You don’t need to go it alone    

Oliver came to 14 weekly sessions.  The psychologist helped Oliver learn about how fear works in our bodies and minds.  They talked about threats and how different types of threat can be misunderstood. Oliver was helped to try out experiments in the dark, with his family and alone, in and out of his home, in a safe way.  This helped Oliver to stop avoiding the dark and learn to manage his uncomfortable feelings, work out whether a threat was small or big and discover which new behaviours, thoughts and activities worked best for him to overcome his fear.

When relevant examples came up at school, Oliver was helped to notice that his feelings of embarrassment were completely normal and that he sometimes set too high goals for himself, goals that no person could expect to achieve all the time.  

Oliver learned that he often made unhelpful assumptions about what teachers may think about him or their behaviour.  He was encouraged to think with the psychologist about how he might go about finding out what the teachers thought and come up with other more helpful reasons for their behaviour.  Oliver was also helped to understand why he was frequently looking to others for approval and instead lower his distress by trying out helpful self-talk.  Self- talk is often used to remind ourselves that we are doing well and are going to be fine even when others do not say so or seem to notice.

When therapy came to an end Oliver said 'I can learn new skills, and manage fears'.  He explained ‘my fear of dark and getting up in the night isn’t as hard anymore’.  Oliver rated his fear at the end of therapy at 2.5/10 (where ten equals worst fear) instead of 10/10 when talking therapy started.  

He went on to explain ‘I took a break from getting my homework done on the same day yesterday…less pressure…I didn’t worry about my rule of getting homework done in one day even when it is not due to the following week…I have learnt that I can take breaks sometimes’.

Penny attended 16 weekly sessions in which she revealed she had begun to self-harm.  Past and present factors influencing Penny’s mood were identified and where they were unhelpful, challenged.

New strategies for managing severe upset and high emotions were introduced and practiced in-between sessions.  Penny was helped to develop a more compassionate view of herself, reduce her constant comparison to others and reintroduce pleasurable activities.

Over the latter part of therapy, Penny reported that she had started attending a drama class which she was enjoying and she had made new friends.  Penny also proudly reported she had not cut herself for over three weeks and didn’t intend to do so again.  

In a follow-up session, six months after initial therapy had ended, Penny explained she had only cut herself on one occasion and was currently three and half months free of self-harm.  Together we discussed how setbacks are normal and refreshed helpful strategies for preventing and managing any unhelpful urges and relapses.

...her family. 

Several therapeutic approaches were discussed including an option to focus on the trauma. Yasmin decided she would prefer to work directly on the pain and impact of chronic illness and remain open to developing a better understanding of how the trauma may be contributing to these.  Yasmin attended 10 weekly sessions in which she was helped to apply Mindfulness for Health and Pain.

Yasmin learned about Mindfulness and how to observe herself and thoughts without judgement.  She learnt about being in the present moment rather than always thinking about the past or worrying about the future.  Yasmin was helped to use breathing and other Mindfulness techniques to move forward in line her goals despite the presence of pain and presence of uncomfortable physical sensations and feelings.  Yasmin completed mindful and behavioural exposure based home practice exercises about her body which helped her to like and trust her body again. 

Once Yasmin felt safe and gained positive experiences from the therapy such as for the first time in years being able to exercise without pain taking over, her confidence in therapy and the approach increased.   A discussion about the trauma and the meaning she applied to it, was reopened.  Using a Compassion Focussed Therapy approach, the psychologist helped Yasmin explore her thoughts about trusting and connecting with others and her ability to keep herself safe.  Yasmin began developing a compassionate voice for herself about the trauma she had experienced and her health. 

Towards the end of therapy Yasmin shared she had begun to date again. She said she still felt anxious about starting a sexual relationship though nowhere near as scared as she had done before therapy, when she had avoided it altogether.  Yasmin learned and practiced where to put her attention as her relationship became more intimate and developed a plan for managing any setbacks.

The home practice activities were shared with Linda who supported him to complete the activities, reinforced the key learning points raised and modelled the new strategies in between sessions so Joe could see how they worked for others as well as experience them himself.  The regular in-between session email contact and reviews with both Joe and Linda ensured progress and pace met agreed expectations.  Joe’s confidentiality was maintained by prior agreement being obtained for any shared information between Joe and Linda.

Five weeks after transitioning to his new school, Linda contacted their psychologist with great news: Joe was doing very well.  He had expanded his friendship group and received badges for excellent performance.

Joe said, ‘the confidence boost was most helpful, I think I have started to cope’. Linda reported that ‘He rarely calls me now after school because he’s scared’ and ‘this is the area in which Joe has improved the most’.  She also explained that ‘Joe is calmer and has made wise choices about people and things to spend his time with’.  The therapy ‘has definitely helped and benefited Joe’.

... was not his fault as it means that the brain had not yet processed the difficult memory. He also learned that the low mood, difficulties in relationships, drinking more alcohol, sleep difficulties and anxiety could all be helped by facing the difficult memories together with his psychologist.

In order for the brain to begin processing the memory, together they revisited the difficult events by talking through them in detail, and although this was difficult Dave felt relieved to have shared them with someone. They were able to consider any thoughts and feelings that happened back then that may be making it difficult to accept or come to terms with. After a few weeks Dave noticed that his sleep was improved, and his nightmares had reduced. This was because his brain has begun processing the traumatic memory.

By the end of the 12 weeks, Dave was able to live his life more, without fearing flashbacks and bedtime. The memory felt as though it was in the past and so he could focus more on his work and family again.

I didn’t think I would ever get back the life I lost in Afghanistan. I feel like me again and I look forward to the future. Although the sessions were testing and it was so hard to spend time thinking about what happened, it was worth it now. I can find it hard to let my walls down but Claire didn’t judge me for getting upset and was understanding every step of the way.

...understanding of the anxiety. Sophie’s grandmother who had lived with them had passed away the previous year quite unexpectedly. As sessions continued, Sophie and her mum were able to learn that the anxiety may be linked with the fear of losing another person that is important to her. Sophie began to learn the checking behaviours and night time, mantras and rituals, were all ‘safety behaviours’ to help her keep her anxiety at bay. However, it meant they were actually reinforcing the anxiety as she never got to learn that she can manage the anxiety without the behaviours, and that nothing bad was likely to happen if she didn’t engage in her safety behaviours.

Together with the psychologist Sophie and her mum made a plan to test out whether Sophie’s beliefs that if she didn’t do her rituals at bed time, something bad would happen. They started small and built up until Sophie realised that she didn’t need to do these anymore to feel safe. By session 10, Sophie was sleeping better without her parent’s bedroom door open and without engaging in her rituals.

Sophie and the psychologist also spent some time thinking about the loss of her grandmother and how this was so difficult for the family. Sophie did some activities to help her to say goodbye to grandmother, as this was not something she could do in person.