Therapy notes

On this page, I want to share my journey towards healing through the notes that my therapist sent me after each session. 

14th December 2016

It was good to meet you yesterday. I’m looking forward to working with you to help you to move towards your goals of reducing anxiety, improving sleep, addressing confidence issues, working on reducing procrastination, not slipping back to unhelpful coping strategies (e.g. drinking) and giving you space to discuss relationship issues.

With a view to getting started on working towards your goals, I’ve attached the sleep diary template I spoke about during our consultation. Please complete this over the coming days between now and our next session – next session we’ll use this as a guide to beginning to make some changes to help you to sleep.

22nd December 2016

We discussed the sleep diary homework – this discussion lead to a plan with regard to you making some changes to help to improve sleep over the coming weeks. We discussed keeping the bedroom for just sleep and sex. We also discussed keeping screens (TV, laptop and phones) out of the bedroom, and implementing a consistent going to bed and getting up time – your suggestion was a 7am alarm and bed at 11:30pm.

We also spent time during this session discussing your relationship – your feelings and thoughts about particular situations. If you would like us to so we can continue to put aside some time each session for you to speak about your feelings about your relationship.

Finally we briefly discussed the links between anxiety and a need for control and intolerance for the uncertain. Following from this I have, as promised, attached some reading about uncertainty and worry and anxiety. There are also two exercises – when you’ve completed the reading I would like you to complete the first exercise: ‘manifestations of intolerance to uncertainty’. I think it would be useful to spend some time next session discussing this homework reading and exercise.

6th January 2017 

You spoke about making some changes to your sleep routine: no more Nitol, getting up – not staying in bed during the day and waking earlier. You reported that your sleep was better for these changes.

We also discussed your homework reading and exercise. You identified several ‘manifestations of intolerance of uncertainty’. These included: avoiding sensitive subjects – you confirmed that this not tend to work and avoided problems often get worse; artificial obstacles, e.g. not doing your next kick boxing grading for fear of failure; Procrastinating, e.g. not doing housework, leaving work to the last minute; waiting before resolving conflict; wanting to do it all yourself, e.g. not liking delegating; partially engaging – option to quit, e.g. kick boxing – if I quit there’s certainty; reconsidering decisions already made, e.g. questioning whether choices made about relationships were the right choice; seeking reassurance, e.g. asking if boyfriend loves you; overprotecting, e.g. thinking the worst when people are late and telling partner how to run his business.

 For homework we agreed that you would try out the behaviour change exercise on the last page of the reading I sent last week (also attached to this email). Some behaviours you suggested you might try included: attending kick-boxing class; returning texts and calls to friends and meet for coffee; stopping asking your boyfriend for reassurance – to help with this final behaviour change I suggested questioning whether demanding reassurance is helping you? Whether you’re getting the answers and reassurance you want? Is asking contributing to any negative feelings (e.g. feeling low or anxious)? I have also attached some further reading about worry and anxiety that I thought might find interesting – if you would like we can discuss this further during our session.

12th January 2017

We spoke briefly about your behaviour change homework – you had begun work on this by contacting friends – returning their calls. Please continue to work on this over the coming week, using the form I sent last week and maybe including another behaviour change.

As a result of our conversation this week, I agreed to send some reading for you to have a look at over the coming days. I’ve also attached some brief reading about anger: healthy and unhealthy anger and the associated thinking and behavioural consequences of these different types of anger. Also as promised here is a link to a brief (7 minute) clip of Albert Ellis speaking about ‘unconditional acceptance’ – I’d like to know your thoughts about this idea: https://www.youtube.com/watch?v=3tZnQvgFZms

We can discuss the reading, listening and behaviour change work that you complete over the coming days when we next meet. I also think it might be useful to complete some more formal CBT work regarding relationships. With this in mind I’d like you to come to session with a specific situation in mind (it can be a recent situation, but doesn’t have to be) that you would like to explore further, when you felt distressed and that this distress was triggered by relationship problems.

21st January 2017 

We discussed your sleeping – you identified a lot of good changes you’d implemented to improve your environment and other interventions such as not staying in bed that this had all lead to better sleep.

