Kathy began the second hour stating she needed me to help her focus because she had had several failed therapies that made her pessimistic about therapy though she wished to feel optimistic. My mind flashed back to her irritability the last hour and how she had been most open when she talked about her wish to grow emotionally. So I asked, "What's gotten in the way of your growth?" To this question she responded with extreme animation, using the metaphor of a puzzle to describe the history of her depression which she had refused to discuss the previous hour.
Her current depression was only the second of her lifetime and was similar to her first depression which had occurred six years previously, following an abortion. Unable to eat or sleep, she lost weight; she felt anxious all the time and shook; she cried without warning. She saw a psychiatrist who prescribed medication and therapy. Although the therapist told her the insights from therapy were important, she felt they were nothing new. The medication helped the symptoms. The depression was striking because before that time her emotions were always steady. In fact, she had been totally stable for 30 years, and suddenly she just fell apart. Ironically, although the emotional instability felt awful, there was also something wonderful about it. She felt vulnerable but also able to make deep emotional connections, previously unavailable to her. It was a very special time. She felt special. She felt attractive in an unusual way - not pretty or unpretty - but able to attract attention almost anywhere she went. And it wasn't that she was, in fact, any more attractive than she'd been before, but more that she was allowing herself to connect emotionally and to feel alive. These connections felt almost electrical. Before that time, when she was steady, stable, and functional, she never focused inwardly as that would be self-indulgent. But at this time she automatically connected to others and focused on those emotional connections 2E This "special time" lasted about 8 months. Then she moved to the Bay Area and returned to focusing on externals again, although never as completely as before. She made a decision to be more stable and functional because she couldn't go on living on what she called a "steep ledge" that felt so dangerous. What was dangerous were the feelings - not the content - but the feelings. She feared she would lose control though she never did. She was able to work a full-time job and be a single mom without ever losing control, but she was just afraid she might fall apart. She felt exhilarated when she was with people, but when she was alone she'd cry and feel lonely all the time. When she returned to her functional self she never lost the crying. To this day she still cries when she hears stories.
By the third hour Kathy appeared more alive. She dressed more lively and seemed less somber and sad. She said she'd thought about my comment regarding crying at joyous events like the Olympics and wanting to share happy times of her children's lives and she was surprised to find it to be true. She said, "I allowed myself the indulgence to think about what triggered my crying and I found it to be happy, joyous times that somehow mark a person's specialness and I linked it to my earlier life in that I probably felt that way about my own life at some point." I commented that she probably wanted her parents to be able to share her joy, achievements and specialness growing up. At this point Kathy explicitly defined her goals for treatment. She described three special times in her life that she called "sunshine times" where she was in the spotlight and felt alive and connected to people and feelings. The first was in adolescence in the sunshine of friends, student government, scholastic excellence, and her first boyfriend. The second occurred in her first year at college (before she met her ex-husband) in the sunshine of politics, journalism, and sports. The third occurred during what she called the "crazy time" after the abortion 6 years ago, when she felt so alive and connected. She claimed proudly, "I want to reclaim the sunshine times without the craziness."
During this first segment of her treatment which lasted six months, Kathy demonstrated a fascinating and complex process which repeated throughout: she would verbally describe what she wanted to do, for example, to allow herself to shine in the spotlight; and then present powerful arguments about why she didn't deserve to do so, and then enact in behavior a refusal to embrace her spot in the sunshine. This initial verbal, goal-setting segment lasted about 4 months and was followed by another two months of arguments and enactments against the setting of these goals. I understood Kathy to be working vigorously to disconfirm her belief that she was undeserving of her goal to feel alive in the spotlight. My task was to help her stay focused on her goals and to help her fight the powerful arguments against that focus. Kathy continually "forgot" this goal and would ask me to keep track of it for her. I responded by sometimes questioning her difficulty focusing on herself, sometimes pointing out how she sacrificed her goals, and sometimes merely summarizing the focus as I understood it. These interventions helped Kathy to experience me as steadfastly interested in her achievements and specialness. Kathy responded by revealing more and more abilities including a talent for writing which she utilized throughout the treatment. I discovered her talent for writing by requesting a copy of some short stories she casually mentioned. My interest in these stories was pivotal in her learning that she did not harm me by demonstrating her talents. Following these interventions, Kathy decided to seek work outside the home and to enroll in a drama class to learn to be more comfortable in the spotlight.