What did the current Psych session mean to pt?

social desirablilty (becoming

Saviour like relationship seeking
described as a more positive
relationship than with others
perfection patient…wanting to do the work, agreeing with reflections/bringing Difficult relationships with MiL and
them to sessions). Male vs female psych? Relating to them better?, seeking
validation, understanding, acknowledgment and reassurance (really appreciative of husband. Acknowledged by
psychology session). Flooding Psych – because they are listening, safe space. A husband, but not sorted. Good
dependency/expectation of session time/day. (maybe something that was a
response from the team i.e., pt taking up their time to talk, burden on team, psych relationship with sister and nieces
sessions became part of engagement plan). Isomorphism relationship with (protective factor). Difficult
therapist – trying to replicate relational patterns with therapist.
relationship with son.

Transference/Therapist Current/other relationships

Using defence (D) compartmentalisation of keeping

Maybe using therapy as way to seek validation, to
have unmet emotional needs met from the past
experiences (p). Sometimes shut of to past
experiences that pt did not want to discuss and
changed the topic (d). Pt felt anxious about past
experiences – a loop often occurred journey
sessions “I feel bad or guilty about what happened”
and surfaced during sessions (a).
relationships in as separate in order to protect or
Triangle of maintain a fantasy relationship with different
Person people on her terms. Feelings from the past echoed
in her current relationships (p). Anxiety (a) of
guilt/shame/blame underpin the current
relationship and stem from the past experience (p).

Past experiences
Sisters illness, parents argued a lot, young carer, previous
admission (inpatient), bereavement, pressure to succeed, sexual
assault, OD (unplanned), house moves, violent/agg behaviours
from husband, emotional abuse from parents (not good
enough)/ not living up to expectations,
miscarriage/hysterectomy.
 Keeping a distance the defence is a reaction to the anxiety.
Changing the subject, dominating Defences (d) potentially learnt from past experiences.
sessions, uninterruptable (mania
symptoms?), bringing items to
steer the session,
compartmentalisation of
relationships, transference of Guilt, paranoia (BP), shame, blame
emotional needs not being met by at fault.
husband/others. Defence Anxiety

Triangle of
Wanting a relationship with parents but wants to push them Conflict Feeling like pt is being treated like a child, may link with the
away at the same time with the feelings being felt; burden (f). impulsive decision around taking an overdose – although no
Potential attachment difficulties still remain as does not feel intention made to end like – potentially seeking some
able to discuss mental health concerns/have an open caregiving from parents (extreme). Moving back in with
relationship, seek emotional support, regulate effectively. parents post discharge symbolic of the child vs parent
relationship even though pt is an adult now – anxiety managing
the feelings and the roles in that relationship.

Feelings
Feeling abandonment, pressured, worried,
shut off, neglected (emotionally), burden, a
disappointment, treated like a child, not
feeling validated. Buys impulsive small items
– unnecessarily.
 Early Experiences
Witness to sisters anorexia treatment hospital/home
parents not picking her up late at night when needed – felt unsafe.
First admission to inpatients at 21 years/open to MH services.
Young carer for sister & parents
Parents argued frequently
Core Beliefs
I am not good enough, my husband/son have/are abandoning me
Something bad will happen to my son/husband (paranoid/BP)

Rules/Assumptions I live by
Must stay married (even though its not working out) because that is what is expected
by my faith/parents.
Critical incidents
Sexual assault when younger
Hysterectomy/miscarriage
“rage” from husband
 Thoughts
• Racing thoughts about husbands
rage
• I feel guilty about what
happened
• I need to do everything to
protect my son

Emotions
• Feeling guilt Behaviours
• Shame • Impulsive behaviours.
• Abandoned • Avoiding topics or domineering
• Holding the blame discussions.
• Fearful • Taken an overdose Hx
• Burden
• Feeling blocked by barriers
(children services) Bodily sensations
• Lethargic,
• Deep depression
• Lack of motivation
• Poor sleep
• Anxious