Therapy in a Nutshell: For Overwhelm and Dissociation

Presenting Issues

Kartik* sought therapy after recently having experienced a severely manic episode, and came into their intake session with a lot of overwhelm, which made it difficult for them to keep track of their recovery at first.

Background Information

In the intake session, they mentioned having received their fourth clinical diagnosis recently after an episode a few months prior, of which they had little to no memory. They felt extremely distressed by the seemingly sudden onset of symptoms, and that their current personality was extremely withdrawn and different from before.

Assessment

In the intake session, Kartik appeared extremely distressed and overwhelmed, over a wish to act and feel in a way that would take them back to a certain level of functionality (that they held in the recent past), and over the fact that because they weren’t able to get to said level by themselves. The latter seemed to lead to a deep sense of grief over seemingly having ‘lost’ themselves.

Treatment Plan

Goals

1. Kartik chose to work with the very present physical/physiological concerns of overwhelm, the felt memory deficits, and most importantly, the perceived differences seen in their personality over a seemingly short period of time.

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. 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 surrounding what their recovery ‘should’ look like.

Frequency and Duration

Weekly therapy sessions for the first 4-5 months, then bi-weekly session work for 3 months before choosing to take a break.

Results

1. Going from feeling disconnected within the body for most of the session period at the beginning of therapy work, Kartik was very slowly, and for progressively increasing periods of session time, able to stay more present and feel less overwhelmed.
2. An important shift occurred after exploration and discussion of their support system(s) - what was absent, what was present, and in which directions they would prefer to be supported differently from what was accessible currently
3. This prompted Kartik to take some time to themselves, assess their support system, and come back into therapy on a bi-weekly basis. In session, they continue to play around with how therapy could help them, and which therapeutic resources are likely to complement that work to bring out more of self-awareness, comfort and resilience.