Session Plan #1111

Review Homework:

• Was she able to do a self-care activity this week?

• What was it?

• How did it feel?

1. Theme: Does not let herself feel sorry for herself:

 i.e. with her pain, reports that it gives her strength and has helped her learn to tolerate discomfort such that she can push through anything, takes pride in this (positive because of resiliency but perhaps also does not show as much compassion to self as she does for others)

Questions to explore: 

1. How do you think this strength has helped you? Followed by, where might it be limiting? 

2. How do you differentiate between resilience and self-compassion?

3. What would it feel/look like to offer yourself the same compassion you give to others? 

Psychoeducation:

• Self-compassion v.s. Resilience: It’s possible to be both. Resilience helps us endure difficulties but self-compassion helps us heal from them. Constantly pushing through can prevent us from acknowledging our emotional needs and taking time to tend to these does not equal weakness. 

    Possible interventions:

• Mindfulness-based self-compassion: Encourage mindfulness practices where pain is acknowledged with kindness and perhaps a small action to help address it (listen to body and give it what it needs). 

• ACT approach?: could be useful as she seems to have accepted the discomfort but then what actions can be implemented to align with needs and values?

• Compassionate role play: ask her to write a letter or pretend I am her and talk to me offering herself the same compassion she would extend to a friend in a similar situation. 

Theme: Avoidance out of fear of hurting others 

Questions to explore: 

1. What fears come up for you when you consider expressing your true feelings?

2. How do you balance your needs with the desire to protect others from pain?

3. How do you feel when you hold back expressing your needs and feelings to others?

4. Has there ever been a time where you did express yourself even though you were afraid that it would cause the other person pain? What happened?

5. What’s the worst-case scenario that you fear when imagining talking to your husband? 

6. How have you and your husband previously handled conflicts?

Psychoeducation:

• Impact of Avoidance: Avoidance may temporarily reduce anxiety, but it often increases stress and conflict over time, creating distance in relationships.

• Healthy Conflict: Conflict doesn’t always need to lead to hurt; it can also lead to deeper understanding and closeness. Avoidance may reinforce an internal narrative that her needs are not important.

    Possible interventions:

• Emotion-Focused Therapy (EFT): Help her identify and express underlying emotions driving the avoidance. Role-play conversations with her husband, possibly work on writing him a letter so he cannot leave during the conversation and she won’t forget what she wanted to say.

• Assertiveness Training: Teach her to communicate her needs clearly and respectfully without feeling guilt. Work on self-advocacy.

• Gradual Exposure: Use exposure-based strategies to help her face her fear of conflict in small steps, practicing difficult conversations in a controlled way (possibly start with work before husband?).

Theme Lack of safe space: 

Questions to explore: 

1. Where do you currently feel the safest, if anywhere?

2. How has the lack of sense of safety impacted your sense of well-being?

3. What would a safe space look and feel like for you?

4. What small steps could be taken to create more safety in your immediate environment?

Psychoeducation:

• Importance of a safe space: this is crucial for emotional and mental recovery, so no wonder she is feeling so out of sorts currently. Without one, it becomes difficult to relax, recharge or process stress. 

• Stress response: chronic exposure to unsafe environments activates the body’s stress response, leading to burnout and emotional exhaustion. 

    Possible interventions:

• Sanctuary Building & Safety Planning: Encourage her to create small, manageable rituals or spaces at home (e.g., a quiet corner) where she can retreat for calmness and identify areas in her life where she can create micro-safe spaces for an escape (i.e. family’s homes and people she feels safe with).

• Boundary Setting: Use CBT or DBT techniques to help her establish clear boundaries at work and home to protect her well-being.

Theme:  Financial stress

Questions to explore: 

1. How is financial stress currently impacting your day-to-day life?

2. What steps have you already taken to address these concerns?

3. What would it feel like to have more control over your financial situation?

Psychoeducation:

• Impact of Financial Stress: chronic financial strain can contribute to anxiety, depression, and physical symptoms like sleeplessness or fatigue. It can also lead to feelings of worthlessness and powerlessness.

• **Budgeting and Financial Planning: Small steps toward better financial management (even seeking advice or support) can significantly reduce stress.

**- just want to be careful here to not have it come across as condescending and also accept that there may not be a solution here (may be doing everything that they can already) 

    Possible interventions:

• Financial counselling: can encourage her to connect with a financial advisor to provide support if not already doing so.

• SFT: take a SFT approach here to look at her resources and ways she has managed successfully previously. 

• Mindfulness (ACT): mindfulness to reduce anxiety and prevent avoidance, acceptance of what is outside of her control (again, need to be aware of the current economic situation and that there may not be a good answer here and the focus just needs to be on coping) 

Theme: She is not a priority: communicated by other's and herself

Questions to explore: 

1. How do you know when others prioritize you, and how does it make you feel?

2. How do you prioritize yourself in your daily life? What gets in the way?

3. What messages do you believe about your worth when others don’t prioritize you?

4. What would it look like for you to prioritize yourself, even if others don’t?

Psychoeducation:

• Self-Prioritization: Self-care is not selfish but essential for sustaining emotional health and relationships. Prioritizing oneself doesn’t mean neglecting others; it allows for a more balanced life.

• Boundary Setting and Self-Worth: Boundaries reinforce self-worth. When we prioritize ourselves, we communicate to others and ourselves that our needs matter, which is important for how others treat you but also our internal dialogue and sense of self-worth. 

    Possible interventions:

• Values Clarification Exercise (ACT-based): help her identify and clarify her values and commit to small, value-driven actions that prioritise her well-being.

• Time Blocking: encourage her to block time each week specifically for her own needs and interests, creating a tangible way to prioritise herself in daily life (start small, like we have).

In general intervention to tie many things together (not yet but when ready) 

• Journal: have her keep a daily journal for one to two weeks where she monitors her stressors. For each stressful event, ask her to note down what thoughts and feelings arise. Encourage her to reflect on how she responds to these stressors and whether she prioritises her own needs, if she avoids conflict or an interaction, etc.... This can help her gain insight into patterns of self-neglect and build awareness of her internal dialogue around self-worth.