Evidence-based counselling services designed to empower you with the tools you need to overcome challenges
Counselling Case Studies
Case studies are up-close examinations of people’s stories.
The following descriptions are not about real people. They are fictitious composites of challenges and experiences people have for the purpose of illustrating Dr. Wiens’ approach and how counselling can be helpful.
Ethan was well-liked by everyone around him. He was helpful, dependable, and always could be counted on to go the extra mile. He was cooperative and had always gotten positive performance reviews in his work in the marketing division of the company.
Over the past few years, however, he found himself feeling very stressed and at times overwhelmed by worry. He kept thinking ‘I just need to push through and try harder.’ He drank more caffeine to fuel his longer work hours but his busyness never seemed to let up. He wasn’t sure why, but he would sometimes feel quite irritable, tense, and unable to relax or sleep. Others around him also noticed that he seemed on edge and less patient than he used to be. He even noticed that sometimes his heart would race uncontrollably, which made him worry about his health.
His wife eventually convinced Ethan to see his family doctor and he was referred for counselling. At first, Ethan was a bit hesitant about seeing a psychologist because he thought they worked with people who had mental health challenges and that certainly wasn’t how he thought of himself. Rather, he thought he was just stressed and going through a difficult time. However, his stress level had gotten worse and he wasn’t sure how to fix it, so he gave counselling a try.
The first part of our sessions focused on exploring Ethan’s concerns and goals. He wanted to be less stressed, more at ease, and to sleep better. He also wanted to ensure that his stress wouldn’t ruin his health. We discussed how stress works, its purpose and how it affects the human nervous system, as well as some coping strategies to decrease and manage it. His health-related concerns were somewhat alleviated when he learned how stress influenced his heart rate. We also reviewed ways to improve his sleep and manage self-care to better cope with stress. His concerns that he would be labelled with a mental health diagnosis that he thought was irrelevant to him vanished as we discussed practical ways to handle his stress and to function more effectively.
Ethan was also given an exercise to identify patterns in his life that were causing his stress. This helped bring to light some key issues that were driving Ethan’s challenges. Until now, he had an only foggy and vague idea about stressors that were bothering him. For instance, he always knew that his boss could be overly demanding, but he hadn’t realized how much worse this had become over the past year. It all happened quite gradually and he was just very focused on doing what was needed to get that promotion.
Through a collaborative process, we developed a clearer perspective of the specific stressors and patterns that were driving much of his stress. Moreover, it also was becoming increasingly clear what he could to do change his situation. For example, he realized that his workload had grown by 40% from the past year as a couple of his colleagues had suddenly left the company. Being a nice guy who was motivated to advance, he never said ‘no’ to his boss and frequently found himself with more than he could handle. His personal life, similarly, was quite full with helping friends and some volunteering work he had taken on at his children’s school.
He was confused because he was a very nice person who loved to help others but lately he was beginning to feel some resentment as well as anxiousness. We examined some of the patterns in his thoughts, emotions, and behaviours and discussed how anxiety and resentment work. He began to realize how his own behaviour had been feeding this cycle. In particular, he did everything he could to please others, something that he was proud of, but the unintended consequences were that he was now quickly burning out.
Together, we identified different areas in his life where he could make changes and how to start going about it. One key area related to being more assertive and able to set boundaries with others. This was difficult for him, not only because he found conflict to be very uncomfortable, but also because he didn’t want to be a mean person. We brought to light some of his unspoken assumptions about niceness and re-examined them together. He was starting to feel relieved to realize that being a helpful and generous person did not mean never setting boundaries or priorities.
We discussed the specifics of how to be respectfully assertive, as opposed to aggressive, and more generally how he could deal with difficult conversations and conflict in a healthy manner. We also discussed and role played some difficult conversations he needed to have with a few people, including his boss. For example, he had always simply done what his boss asked but now that this was unmanageable we explored how he could approach his boss on this issue in a diplomatic yet assertive manner.
We also discussed strategies he could use to manage his anxiety around conflict. While having difficult conversations was uncomfortable for him, it wasn’t as hard as he thought it would be. Doing some of the assertiveness exercises we came up with actually led to improvements in his work a few months later and a higher level of job satisfaction. He also realized some areas in his work and personal life where he had been continuing to do something simply because he was afraid to end it, not because he thought it was meaningful. He continued applying some of the skills and tools he learned in counselling and we would troubleshoot issues in our sessions. As he developed these skills, we also identified other sources of frustration that he could address at work and more generally how he could be strategic in advancing his career. He eventually left equipped to reverse the stress cycle and gradually gain control over his life.
Over the course of counselling, Ethan addressed the sources of his stress and gained control over his life. More importantly, he developed many of the skills and tools needed to deal with his challenges and was pleasantly surprised that these also helped him to improve his personal life. He later returned to pursue coaching sessions to help him advance his career to a leadership position.
Jennifer was a friendly but also somewhat shy individual. She had a small close group of friends and liked to focus on her own tasks and goals. She placed high expectations on herself to succeed in her work as a corporate lawyer and prided herself on always being there for her friends. While she experienced some periods of depression in her teen years, she had been doing well for over a decade since then.
Her depression returned in her early 30s and she quickly recognized some of the signs: apathy, fatigue, over-eating, struggling to get out of bed in the morning, and feeling hopeless about her situation. She stopped exercising, lost motivation and drive, withdrew from friends, and her performance at work suffered. A colleague noticed quite the change in her and suggested working with a psychologist to help her get back to her usual self.
