The names and details of the people described below have been changed to ensure that they are unrecognizable. However, their problems and treatments remain true to life.
Sarah and David have been chosen because they illustrate how psychological treatment can be extremely beneficial both to people who have only recently developed a difficulty, as well as to people who have had difficulties for much of their lives.

The central point about this type of therapy is that it focuses at first, on helping each individual to reach an understanding of what has caused their difficulties, as well as what has prevented them from feeling better. The second part of therapy then concentrates on using that understanding to help develop strategies for creating lasting improvements.
Understanding your problems, and developing solutions to suit you, puts you in control of your own situation and ensures that you have a set of unique, tailor made skills to use throughout your future, well after therapy has ended.

Sarah felt extremely anxious around other people. This started two years ago when a group of friends had laughed at her for making a comment they thought of as silly. She felt hurt and self conscious at the time and ran out of the room in shame.

Days later, Sarah began to feel panic stricken whenever she was in a position where she was expected to talk to other people, especially, people she knew. Meetings at work, social gatherings, and trips to the supermarket or video store became very difficult and she began to avoid them. The more she avoided each situation, the more terrified she became. Sarah described her heart pounding, a shortness of breath, becoming flushed and hot, and tight in the chest, and an overwhelming sense of panic, and desire to run away.
Sarah’s friends and colleagues began to notice that something was wrong. Sarah’s biggest fear was that her friends might see her reaction and think she was ‘odd’ and a ‘non coper’. Her relationships and her career began to suffer. Sarah’s self esteem hit ‘rock bottom’ because she blamed herself for feeling afraid.

Sarah’s treatment lasted twelve sessions. She learned firstly that she was caught in a vicious cycle which with practice, some physical techniques and some thinking strategies, she could escape from. She quickly developed some skills in relaxing her body, so that she could control her symptoms effectively. Once she had learned the technique of reversing her body’s response to feeling anxious, she felt more confident to approach situations because she believed that she had more control over ‘looking silly’. In the second phase of treatment, Sarah began a programme of allowing herself to attend a short meeting, go to the supermarket etc. She slowly rebuilt those aspects of her life which she had avoided for so many months. Sarah’s mood lifted and her self esteem improved.

David became extremely depressed and suicidal when his wife left him for another man. However, it became clear that David had also experienced several other times in his life when he had become extremely depressed, even in childhood. The depression which haunted him, had played a role in the breakdown of two significant relationships because his partners had found it difficult to live with.

David was asked to read a self-help book from the recommended book list on this website. He read this over the first month and also received weekly therapy sessions. David began to understand that his depression was partly caused by negative beliefs or ‘sneaking suspicions’ about himself which had begun very early on in childhood. He learned to look at these beliefs in detail and to challenge their validity.

The next phase of treatment helped him to notice that the way he lived his life, in particular, the way he tried to make up for feeling bad about himself, also played a role in causing and maintaining his depression. For example, David believed that he was unattractive and stupid. Although he believed this, it was very clear to me that his belief was incorrect. However, because he believed it, one of his responses in life was to try to ensure that other people would like him despite his perceived faults, by acting ‘the underdog’. David described how he always tried to help people but that he tended to do this to the detriment of himself. He noticed that other people often tended to abuse his kindness and in the end they tended to treat him badly, leaving him feeling worse about himself and more convinced that his beliefs about himself were true.

The majority of treatment involved providing David with a detailed ‘map’ of each of the patterns that he tended to use in his life, which although understandable, were in fact leading him to feel worse and enabling other people to treat him poorly. David then began to work on each of these patterns by setting himself weekly, achievable goals to change his patterns of behaviour through careful small steps.
At the end of therapy, David was no longer currently depressed but he had also been able to challenge his long standing feelings of low self esteem which were based on his negative and unfair beliefs about himself. David’s improved sense of self esteem should help to prevent him from suffering another period of severe depression in the future. David’s treatment lasted thirty sessions.