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*Ruthie, a 28-year old single, professional woman came to see me due to a recent breakup. She reported experiencing recurring feelings of isolation and loneliness. 

Ruthie is the youngest in her family, with two older brothers and a sister. Her parents divorced when she was ten years old. Ruthie lived with her mother and visited her father on holidays and summer vacations. Ruthie’s early life was full of disruptions and traumas that left her with low self-worth, a somewhat anxious attachment style, and difficulty trusting. This prevented her from connecting fully with others. 

Early clues in her detailed descriptions of relationships, work colleagues, dating partners, family, and friends included her sense of feeling rejected, lonely, and difficulty feeling that she could join with others. When she began to display concerns about various aspects of my practice and of me, I knew the pattern was going to lead to an early exit on her part. 

When she attempted to reschedule yet a third time, I decided to address the repeating theme directly with her. “You have been through so many difficult and painful changes and losses that have left you feeling let down by others. That must be very painful for you, and I am wondering if it keeps you from feeling as though you can join in with others? I really want you to you to let me know when you start to feel that way with me so we can discuss these feelings together. If you ever feel I am not attentive or helping you in any way — because I am human and do make mistakes — please let me know. You may have a strong need to not return to your next therapy session because the feelings are so powerful and you’ll want to protect yourself from hurt and pain of rejection here. If we can discuss this together, I promise I will do my very best to hear your needs so we can make a plan that will work for you to continue your therapy.” 

I had hoped that this predictive early intervention would be a reset for Ruthie to have a corrective emotional experience in this environment that would set the stage for success in her personal relationships. Ruthie was able to stay in therapy consistently and began to share her concerns, criticisms, and fears regarding my role as her paid therapist… paid to care, various office issues such as not having bottled water available, my scheduled vacation absences, etc. I reassured her that although I am her paid therapist, I am also a human being with genuine care for her, a sincere calling and passion for helping her with challenges, and I will be here for her until she feels less symptomatic and more hopeful about her future. I listened openly to her concerns without defensiveness in order to role model a new skill set for her of self-acceptance, self-awareness, and an understanding that we as people are all full of both positive and negative traits… flawed and fully human. My overall goal was for her to achieve second-order change, and by detecting early clues in her thematic life patterns, I was able to address them directly with her for a successful therapeutic experience.

*Names and details changed to protect client’s confidentiality.

Sally E. James is a Licensed Professional Counselor in Spring, TX.
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