 We also spoke about your relationship. You identified a situation in which you’d felt angry. We also discussed what you’re getting from the relationship and asked the question: what advice would you give to your son or a friend who found themselves in a similar relationship? Following from this conversation I suggested that it might e useful to complete a ‘costs / benefits analysis’, that is a more detailed pros and cons list, comparing two situations: 1) staying in the relationship, 2) ending the relationship. With this in mind, I’ve attached a blank ‘costs / benefits analysis’ form.

We also spoke a little about ‘passive aggression’, e.g. retaliating when he stays out, by going out with the purpose of causing worry – you recognised that this is an expression of unhealthy (and ultimately likely to lead to more distress to yourself, e.g. ‘I felt stupid’) anger. This conversation lead to brief discussion about the function that you see in worrying, e.g. having always worried, that it shows you’re doing something and it’s protective – to you and your children. Following from this I’d like you to have a look at the ‘function of worry’ document attached – we can discuss this further next session.

Finally we discussed you continuing to work on the behaviour change exercises (see ‘manifestations of intolerance of anxiety’ that I sent over a couple of weeks ago, if you need a reminder of this exercise). You’d already made a start on this by getting back in contact with friends. We suggested that you arranging to see your friends when your partner is not busy as a possible behaviour to with which to experiment – to predict how you’d feel, experience any anxiety and see how long this takes to pass and whether it is as you predict.

28th January 2017

We discussed your homework reading about worry – you concluded that you saw functions of worry as: showing care, protecting and preparing for when something goes wrong and you identified as being a worrier. We spoke about you re-reading the function of worry reading – I’ve attached this again. I’ve also attached some reading about problem orientation and solving – this begins to explore some alternatives to worry. There are two exercises with this reading, the first to list recurring problems, the second is finding resolution to a problem – this will be a lot to do over this week, so please look at the reading and if you have time you can begin to work on the exercises, alternatively we can discuss the reading next session and you can work on the exercises over the coming weeks.

 We also discussed a situation when you felt angry about your partner being dishonest and breaking promises. We identified a core belief that is a strongly held belief that you hold with regard to keeping promises, that if somebody says they will do something, they should do it, they should keep promises, as this is something that you would do. I’d like to return to this next time – to see if there’s a less distressing alternative for you, for example rather than: ‘he should keep promises, as I would’, ‘I would like him to keep promises as I would, but understand this does not mean he must do as I would like’. I’d like you thoughts about these two alternative approaches and the impact each would be likely to have on how you feel, think and behave.

 We also spoke about the costs / benefits analysis that you had completed – you identified that this had been a way of discussing with your partner how you feel without arguing. You concluded that the in your mind the costs of staying outweighed the benefits. I drew a parallel between what’s happening and an abusive relationship, for example behaving aggressively, then being very apologetic and making promises for a time, then slipping back to aggressive behaviour and continuing this cycle.

 We also discussed you stepping back from doing lots of things for your partner – allowing him to take responsibility: for example cooking his food, his tax return – and how stepping back might in the short term be a cause for anxiety, that in the long term it would be likely to help you to practise tolerating not being in control and be helpful in reducing anxiety. We also discussed other behaviour change homework that you wanted to continue with: going out with you friends, even when your partner’s not busy, and attending kick boxing.

3rd February 2017

You spoke about your relationship and about being busy at work. We also spoke about your homework of taking a step back from doing things for others. You reported some success in this. I’d suggest you keep up these behaviour changes, as although there might be a short term increase in anxiety when letting go and not being so protective, in the long term being able to tolerate the uncertainty, letting go of need to be in control of these activities, will be likely to both give you more time (as others’ become more able to do tasks for themselves) and lead to a decrease in anxiety.

