Therapy in a Nutshell: For Assertiveness & Boundary-Making

Presenting Issues

Isha* reached out with overwhelm, crying outbursts, and a general need for support around the break up of her engagement, which she initiated owing to perceived differences between her biological family and the one she was marrying into. She mentioned some of her past history of intimate relationships, how she chose to remain in touch with her ex-fiance, and hopes they can still work out their relationship albeit differently, and needed help with this effort in therapy.

Background Information

In the intake session, she mentioned that her relationships and her Self seem a bit ‘messed up’ sometimes, as she grew in a house with parents whose relationship often seemed strained and sometimes became violent. She mentioned feeling like one of her roles within the family growing up was to mediate between the two. She reported feeling a bit stuck now, between her mother’s and her partner’s (and his family’s) wishes, while she relocates to another country due to a valued work opportunity.

Assessment

The client appeared to show tendencies of an ‘anxious/avoidant’ attachment style in the intake session. This further seemed to impact their ability to show up authentically in relationship (with the Self, or with others) at work and otherwise. A few major life transitions also seemed to be kicking up dust and adding to overall distress and discomfort; however, the client seemed quite open to working on themselves at the same time.

Treatment Plan

Goals

1. Isha chose to work with the ‘stuckness’ she spoke of, by way of working with her sense of self and body awareness of her boundaries, realizing her own needs and the pathways to help achieve them, learning to work with the different emotions and parts of her that showed signs of stuckness and possible internal conflict along the way, and finally, continuing to make decisions based off of this heightened awareness of her now more authentic Self.

Intervention Strategies

1. Slowly and deliberately incorporating various grounding and orientation techniques to help the client feel more present and regulated within each session.
2. An eclectic mix of Somatic and Nature-based techniques allowed for plenty of room, resources, patience and persistence for all of Isha’s Self to safely arrive and to build upon itself.
3. This sort of work tends to follow the client’s lead (making it client-centred), so their natural responses can show up to aid in their recovery and most importantly, their empowerment.
4. Psycho-education about these responses was also paired so the client wouldn’t inadvertently repress or suppress them (for example, to one’s response to clamp down on tears, the therapist is likely to gently remind them that such responses are likely a form of nervous system ‘release’, which needs to be supported by us instead of being put down). We hope, in this way, to learn to be more assertive about our choices by making allowances for our bodies in such a manner.

Frequency and Duration

Weekly therapy sessions for 9 months, and continuing.

Results

1. The distress around sudden changes initiated was first worked with, as it related to a very immediate sense of overwhelm. Even as these changes were initiated by the client themselves, they were still sudden enough to their nervous system.
2. Isha over time came steadily into her own needs and thus was able to add some definition to her sense of Self, which without this anchor, had been feeling more insecure and unworthy of attention, appreciation, and love.
3. She continues to work on her relationship with her partner and her mom to figure out the boundaries she wishes to keep with both of them. Many choices in this time have been made assertively since, while making efforts to be in genuine connection with both of these relationships.
4. Ongoing efforts are additionally being directed at understanding how much, or what effort is likely to be ‘enough’ in these situations.