13 Appendix B – One-page Formulation for the Case of Emily

Emily presented to counselling wanting to gain clarity on what she said was “a lot going on” in her life. In particular, she named significant changes that have happened as a result to her marriage, 6 months ago, to her new husband (Sai). Emily and Sai met 18 months ago and moved in together when they were married. Sai has two children (aged 7 and 5) from a previous marriage who are also living with them. Emily reported feeling very excited about the chance to be part of a family with children, given that she had always wanted to have children, but had not been able to due to fertility difficulties with her first husband. Consequently, Emily chose to reduce her work commitments so that she can be the primary caregiver for the children.

Given her excitement about this role, the reaction of the children has been very distressing. Emily reports that the children’s behaviour toward her has been very difficult to manage, such as refusal to eat, throwing food, difficulties going to bed, and not completing homework. As a result of this, Emily describes experiencing:

• little happiness in her role in the family, and that family life is an exhausting struggle
• shattering of beliefs about what parenting should be like
• belief of not meeting social and personal expectations
• feeling stuck and not knowing what to do
• loneliness, rejection and low levels of social support
• disappointment in self, due to sense of failure in a central life role.

In contrast, Emily also reports a positive relationship with her husband, shows evidence of self-reflection, ability to express emotions, and ability to cope through other adverse life events.

Nevertheless, these recent events and their effects pose a threat to a number of her fundamental needs. She reports finding it difficult to feel a sense of joy in her life, which is compounded by the expectations of this time of life being one of happiness. There is a sense of a loss of control due to experiences not fitting previous beliefs and expectations, and due to attempted strategies to solve the problem not causing desired change. Her need for attachment is threatened through feelings of rejection and inferiority, coupled with a lack of adequate support in the midst of this interpersonal crisis. Finally, her sense of self and meaning built around being a ‘mother’ is threatened by the dominance of a social story of failure.

Emily herself makes meaning of this through the metaphor of a dense, grey fog that is made up of the very many people and things she has to consider in everyday life. This fog leaves her feeling emotionally blocked, as well as so mentally clouded that she does not have the space to “think properly”. She finds it difficult to get a clear view on what is most important to her, namely the children’s needs. Nevertheless, she maintains her belief that there is something beyond the fog, even though she is not sure how to access it yet. She is therefore confident of the future, especially if her core need of feeling valued is able to be met.

Given the information we have so far, the working hypothesis is that Emily is overwhelmed with the number and intensity of adjustments and demands that have occurred as a result of the changes she has recently experienced. This is likely exacerbated by beliefs and narratives that have developed through previous significant relationships. The therapeutic relationship should be marked by the support and validation that Emily has said has already resulted in her feeling calmer and with a plan to talk to her husband. Granting this, due to the immediate concern of breaking through the ‘fog’, in the short term it is proposed to focus counselling on solution-focused processes. The aim of this is to open up a variety of best-fit practical options, such as self-care, increased support, or reviewing interactions with children (or others). In the long-term there is scope for restructuring cognitions or re-authoring narratives to challenge unhelpful thinking and/or reconnect with a more enriched sense of self.