use the mirror in my consulting room and we would explore what she saw and reflect on that.

We also worked on a exercising and diet plan that would help her in loosing weight and still enjoy her food. I noticed a shift in her confidence and in one session she even referred to herself as ‘good looking’. In our 7th month, Luisa told me that she had spoken to a work colleague and together had joined a local gym. I was pleasantly surprised to hear of this development. She had also met a potential boyfriend, Jamie, and was worried that her anxiety would drive him away.

In a matter of a few months, Luisa had lost over a stone and said her comfort eating days were behind her. She also surprised me in one session when she told me that she had gone away for a long weekend and left her anti-depressants behind by mistake. During the four nights away with Jamie, Luisa had not felt the impact of not taking them and on returning home; she decided to stop taking them. It had been over a week now and she didn’t feel depressed or moody as a result! I encouraged her to book an appointment with her GP and talk about coming off the tablets. This was a remarkable change considering that she had been taking 30 mg every day for more than two years. I was optimistic but cautious.

Luisa was a different woman and three months after meeting Jamie, she was enjoying life and although she still felt anxious; she was in a better place. We didn’t cover everything – there were still issues with her mother but she had decided to put them in a box for now. She had come a long way and was learning to like her mother as she was. If anything, she said she felt sad for her and wished she could get her to seek help in order to enjoy a much better quality of life than stay at home most of her life feeling like a victim of circumstances!

I will never forget the morning of September (0520am to be precise), switching my mobile on and hearing a text message alert that had just come through. Andrea passed away around midnight, it read and I stared at it waiting for another message to come through and say it was the cruellest joke to wake up to. Half an hour later, I was to get the confirmation that my sister had indeed died. My younger sister had sent the message from her mobile after several attempts to call me had failed. Part of me understands the need to get the message to me somehow although I have never got over the shock of learning of such news through a text message. I have grown to dislike communicating via text messaging and on a bad day I still get goose pimples when a text arrives especially from my family who live abroad.

That was seven years ago, yet on sometimes it still feels like only yesterday. I have had nightmares and a deep sense of sadness that I think I will live with for the rest of my life. I have lost a few family members and relatives over the years yet not one of those deaths hit me as hard as losing my sister. I felt like apart of me had died withher and even wished it was me instead of her. Why her? She was such a bubbly spirited young person who could light up a room with her laughter and positive energy. For her to die so suddenly left me not only in shock, but for many years after that refusing to accept that I would never see her or hear her infectious laughter ever again. I also became secretly afraid of going to sleep at night and could not understand why life had to be so cruel. I should say through it all, I was never suicidal but very angry at the world.

After losing a few loved ones, you would imagine that one could more readily accept the notion of death. I became withdrawn and suffered quietly yet I kept going until things got so out of control that I consulted with my GP. She recommended that I saw a professional therapist to deal with my reaction to the bereavement. Two months later, I walked into a large, clean room beautifully decorated and furnished with two huge couches and I nervously asked if I could lie down on one. To my surprise, the therapist did not mind. I didn’t know where to begin. After a few minutes of trying to make myself comfortable on the old couch, I decided to sit up and face the therapist who was watching me with some curiously at the same time with gentle eyes that were reassuring.

This was to be the beginning of a new chapter in my life. Once I opened my mouth, it was as if a tap of water had been turned on and left to run. I felt like I could go on talking but before long it was time to go. Memory was gentle and made me feel at ease.

Over the course of time, she never changed her sympathetic demean our even when I would vent my anger at her (something I regret) but at the time it felt like the pain was too much. I think being a professional, she understood what I was going through. Hence, she never gave up on me. She used a psychodynamic approach mostly which I found useful although at times difficult and together we explored my upbringing and family history. Sometimes, I found the sessions painful yet I knew it was a systematic process and no one had promised that it would be easy. I was convinced deep inside that I was doing the right thing. Some days she challenged me and other days she would sit back and use a person-centred approach (non-challenging and more empathetic). On a few occasions, she would use self-disclosure and it helped knowing that she was not just relying on theory but had been through grief too. The more I opened up and shared my heartbreaks, the more I started to let go of the feelings of anger I had towards some members of my family.

I had been carrying more anger, sadness and fear of death over the years than I had realised. Fortunately for me, I do not drink much nor do I smoke but I had turned to self-harming which took the form of overeating and forcing myself to throw up. This had started about six months after losing my sister. I was overwhelmed with grief and would cook my sister’s favourite meals and eat until I could not move. Then I would go to the bathroom and pretend to others to be on the toilet while I secretly threw up. This was the beginning of my Bulimia which lasted for a couple of years and I became addicted to. At the time, I felt like I had no control and became more secretive so that no one would find out that I had become an addict. I had never shared that side of my life with anyone because of feelings of shame. Once I revealed it to Memory, I felt a sense of relief as we explored my emotions further. She reassured me over time that I was not to be ashamed but perhaps I needed to find other things to distract me. Before seeing her, I only associated self-harm with harming oneself physically. Yet, for years I had been psychologically inflicting pain upon myself to relieve the overwhelming sadness and anger that I carried with me.

