Please note that the names, details and circumstances of the clients are either fictive or changed in such a way that there are no identifiable factors! Privacy is of outmost importance!

M is a thirty-year-old woman who lives on her own. She comes from a single parent household – mother -, as her father was an abusive alcoholic – and no male role model around.  She grew up in a very poor family and as a result she was dressing poorly, she did not look after her physical appearance, she has squint on one of her eyes, which is easily visible and had acne on her face throughout puberty. Because of her physical appearance, she has been severely bullied for 10 years during school, initially by a boy, and afterword by other kids who joined in overtime. As a result, she grew up with very little to no confidence in herself and did not know how to act around boys. She had very few friends for the longest time, and her mother was not able to support her during the bullying years.

She was however intelligent and did well in school, and she ended up in a decent job. With better finances, she started to look after her physical appearances better: she had an eye surgery, she started wearing nice clothes, and in time the acne cleared out. She is describing herself as a moderately attractive woman.

Due to the lack of male role models in her life, bullying from boys and a very low self-esteem, she has never had any healthy relationships with men. The only one good relationship, she was not able to sustain as she was not used to being treated well by men and she ended it. She has had a string of very toxic, emotionally and physically abuse relationships, which have left her feeling unworthy of love.

She is now seeing a counsellor to help with her trauma healing; however, she would like to work with a life coach from a more proactive, goals-advice oriented perspective, whilst doing it from a trauma informed perspective.

She is feeling ready to do the work needed in order to regain her self-confidence, and the end goal is to find a good partner.

She spends her free time at home, either reading or watching TV. She does not exercise regularly, and she does not have any big hobbies. She would love to start exercising and perhaps join a gym; however, she does not feel safe in environments where men can see her in a vulnerable position.

She has a relatively healthy diet, however, when she is sitting home watching TV, she eats many sugary and salty snacks, as she finds the comforting. She is physically healthy; however, she feels like she lacks energy at times, and she believes that if she were to join a gym and cut down on the sugary and salty snacks it might help lift her energy levels.

She has a good relationship with her family, and has a couple of good friends, but otherwise she is not very social, other than at work, where she is mainly surrounded by women.

Action plan:

In order to be able to create a plan for M, we need to understand what the signs and symptoms she is struggling with are.

The following symptoms are present for her:

-       Heavily self-critical attitude and general dissatisfaction with her social life and skills

-       She struggles with making decisions, as she fears deeply that she will make a mistake – such as talking about the wrong things in a social situation or during a date for example

-       She has an excessive willingness to please others, and this has shown in her past romantic relationships

-       She cannot set boundaries out of fear of displeasing others

-       She has deep regrets and shame associated to the mistakes she made in her past relationships

Now that we have a list of symptoms, we need to understand how these are impacting her quality of life. To get a good understanding, M can do the following exercise:

She can make a list of the following:

-       Emotional symptoms

-       Bodily symptoms

-       Behaviour

-       Cognitive symptoms

All of these are interrelated, and they can fluctuate by day, some becoming more obvious than other. Therefore, it is important to track these daily for at least one week in order to get a good understanding of them.

Furthermore, M can complete a series of questionnaires designed to give her awareness of the things she struggles with the most. By doing this, she will have a clear list of the problems, enabling her to create a hierarchy. The following questionnaires are to be filled: PHQ-9, GAD-7, Phobia Scale, Social Adjustment Scale, Self-Esteem Scale.

Following from that, we can break them down individually, allowing for clarity in work and to be able to create SMART goals for each of them.

As an example, she struggles with going out for social events. When she got invited to her friend’s wedding, she started feeling very anxious. She then accepted the invitation, because she was afraid she will upset her friend if she said no. In the weeks closer to the wedding, she started feeling more and more anxious: she was anxious about going shopping for an outfit, and worried that she will somehow make a fool of herself at the wedding. Now, the wedding is in two week’s time and she doesn’t have an outfit yet, and she is considering finding an excuse to not attend the wedding. She is aware that the wedding would be a great opportunity for her to meet someone, however she cannot find the strength to go.

Practice:

We can break the tasks down in two different issues:

1.     Shopping for an outfit

-       She can order different outfits online, and she can try them on in the comfort of her own home, and then return the outfits she does not want to keep. This will allow her to cut down the social element of searching for an outfit (such as going into busy spaces like a shopping mall, talking to shop assistants or asking for help)

2.     Attending the wedding

-       She can set small defined goals, such as: going to the wedding reception for only one hour. If she enjoys it, she can always stay more

-       This would be a very good opportunity for M to find herself in a social setting where she is not the centre of attention, and it will allow her to track herself, i.e. being aware of her feelings, bodily sensations, and of her overall behaviour.

I believe M will benefit from weekly meetings for at least 4 to 8 weeks, during which we can look at how the goals for the previous week developed and set goals for the next week.