 We also spoke about sleep – this is an area where you reported lots positive changes and improvement, but that anxiety and worry still sometimes lead to sleep problems. We discussed a couple of things that you can do to help. The first was to limit procrastination (and subsequent anxiety about the task not being completed) when faced with not very interesting tasks, for example work paperwork. One way to approach this might be to use the costs / benefits approach you used previously – this time looking at the long and short term costs and benefits of completing a boring (but necessary) task – I would hypothesise that there are likely to be short term benefits (i.e. not doing the boring task), but that these are likely to be outweighed but the short and long term costs (e.g. anxiety). I’ve attached another costs / benefits form for you to use if you would like to. We also discussed keeping a pen and paper by your bed so if anxiety about tasks ahead is keeping you awake you can make a note of the actions you need to do, freeing you from having to hold this information in your memory. Finally, I’ve attached a relaxation exercise (‘safe place’ attachment) that you might find helpful to do just before sleeping.

We also discussed your ongoing behaviour change homework. You reported continuing success in maintaining and rebuilding links to your friends. I’d like you to consider whether you would like to go further with this this week by seeing your friends when your partner’s not busy. Also whether you would like to go back to your kickboxing class.

 Finally we spoke briefly about the progress you feel you’ve made. You identified feeling like you’ve made progress since the summer when you were feeling very low. You also identified progress in stepping away more for overprotecting. You also spoke about realising that you cannot expect others to always react in the same way that you do. Following from this we spoke a little about demands versus preferences (rather than the demand ‘they must…’, the strongly held preference ‘I would strongly prefer that they…but this does not mean that they must’) how preferences allow for reality, that others do not have to do what we ask, and therefore lead to less distress when others don’t do what you’d like them to – we can return to this idea again in future sessions. We also agreed that we would have a review session next week, allowing you to bring together what you’ve taken from sessions so far and for us to review your therapy goals.

10th February 2017

You spoke about feeling that you’d made progress – that you felt happy, free and strong. You identified seeing your friends, therapy sessions and looking at costs / benefits with you friends as helping you to feel strong. You also spoke about an old letter that you wrote to your partner that showed a very different you to now – you described the letter as pathetic and submissive and described yourself now as much stronger than the you who wrote the letter.

As agreed, over the coming days I’d like you to have a look over your previous notes and reading and consider these review questions:-

1) What useful ideas and techniques have you taken from therapy?

2) What goals do you have for the next few months? (these can be practical (e.g. visiting family, seeing friends more), or emotional (e.g. continuing to work on reducing anxiety and improving confidence).

3) What situations might trigger a lapse or relapse?

4) What would the signs be that you’re slipping back?

5) What will do if you notice these signs?

6) What are you going to keep doing to maintain the progress you’ve made?

Please note any thoughts you have or answers to these questions. We can discuss them further, and address any questions that you have about them, next session.

16th February 2017

You spoke about your relationship, that you were giving things a week to improve. You identified some of the things you feel you need (and do not need) from a relationship: boundaries around work – time for your relationship, companionship, no aggressive behaviour, no points scoring (no passive aggression), consideration and consultation before decisions are made. We discussed whether it’s ever your job to ‘fix’ somebody else’s problems – you identified that although you would like to, that for change to happen the other needs to recognise and admit to their own problems and have a desire to change themselves.

We also briefly spoke about the ‘review’ questions I sent over. You identified useful ideas and techniques: improvements to sleep routine, e.g. not spending time on bed outside of sleeping hours; looking at pros and cons of situations – the ‘costs / benefits analysis’ form; letting go of doing so much for others. You identified your goal as making a final decision about your relationship. You identified a possible trigger to slipping back as a situation with your relationship. You identified a sign that you’re slipping as feeling anxiety. Finally you identified several ways you’ll maintain your progress: keeping up sleep habits, keep seeing your friends, keep up your organisation and problem solving at work, keep backing away from doing too much for others, building relationships with your children.

Finally we discussed a task for you to think about over the coming days: similar to the costs / benefits, to consider what you’re getting from your relationship versus what it’s costing you. It might also be useful to have another look over the review questions again, to see if there’s anything you’d add.

25th February 2017

After many more rows with my partner, I have decided to end my relationship. I was wondering if you had a free appointment Monday morning as I will need some support. I would like to thank you for the advice you have given me so far.

13th March 2017

You spoke about your relationship. You spoke about recognising that during your relationship your self-doubt had increased leading to increased anxiety. You also identified feeling angry that you had given two years to the relationship.

