“Barbra” was a married woman in her 50s with one adult child. She described a loving and supportive marriage, a healthy relationship with her son, an active social life and meaningful work. On the outside, she appeared to have it all together.
She was referred to me by her psychiatrist via the public mental health service after she had 7 presentations to the emergency department in the preceding 12 months presenting intoxicated and suicidal. On multiple occasions, Barbra had taken an intentional overdose of medications. More than once she required medical intervention for this.
Several years prior, her son had a serious drug addiction. Although the family as a whole were able to talk about this time and the impact it had on them, Barbra reported detaching herself from her feelings about this. As it turned out, this was a common thread with how Barbra would cope with a lot of her own distressing experiences.
Barbra had a long history of alcohol abuse since age 14. There were short periods of abstinence throughout her life (for instance, during her pregnancy) but she would always eventually return to her drinking habits
She had experienced sexual abuse from a family member as a child. Incidentally, Barbra’s suicidal thoughts and subsequent attempts began 5 years prior when she was involved in a court case which resulted in the conviction and incarceration of this family member for sexual abuse.
Barbra had completed an outpatient group therapy program around alcohol abuse and had previous individual therapy at the time of the court trial to help her cope with this. Barbra reported she did not find this to be helpful at the time.
Barbra described a lifelong pattern of emotionally distancing from herself. She noted that her husband would point out to her (long before she herself would notice) signs that her mental health was deteriorating. She described feeling vulnerable by her husband noticing this part of her and would pull away and detach from him.
The alcohol was seen as a crutch by her, describing it as “reliable.” Barbra preferred the familiarity of the alcohol to confiding in her husband about her thoughts and feelings (which was unfamiliar to her). Barbra could give out care and support to others, but she had great difficulty with being able to rely on others or open up to them.
During treatment, there was a focus on how Barbra would pull away from the therapist (in much the same way that she would pull away from her husband and others in her life). Focus on this characteristic way of pulling away, led to the emergence of strong feelings inside, which she was helped to feel and work through.
This then led to repressed feelings of anger towards family members who failed to protect her and the man who abused her. Helping Barbra to face these feelings was done in a gradual and progressive manner. In the early stages, rather than notice the experience of anger in her body, she became anxious with tears, nausea and dizziness. This was an indication to take a step back, help bring down her anxiety before going back to working through the emotions that triggered the anxiety. Over time, Barbra was able to feel her feelings with greater intensity, which led to reduction in anxiety, drinking and cessation of suicidality.
At the end of therapy, Barbra had enrolled in a university degree in a field she had always had a passion for. There were nil further admissions to the ED department. She had lost 5kgs and reported increases in self assertiveness, openness with her husband. She was regularly attending alcoholics anonymous.
Barbra reported mixed feelings about the therapy process. On the one hand, it was emotionally taxing and brought up strong feelings inside her. At the same time, it helped her to connect to her husband and son in a more deeper way, helped her feel good about herself and had led to a cessation of wanting to kill herself when she was intoxicated.
Treatment lasted 9 sessions (treatment ended due to my relocation from Qld to Melbourne). I referred Barbra on to a colleague as although we had made some impressive gains throughout a short duration, it is likely she would need further therapy in order for these changes to be enduring and resilient to further stress.
*NB names and certain demographical information has been altered in order to preserve client privacy and confidentiality
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