​

​

Lily was referred to me by her friend who has been in therapy with me for a few months.  Lily is warm and friendly, though she also seems apprehensive.  She tells me this is her first visit to a therapist’s office and so she didn’t know what to expect.  She seems to relax quickly as I introduce myself and overview the process of therapy with her.

 

At the first session, I always draw a multi-generational picture of my client’s family, called a genogram.  This tool introduces my clients to me and I learn much beyond basic demographic information from this.  I learn that Lily is 45 years old.  She was married briefly after undergrad to her college boyfriend.  They had a child together, Sam, who is now 19 and in college himself.  Lily’s marriage ended when Sam was 2.  It was a contentious divorce and Lily and Sam’s father spent years in court over issues related to custody and child support.  Lily’s primary support during this period of her life were her parents.  She and Sam lived with them following her separation.  Though Lily was close to her mom, this was a difficult time as Lily’s mom often undermined her parenting of Sam.  Lily felt she could not complain as she felt indebted to her mother for her help.  Lily’s mom babysat for Sam and Lily worked full time as a sales rep.  She was bright and well liked by her managers who encouraged her to get her MBA to further her career.  She did an executive MBA program and worked full-time.  Lily worked her way into a management position at her company with the help of her MBA and she began to travel out of town occasionally, having been given responsibility for bigger accounts.  Though she could now afford a home of her own, she stayed with her parents because of Sam.  He was very attached to Lily’s mother, and though she often felt jealous of their relationship, she said nothing.

 

Lily dated men she met through online dating sites, but had no significant relationships until she met Matt.  She and Matt married 12 years ago and had two children together, Stacy and Justin.  They are 10 and 7.  Lily still works full time and the demands of her job are often overwhelming.  When Stacy and Justin were little, Lily’s mom again helped considerably.  Now they are older and busy with school, soccer, baseball, piano lessons, religious school and friends.  Lily’s mom is less available to help as her dad developed serious health problems and now needs help himself.  Matt has a very demanding job and spends a lot of time in airport terminals during the week.  Matt likes to relax on the weekend with couples who are friends and there is a constant flow of food and alcohol at these gatherings.  Lily is exhausted on the weekends and would prefer quiet family time, but doesn’t express this to Matt.

 

Lily is unraveling.  There is the cumulative effect of years of conflict with her ex, concerns about dad and worries about his death bring tears to her eyes, and unspoken resentment towards Matt for carrying none of the home and child related responsibilities during the week and then insisting that every weekend be a food and alcohol party scene.  Lily wonders if Matt has an alcohol problem.  She wonders about all the time that Matt is away during the week.  Her friend was devastated finding out that her husband was having an affair.  Could Matt also be having an affair?  And this winter was particularly brutal, with snowstorms every week or so.  The kids had snow days, Lily’s mom didn’t drive in the snow, so Lily had to work from home.  This was difficult and frustrating for her since the kids kept interrupting her as she was trying to work and she needed resources from work that she could not access from her home computer.  And then Lily’s mom slipped on the ice and fell and seriously injured her back.  Now Lily’s mom is asking Lily for help for both her and her dad.  Lily does have a brother and a sister, but both live far away and have not offered help.  

 

All of this background information is important.  Lily’s story tells me she has faced and continues to face significant stressors.  I ask her to continue her narrative, starting with what brought her into therapy now.  Lily says she has been feeling more and more sad, withdrawing from her family, feeling exhausted but not sleeping well at night, crying easily and often, feeling hopeless and losing a sense of pleasure in things she usually likes to do.  She is worrying a lot, and on those sleepless nights, she is finding herself biting her nails and thinking about things that make her feel sadder.  She is not suicidal but she is uncomfortable feeling this bad emotionally.   Two weeks ago she was walking with her friend who was talking nonstop about her husband having an affair.  Lily suddenly had a panic attack while listening to the story.  She could not breathe, her heart was racing, and she felt off the rest of the day after the panic attack subsided.  Her friend was concerned and suggested Lily contact me.  She has never been in therapy before and wonders how therapy can help her.

 

Lily is reporting symptoms of anxiety and depression.  I tell Lily that cognitive behavioral therapy can help with symptom management.  There are lots of self help strategies that I can teach her to cope better and manage her mood.  She leaves with several resources to read and relaxation strategies to practice.  I suggest that perhaps those symptoms are pointing us to look deeper, to figure out what is causing those symptoms.  I tell her I hear resiliency and strength in the narrative of her genogram.  But perhaps there are unresolved issues as well as an accumulated effect of stressors impacting her now.  She is willing to come back to explore these possibilities.  I tell Lily I am very interested in her self talk and would like her to begin listening to her inner voice.  I want to know what she is thinking and ask her to mindfully pay attention to her self dialogue, so we can explore this at our next session.  Lily tells me she feels better just speaking to someone and says she feels more hopeful as we make our next appointment.  

​