I suggested that you give some focus to your goals. You identified several goals including: travelling, going out, re-doing your house, using a personal shopper, starting a course, reading, phasing out the relationship and enjoying freedom. I’d suggest that you also think about your goals with regard to therapy – what you would like to work on or get from future sessions.

We also discussed including some self-care activities to add to your daily routine. Activities we identified included: eating properly (e.g. three balanced meals per day), refreshing your wardrobe, seeing friends, exercising for 30 minutes / day, limiting drinking alcohol to social situations, stopping checking on him. I’ve attached an activity planner that, if you would like, you can use to plan these activities.

I also suggested that you might like to use another costs / benefits (form attached) to break down the costs and benefits of keeping in contact with him.

29th March 2017

You spoke about you relationship with your ex-partner. You identified that more things were now making sense and that you could see that his behaviour is not your fault. You also identified that stopping contact with him would be a good approach for you and would allow you to focus on yourself.

You identified an increased ability to feel relaxed and enjoy being with your family and seeing your friends. However you also identified drinking more than previously and more than you’d like to be. As promised I’ve attached a link to an app that you might useful – it’s called ‘drinkaware’ and is a way of tracking how much your drinking, whether the level at which you’re drinking is posing a health risk and some tips to reduce:- https://www.drinkaware.co.uk/tools/app/

I’ve also attached an activity planner for you to complete over the next week. We discussed possible things to include, these were: kickboxing classes, lesson prep, seeing friends, sleep routine (e.g. regular bed time), a couple of drink free days, cooking with your son, and going out for dinner with your kids.

We also spoke about your goals. You identified the following goals: drinking less; continuing your exercise plan; starting a hobby at home; increasing tolerance for boredom; being ok with being on your own; reducing time spent rocking on your bed; working on anxiety and its triggers and improving sleep. We’ll continue to focus on these goals during the coming sessions – as agreed we’ll shift the focus to being primarily on you and your goals for the future.

I’ve also attached a brief guide to anxiety and what maintains it. I think you’ll already be aware of some of this information. However I’d like you to have a read and begin to consider what safety behaviours you tend to employ when you’re feeling anxious? For example, I suspect that rocking to soothe yourself has become a safety behaviour.

7th April 2017

As promised I’ve attached some reading about trauma and instruction on how to go about starting this work by writing an impact statement (impact statement). I’ve attached an explanation of what happens in the body when we experience anxiety (threat system); how PTSD can affect the brain – particularly memory (PTSD and memory); some information about ‘stuck points’, that is negative beliefs that can lead to distressing thoughts and problem behaviours); some reading about what can happen when events don’t fit with our beliefs (Cognitive theory).The examples in the ‘cpt manual’ trauma work refer to trauma following military service, however please don’t let this put you off as this method of trauma focused therapy is entirely applicable for any traumatic event.

We also agreed that next session we would bring the focus to you. You identified a few goals: being OK with being on your own; working on your boundaries in relationships; reducing drinking. The first goal we agreed it would be useful to begin to address is working on the trauma you experienced as a child – to begin to process what happened and put it behind you. The reading and impact statement exercise I’ve attached will be the beginning of this work. We can continue this work further during our next session.

19th April 2017

You spoke about seeing your ex and looking at his Instagram. You identified that it would be of benefit to you to not see him or check his Instagram. We discussed one possible thing to do is question the impact of seeing him / looking at him online: what impact does it have on you? Is it helpful to you?

5th May 2017

You spoke about your relationship with your ex-partner and about speaking to the police for advice. You identified that you found it nice to be believed by the police. You also spoke about checking social media and wanting to see your ex-partner. Please continue to question the impact that checking his social media is having you. Please also consider the content that he’s likely to post and whether you’re likely to see his failures or his edited highlights.

You also spoke about wanting to reduce your drinking. You identified feeling worse the day after drinking and also associated drinking more than previously to being a ‘victim’: ‘drowning my sorrows’. You suggested that limiting drinking to social situations would be a good way to reduce drinking this and that after completing your tooth whitening would be a good time for you to begin.