Jennifer had only seen a psychologist once before in her teenage years and found it unhelpful because it focused very much on her childhood and other areas that she didn’t feel were relevant to her difficulties. This time she looked for a psychologist who had experience working with busy professionals and had a goal-oriented approach.
In our first session, we explored Jennifer’s goals. She wanted to address her depression and improve her mood and energy levels. We began by exploring the patterns in her thoughts and behaviour and how those affected her mood and energy. Together, we identified some triggers for her depression as well as ineffective coping behaviours that were actually making things worse. She was unintentionally perpetuating a depression spiral that would only worsen until it was reversed. We discussed strategies for how she could better manage triggers for her depression and we also identified self-care behaviours to improve her mental health. We set goals for making small but impactful shifts in lifestyle to improve her functioning and wellbeing.
We worked collaboratively to identify the specific factors that were weighing on her. It had felt like she was carrying a 100 lbs backpack, but listing these out in specific terms felt empowering. The quote by John Dewey, “a problem well put is half solved,” really resonated with her. By clearly identifying her challenges, we were then able to discuss strategic ways to handle her work and relationship challenges and outline actionable steps to move forward. We also discussed the types of cognitive biases and patterns of thought that make some people susceptible to depression and how these were contributing to her feelings of being overwhelmed.
As our sessions progressed, Jennifer’s mood improved and she learned some of the tools to cope with depression and better manage her mood. However, she also realized that one source of her depression was feeling that she lacked self-confidence. In her work, she felt that she had imposter syndrome in which she often questioned her abilities and struggled to be decisive around making decisions. She had received feedback that if she wanted to make partner, she needed to develop these skills. She also struggled to make decisions in her personal life and it bothered her spouse that sometimes she would withdraw, procrastinate, or just shut down.
We discussed the types of common situations that would bring self-doubt or lead her to a so-called paralysis of analysis. After dissecting how she would often handle such situations, we identified some strategies to increase her effectiveness in these areas. One of the drivers of these challenges was her very high and rigid expectations of herself. She had often been told she was a perfectionist, but always thought of this as a positive trait that helped her be successful. We discussed how high achievement differs from perfectionism and the ways the latter actually decreases performance and fuels depression. She learned some tools for dealing with perfectionism and not letting it be a barrier for her. We also discussed actionable steps for her to take to strengthen her self-confidence and have a stronger presence in the workplace.
Jennifer came into counselling worried she would talk mostly about her childhood and hoping that she would learn some strategies for coping with depression. She learned to manage her depression but she also got more than she expected in that she developed ways to improve her effectiveness in the workplace and in her personal life.
Calvin was known for being a worrier. His mind was always running fast and thinking about the next ‘what if’ scenario. Although he didn’t like the stress of worrying, he credited it with helping him do well in school when he was younger and now in his work. He was rarely caught off guard, because he had carefully thought about and planned everything beforehand.
He was generally a fairly quiet individual and certainly not one to raise his voice. So it scared him when he all of a sudden found himself yelling at his partner over a minor frustration. “I don’t know what got a hold of me” he said in our first counselling session. He was about as confused as he was worried. Together, we explored different aspects of his life and also took inventory of the different stresses he had been experiencing. He had some ideas of what stressed him out, but it was quite blurry given that he often worried about most things.
Calvin completed an exercise between sessions designed to increase his awareness of the sources and patterns that were driving his anxiety and we explored these collaboratively in session. He had been feeling increasing levels of pressure and stress at work and he was frustrated with a lack of social and romantic relationships. He learned that his irritability was influenced by his discontentment in these areas but also because he was having difficulty sleeping, feeling tense, getting headaches, and constantly ruminating about what could go wrong. He even had a few panic attacks in which he thought he was having a heart attack. These were all common signs of anxiety.
We discussed how anxiety and panic attacks affect his physiology and mind and different ways to cope with them. We also reviewed lifestyle factors and strategies to decrease his level of general anxiety, manage stress, and improve his sleep. We then worked together to identify the key areas in his life that made him anxious. Together, we uncovered how his pattern of worrying and anxiety cause him to avoid situations and how this had developed into a vicious cycle of anxiety.
His work had been pilling up over the past couple of months. What began with uncertainty and procrastination had now snowballed into unintentional neglect of key responsibilities that were overwhelming to address. We discussed his patterns of procrastination and avoidance, and the powerful emotional and behavioural patterns that were driving these. We also created an actionable plan with strategies for managing his anxiety, which helped him to feel empowered.
Another area we discussed regarded his frustrations with his lack of social and romantic relationships. He began to learn that his lack of success in these relational domains was also a function of his avoidance. He had some anxious patterns of thought and cognitive biases that worsened his social anxiety. Using some of the knowledge and skills he developed in addressing his work-related challenges, he now was also able to set small goals and actionable steps to gradually overcome his anxieties about pursuing relationships. We also identified exercises to increase his self-confidence in social situations as well as ways to be strategic about attaining his relationship goals.
As is quite common with anxiety, Calvin’s confidence grew the more he tried to overcome small but meaningful goals in his professional and personal life. He had started counselling with several weekly sessions but as he developed the knowledge and skills to deal with challenges, our sessions tapered off to bi-monthly and then an as needed basis when he wanted to discuss new challenges.