Memory suggested some Mindfulness techniques that she felt might help me on a day-to-day basis. As sessions continued, we explored my lack of confidence and seven months later, I pushed myself, cut back on a few luxury items so that I could join the gym. By now I was starting to feel a lot better as I slept well on most nights and the nightmares I had become accustomed to seemed to have gone or I would have one, only occasionally. I started to feel alive again and besides enjoying my work and being more focused, I really liked working out in the gym and doing yoga. I don’t really know how, but within weeks, I found no place for Bulimia and stopped my habit of overeating. Now when I cook foods for comfort (which I don’t do often), I make sure I eat sensibly and it’s true that Bulimia is always at the back of my mind. What I have learnt to do through mindfulness is to manage the triggers and confide in someone when I feel overwhelmed. Now I am coping well I still reach out to Memory (only done twice since ending therapy). It is helpful to know that I have professional support. There are days when I miss my sister especially at birthdays and Christmas. Memory told me that it’s okay to remember my loved ones in ways that may seem bizarre to some because it’s about me and the memories that I treasure. I sometimes look up to the sky at night and happily whisper something to the universe and it gives me comfort.

As I reflect, it’s been six months since my last session with Memory. When the moment came, we both knew it was time to move on but saying goodbye after nearly two years was not easy. I worried that I might relapse. She was as reassuring as ever and said I could come back if I needed to see her again. That was good to hear and today I am in a much happier place than I have been for years. I still miss my sister as well as other relatives I have lost. When I do, I allow myself to feel sad for a while and cry if I get emotional. Its nearly a year since I last experienced Bulimia. The urge still comes up occasionally and because I am in a better place and feeling a lot healthier than I have felt in years, I refuse to go back to my old ways. I am still going to the gym and have become more confident in myself and in social circles than before. I really think that I could not have come this far without the help of Memory and my GP.

Written for closure and in loving memory of Bev.

By Vicky

Tina was referred to me by a colleague. She had been made redundant from work two years previously and her normal pattern had become ‘chaotic’ to quote her own words. She was on a light dose of Citalopram which her GP had prescribed for depression. She had become increasingly anxious and dreaded going for job interviews because she had stayed in the same job for sixteen years and felt that she was no longer ‘good enough’. Her long term partner had recently left her and this only compounded her situation. We first spoke briefly on the telephone and agreed to meet for an assessment. Through observation, I could tell that she was anxious and I offered her a glass of water which she accepted with a smile. I spent a lot of time during our first session taking notes of her history and things in her life that had led to her feeling overwhelmed by anxiety.

I also managed to formulate a diagram of her feelings, behavior, physical state and thoughts which she helped me to fill in by illustrating on each in her own words. This was useful for me to understand how her life revolved in this cycle which had become increasingly unhealthy for her.

Feelings – anxious, lonely, afraid, afraid and guilty

Behavior – drinking too much, eating junk, easily getting angry

Physical state – not sleeping well at night, tired most of the time, Obese, Constipation

Thoughts – unattractive, low self esteem, always worrying about bills, not good enough, hated men and hated herself even more.

We agreed to meet for twelve sessions. There was a lot on my diagram to work with, most of which could not be achieved within six sessions. We agreed to focus on change in behavior as this was realistically achievable. During the next sessions, I would give Tina homework which she reluctantly agreed to try. She started preparing fresh food and eating home cooked meals to fast foods every day. In our fourth session she was pleased that by eating freshly cooked meals, not only had she rediscovered her love of spices but she was saving money which had become tight and had also lost a stone in weight. She was starting to slowly tell herself that with self discipline and determination, she was good enough to find another job.I have worked with other clients before but not like Tina, she was driven to make a change and had decided to stop drinking at home.

She reluctantly agreed to contact one or two old friends to meet for some social activities. When she did, she said she did not realize what she was missing because she had such a great time. One other thing she had started doing was walking to the shops which were about fifteen minutes walk from her house. She said she had become so lazy that she would use the bus all the time.
During our last session, Tina looked different from the shy, reserved woman who had walked through my door a few weeks earlier. She still had a long way to go, but she was taking control of her life and slowly changing her negative thought patterns which had kept her stuck in an unhealthy cycle for nearly two years. She said overall she felt less anxious and was preparing for a job interview to go to in a few weeks time. Having asked her how she felt about it, she smiled and said for the first time she was excited but still a bit anxious.

