6.)  KP: Can you share a success story that you are particularly proud of?

Natasha: I will talk about a case I had while I was working at a community mental health clinic in California. I worked with a young mother who had been the victim of repeated abuse when she herself was a child; pretty horrific and terrible abuse that she experienced.  She had spoken out when the abuse occurred and her family took the situation very seriously, so she was able to receive treatment as a child.  But throughout her life, all into adulthood, she struggled on and off with self-harming behaviors, depression, feelings of isolation, lack of motivation and suicidal ideation.

Since the birth of her second child, she began cutting herself almost daily and wanted to stop.  She was also having suicidal thoughts daily and was very concerned.  She didn’t want this pattern of a behavior to continue and she wanted to be healthy and stable for her children.  She sought out counseling and we started working together.  As I got to know her she also shared that she was having some conflicts with her husband and while she believed they had a loving relationship, she really struggled to trust him. Her mistrust led to experiencing feelings of jealousy and suspicion that didn’t seem to be based in reality. This was creating conflict and stress in the relationship.

We worked together for a little under a year and initially our work was very focused on decreasing the symptoms of her depression.  She had some deeply formed beliefs about the world and her sense of safety in it; she often felt that others were out to hurt her. I worked on helping her develop coping strategies when she was feeling depressed.  For example, we identified ways to decrease her isolation, as this fed that cycle of feeling depressed.  All of this was all related to her trauma history. We spent a lot of time looking at her belief system about the world and about others.  Through this process, we were able to identify how she viewed all experiences through this particular lens — that people were out to hurt her and that the world was an unsafe place.

She had a hard time focusing attention on any experiences that were in direct contradiction to those deeply held beliefs. I utilized cognitive behavioral therapy (CBT) throughout our work together, as a way to challenge some of her deeply held beliefs.  One CBT tool I used was a thought record, in which we look very closely at some of the automatic thoughts that she had in any given situation.  With this we were able to identify that her automatic response to many situations reflected the belief that people were out to hurt her.  I also used the thought record to track evidence that contradicted these automatic thoughts.  Using this tool, she was able to start identifying and generating more balanced thoughts.

Here’s an example: Let’s say her husband came home 10 minutes late from work and the automatic thought in response to this was “he is sneaking around on me, I can’t trust him, people are out to hurt me.”  We then looked at what evidence there was to support this belief as well as contradict this automatic thought.  Her evidence supporting the automatic thought might be the fact that her husband is 10 minutes late.  The evidence that contradicted her automatic thought was that he came home with a grocery bag full of baby formula and diapers.  Using this structured way of identifying underlying beliefs and finding evidence to support and discount the belief can lead to creating a more balance perspective – that he stopped at the store on the way home and that’s why he’s late.

So, I utilized very structured techniques to work to help her come to a place where she shifted from having the automatic thought of “the world is a horrible place” to the ability to have a more balanced thought response to given situations. I coupled this cognitive work with the development of coping strategies, so that when she was feeling depressed or isolated she would push herself to go for walk with somebody, for example.  I brought some family members in to help support her in that process

We identified other activities to help increase her mood. She was very artistic so she started drawing and journaling. She was able to engage in those activities when she was starting to feel depressed or scared; having a creative outlet would help soothe her and calm her.

So, over time, those two things – the cognitive and behavioral interventions – allowed her to make quite a bit of progress and when we were getting ready to conclude our work together, the level of depression had significantly decreased, she was a happier person than she had been before.  The cutting behavior was significantly reduced in frequency, and the suicidal thoughts had stopped.  She was also thinking about getting some part-time work; when she first started with me, she didn’t think she could handle the stress of a job.  It was a real 180 from the young woman who presented in front of me when we initially started working together. When we concluded our work, she and her boyfriend decided that they wanted to do some couples therapy to continue working on some of the issues that they had; they were interested in having some premarital counseling, so that led to our work ending and transitioning them into couples therapy.

I really felt very good about the work that we did together.  It was a real clear outcome, where she came in with some discreet and serious behaviors, and over the course of time, was able to see a real reduction in those symptoms.

KP: That must have felt really good, to see her actively participate in the work and start turning her life around. Like you said, this woman had a significant trauma history, which sounded really difficult like you said, and that can contribute to a serious depression that’s hard to shift. It sounds like you got her to quite a stable place and then after doing that individual work she was ready to move on to some of the couples pieces. I can attest to how it’s so satisfying as a therapist to see somebody heal and grow.  Thank you for sharing that.

Next Section: 7.) What are the primary treatment approaches you use and how do they help clients?