18th May 2017

We spoke about your focus on your log and reading about narcissism. I questioned what effect on you that this focus is having. You identified the positive effects of it helping you to understand that the problem was not you and that your blog was giving you a voice and a connection with others. You also identified some negative effects of this focus including it holding you back and your reading becoming too focused on this subject. We also briefly discussed checking social media. You identified that checking always has a negative effect on you.

We also spoke about supplements for mood that can be of help, as promised I’ve attached an information sheet about these.

Also with regard to improving sleep, spoke about a ‘grounding’ technique that I suggested you try when you feel restless and uncomfortable – the times when you would previously have moved in bed to calm and comfort yourself. I’ve attached two versions of this exercise – one written and one sound clip. Please use whichever you feel happiest to follow and try out this technique over the coming weeks.

Finally, we spoke about the importance of keeping up good self-care: ensuring that you include getting outside each day – even if just for a brief walk. If possible making this walk in the morning will be likely to be of most benefit to both improved mood and sleep. Also ensuring that you’re eating regular healthy meals and snacks. Planning some exercise. Seeing friends and family. I suggested planning these activities ahead of time can be a good way to stay motivated. You also suggested that writing about the importance of self-care in your blog might be another good motivator for you.

3rd June 2017

You used some of the session to speak about your feelings about and action that you’re taking with regard to your ex-partner.

You identified sleeping well after having a bath with Epsom salts. You also spoke about getting back to spending less time in bed when not sleeping – this is a really positive move as it means you associate bed with rest and sleep, not other activity. You also spoke about starting running – here’s a link to the ‘couch to  5K’ programme – it’s a great, easy to follow and stick with plan: http://www.nhs.uk/LiveWell/c25k/Pages/couch-to-5k.aspx

You also spoke again about your next blog being about ‘self-care / ‘spring cleaning’ and being ‘better not bitter’.

We also spoke the ‘light stream grounding’ exercise. You were not keen on this exercise, so we practised an alternative version of grounding in session. I’ve attached some instructions on how to go about
grounding – please try this when you feel distressed, restless and like ‘dancing’ over the coming days.

Finally, at the end of session you spoke about continuing to check your ex-partner’s social media and that this was having a negative impact on you. I’ve attached a costs / benefits form with headings: Continue to check his social media versus Do not check his social media. I think completing this could help to provide you with further evidence – that you can look back at when you’re tempted to check – about the impact that checking his social media is having on you.

16th June 2017

You used the beginning of the session to speak about hearing some distressing news about your niece. Please be mindful of any impact that this might be having on you – if you feel you need to speak about this more we can make time during our next session.

You also spoke about making a lot of positive changes as a result of illness. Following from this we spoke a little about the negative impact of worrying. As promised, I’ve attached some (revision) reading for you to have look at: ‘intolerance of uncertainty handout’. Please have a look at the example on the first page.

You also used some of the session to speak about the positive impact that writing your blog is having. We also spoke about focusing on self-care and recovery in your blog posts to help to keep you motivated.

You also spoke about making a ‘bucket list’ – a list of goals – things you’d like to do. Please continue with this over the coming weeks.

Finally you spoke about checking your ex-partner’s social media we discussed this maybe being a good time to stop and draw a line under this, as it appeared things were not going well for him: you’d seen a lack of posts about his competition, suggesting that he’d not done well.

3rd July 2017

You used some of the session to speak about your relationship with your ex-partner. You identified that being in contact and seeing him again had strengthened your conviction to not restart this relationship.We also briefly discussed what you might tell a friend or family member if they were in the same position as you.

We also discussed beginning a problems and goals list to help you to have some focus on yourself – on what you would like to work towards. With this in mind, I’ve attached the list we started in session. Please have look at this and add to it. We can then use this as a guide as to what you would like to work on in future sessions.

During session I also spoke about a book that provides a good introduction to mindfulness practice: ‘mindfulness for beginners’ by Jon Kabat-Zinn. Another good mindfulness resource is the ‘Headspace’ app.

Finally we spoke about what can hold one back following a loss (e.g loss of a relationship). We spoke about longing – how longing for what is gone or past (and, in the case of looking back through ‘rose tinted’ spectacles, what never was) can be a block to moving on with life.