Therapy in a Nutshell: For Overthinking, Indecision & Procrastination

Presenting Issues

Sana* recently started her first job after graduation and was also going through some changes in one of her closest friendships – she reached out for a session (her first in over 3 years) in hopes of receiving some additional support considering these transitions.

Background Information

In the intake session, they presented with symptoms of anxiety in relation to their relationship with a very close friend, whom they were also intermittently romantic with. They mentioned a need to figure out how to be themselves without completely pulling away from others, even as they said they’ve found it very difficult to break up, or even take some space away with their friend/romantic partner. They seemed to keep getting ‘stuck’ at certain points in life, around which certain depressive symptoms and impulses were observed as well (like ‘overthinking’, ruminations, felt indecisiveness and related procrastination particularly felt when in relationship, low mood, self-blame and subsequent guilt). They further mentioned their childhood experiences of having to seemingly single-handedly take care of their father and younger brother (which continues to be their situation currently as well).

Assessment

Sana appeared to be feeling stuck within her own trauma responses, which likely built up to help her survive despite experiencing possibly traumatizing situations from a very young age. Various likely maladaptive coping strategies may be present, working on which they may be likely to move towards the resolution of their trauma.

Treatment Plan

Goals

1. Sana’s goals involved wanting to work towards a more secure sense of Self, while seeking support for her most present concerns as and when they came up.

Intervention Strategies

1. Grounding techniques were found to be helpful when working with overwhelm experienced within the session at different points (such as when talking about something distressing or traumatising).
2. Usage of cognitive-behavioural techniques mixed in, based on the client’s preferences and past affinity to specifically help in working with a few ‘rigid’ beliefs and expectations around how the world ‘should’ be, and how they themselves ‘should’ be in retaliation or in response to it.

Frequency and Duration

Restarting bi-weekly sessions after a 3 year break in therapy.

Results

1. Sana took some time re-establishing her rapport with the therapist, a period supported by psycho-education from the latter’s side about what their approach looks like presently.
2. In various sessions, she chose to reflect on her ability to make sustainable connection with herself and with others by way of situations that were coming up for her naturally.
3. Grounding and other somatic work involved helped her feel more comfort in her own body and decisions, thus allowing her to slowly expand on how she shows up for herself as an alternative to relying only on her thoughts for comfort.
4. Use of trauma-focused modalities (like Somatic Experiencing, or SE^TM) allowed for us to work with the stuck-ness of the conditioned roles the client was exhibiting (even when she didn’t ‘need’ to) that are seen commonly within adults that grow up from ‘parentified’ childhoods.
5. They are over time, learning how to ‘reparent’ themselves, as they learn more about their own needs, boundaries and abilities in the here and now. As they do so, it becomes more possible to also feel more of their own choices (including a sense of natural clarity about the choices that fit best for them in current situations), so making decision-making a lot less burdensome.
6. Thoughts and actions that were earlier felt as though ‘too much’, as a result, became easier to work with, even feeling like allies in time.