Cherrys Background:

Job: Cherry is a 40 year-old scientist working full time in a research department. She had always loved her work. Recently she had lost a work colleague to whom she felt very close and had to take time off work. This had triggered deep anxiety and depression that she was not coping either at work or at home. A new much younger, ambitious and assertive colleague had recently joined her team and they clashed.

Home: Cherry has a three-year-old daughter who was not planned. Upon discovering that she was pregnant, she had decided to marry her long-term partner so as to bring up their child in a stable environment. She had not planned to become a mother and had a very traumatic labour which left her with a lifelong physical disability. Although she always described her husband as sweet, there had been very little intimacy between them since she was roughly four months pregnant and now three years after the birth of their daughter, they were more like co-parents and friends than lovers. She did not find him attractive anymore as he had put on a lot of weight and in her words, was too lazy to workout.

Upbringing: Cherry is of Native American origin and her husband is English. Her father passed away a few years back and has two siblings and her elderly mother who are based in New Mexico. Her parents were very strict, especially her father who had such high expectations that she constantly felt not good enough. Her parents marriage had been arranged and although they brought them up to be liberal thinkers, beneath it was an expectation to marry within their own culture. Her relationship with her father had been very strained and was only made worse when she chose to marry her English boyfriend of whom her father did not approve.

Presenting Issues: Cherry was very anxious and when she talked about her colleagues sudden death, she cried uncontrollably. I wondered if she had lost someone else close and she told me how a few years back she had lost her father but couldnt travel in time to attend his funeral. She went back to New Mexico two weeks after his burial and never got any bereavement counselling as she did not think she needed any. She immediately went back to work and threw herself into her work and family life. She described the birth of her daughter as being both emotionally and physically traumatic. She had resented her daughter at first because she nearly lost her own life during a long and distressing child labour. She could not bond with her child for the first six months while she recovered. Her mother had been supportive but not fully. In her mothers culture, people died in child birth.

Hypothesis: I sensed that Cherry was grieving the loss of a trusted colleague whose death had also brought up her own unresolved issues surrounding the loss of her father. She had admitted to loving him and trying hard to please him yet it never seemed good enough. There was pain and the need to process that. She had also Post Traumatic Stress from the birth of her daughter. Given that she loved her work and devoted much of her time in the laboratory, the changes that came with being a new mum meant she could not go back to the old self. This brought with it existential angst which was worsened by seeing a younger colleague as a threat as she mirrored her own ambitious side which she could no longer go back to given that her priorities had shifted. Her husband was another challenge and she seemed content with the reassurance that at least he and his parents were dotting on her child and for her that was all she could ask for at the time.

Psychological Approaches: Its always important for me to work on establishing trust and a safe environment at the beginning of my work with someone. Cherry seemed keen to get started although i warned her that there was no easy fix although we could possibly achieve a lot within a time scale of six months. I proposed to use a Psychodynamic approach as my main model because her traumas were linked to her past. We needed to explore her past experiences in order to understand her current behaviours. Cherry was initially sceptical of my proposal. She had come to me requesting Cognitive Behaviour Therapy (CBT) because she had heard the was good evidence for its effectiveness; her work was based on evidence. Up until this crisis (as she described it), she had often dismissed Talk Therapies such as I proposed. However, within minutes of listening to her narrative, I felt that she needed more than CBT.

Sessions: She wanted to take anti-depressants at the same time as having sessions with me and given how she feeling and the panic attacks she was experiencing, I did not think that it was a bad idea. Our sessions revealed a lot of shame that she had not been able to bond with her daughter at birth and perhaps it was the universe punishing her for never wanting a child in the first place. Allowing herself to express her fears at competing at work with a much younger colleague was empowering for her and she felt liberated that all she had to do was her best and to stop comparing herself with others. We also used a lot of CBT Mindfulness exercises to help her stay calm in challenging situations e.g. at work. She was making good progress and after three months she was a lot calmer and able to make links to how some of her cultural influences, fathers expectations and environment had shaped her and the struggles she had with finding her own identity. Her relationship with her husband improved in that she started opening up more and communicating respectfully (without treating him like a child). Together they agreed to change their lifestyles and eat more healthily as well as go out for walks with their daughter.

Outcome: When I last saw Cherry, she was a lot happier and making light jokes of how she was now 100% in favour of Talk Therapy. She was feeling a lot better and being able to communicate better with her husband and although making love had not happened, they were certainly closer and intimate in other ways. She had also reached a decision to change jobs. She had agreed to work from home in her current job and only go to work three days per week. That was helping although her colleague had stopped talking to her altogether. It did not bother her as much as it used to but it was a factor in her decision to seek a different job.