Depression Chelmsford, Essex
Diagnosis: Depression (client lives with her parents, in late-middle age, in Chelmsford, Essex)
"Jenny" (not her real name) was 29 years of age when she first came to see me for her depression. Quite a shy woman, she came with her mum for moral support. they began by explaining that Jenny had had quite a few therapists, and one or two psychiatrists, but that CBT had not really worked for her and that Jenny had remained depressed since the age of thirteen or fourteen.
Jenny was able to give me a history, and what stood out was that at school Jenny had been consistently and relentlessly bullied for about six years, which had, understandably, left her rather traumatised.
As a consequence, Jenny had developed the idea that home was a "safe place", but that anything outside of the home was dangerous. She had never really built a life outside of her home. With no friends, except one who was really the daughter of one of her mum's friends, a few doors down the road, Jenny had recently got a part-time job, secured for her by her mum, at a hospital just across the road.
Jenny is very quiet and passive and, while at work, where others are being assertive, almost bullying towards her, Jenny's lack of assertion skills or ability to stand up for herself can be extremely problema.
It was clear tht Jenny has, over the years, purposefully made her life very small.
When we looked at her history of therapy, in particular CBT, it became clear that therapy had just not worked for her, partly because Jenny is dyslexic, so standard CBT techniques such as diary cards, thought records, activity schedules, had been challenging (and had confirmed her self-belief that she was "thick" which, in turn, reminded her of the bullying she suffered at school), to the point where she would simply not engage with the therapy. She would give up quite quickly. Followed by a recurrence of her depression.
When in session, I used to hear a long series of sighs whenever I mentioned homework, and in a rather wearisome, self-pitying voice she'd say "I just can't do it".
These avoidance techniques, which existed to sabotage her therapy, would come to the fore whenever I tried to explore her core beliefs, or when looking at activity schedules. Jenny would get tired, or skip sessions, or there'd be more sighing, and it was clear that she arrived at a session only because she'd been dragged there by her mum. Something had to give!
Finally, I decided to park the CBT strategies, take the pressure off and just talk. I got to know her a little more, got to know about her family, and the degree to which her life was completely dependent on her mum and dad.
These talk sessions were difficult and it became clear that there was a deeper belief in operation that caused Jenny to sabotage any real attempts at change.
Ironically, it was my own frustration that was the key to unlocking this impasse, as I challenged her in a direct way,
" Jenny, you're 29. You've told me your mum does your washing. She does your ironing. She takes you to the doctor when you're unwell. True, you go to work, but you don't drive, you've never seen the inside of a bank, you can't use an ATM machine, your Dad takes care of your finances", and detailed all the evidence for her dependency on her parents.
"Have you considered how your life will continue when Mum and Dad are no longer here to look after you?"
Jenny sat bolt upright in her chair, her head stood to attention. She looked at me and then burst into tears.
Being genuine and going with my gut feeling led me to verbalise the single fear she had failed to express in therapy. The one thing she feared the most: being alone and not knowing how she would cope without mum and dad.
She replied, "I've never wanted to think about that. I DON'T want to think about that".
I continued, "but it's inevitable, Jenny. How many years have you been playing out this cycle of going to therapy and then pulling out? I'm sure your mum and dad will be around for a long time to come but, if you don't learn how to be independent and break away from home then what's going to happen to you?"
This proved to be a breakthrough moment in therapy. Jenny had some thinking to do. One day, it would happen. She would be on her own. And she was terrified of this prospect. This was a pivotal moment in our therapy. This one inevitable fact, that she would in all likelihood outlive her parents, was the 'elephant in the room'. For many weeks, once it was out, she could admit it to herself.
This new-found awareness was almost tangible, "I can't live like this anymore. I have to change, don't I?!"
Before we finished the session, she made a commitment to herself that she would apply for her provisional driving licence and book some driving lessons. This would be the first, and symbolic, step towards becoming independent and beginning to look after herself. And, given that up to this point, Jenny wouldn't even leave the house on her own, except to go within two hundred yards of her front door (to see her friend or to go to work), it was a major step, indeed. At least, she figured, if anything happened to my parents, I'd be able to get places I needed to go to.
Her mum and dad were thrilled and amazed, and really encouraged Jenny. This challenge seemed to energise Jenny, and her therapy went from strength to strength. It meant we could use the CBT techniques, and successfully. We also worked on some assertiveness strategies. She began to really embrace the therapy, and the driving. She passed her Theory test in a matter of weeks.
It became clear that all along it had been Jenny's fear of not being able to cope with things that had driven her avoidance and maintained her depression. She could now embrace a little bit of risk. We finished therapy a few months later, her depression had gone.
A few weeks ago I bumped into her and her mum while out shopping. It had been about seven months since I last saw her. She came up to me and gave me a big hug, and told me that, although she'd failed her driving test, she felt sure and was determined to pass next time.
She told me she goes out with friends a bit more, and can't wait until she starts driving (she's looking at cars to buy), she's more independent and there's been no recurrence of her depression.
She's stayed well.