Help with a client who is overwhelmed with responsibility

Postby lmwalls » Thu Oct 26, 2017 12:58 pm

As a fairly new psychotherapist (I've had my LCSW for some time, but just started in private practice), I've came across a client who is simply overwhelmed with responsibility. While her husband works full-time and rarely helps when not working, this client home schools 3 kids PLUS has a toddler to care for. She's involved herself in extra activities as well and, I get the sense, she's feeling a bit of pressure (from her husband maybe) to perform these amounts of "duties" extra well without time for herself.

Obviously, I have already discussed the baseline of stress and tried working with her on balancing her life's daily schedule with activities of interest/enjoyment, achievement, and family, and we've already discussed behavior activation type homework (which she is not consistent with).

I'm looking for direction from other therapist as to how to approach her therapy now. I've been focusing on a CBT approach (and some solution-focused approaches as well). She has requested monthly sessions (vs weekly) now bc of her time and schedule not allowing weekly sessions. Should I begin a more client-centered approach to therapy now and not focus so much on CBT tools, etc.? Any suggestions would help.
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#1

Postby Richard@DecisionSkills » Thu Oct 26, 2017 5:18 pm

lmwalls wrote:...She's involved herself in extra activities as well and, I get the sense, she's feeling a bit of pressure (from her husband maybe) to perform these amounts of "duties" extra well without time for herself.


As my tagline states, I'm not a clinical psychologist. Regardless, my speciality is educational psychology and her involving herself in extra activities is a learned behavior. If I had her as a student (given I don't have patients), I would conduct two exercises:

-1- Maybe you have already done this, but have her create a thorough list of all the things she believes she must get done or participate in. In effect, have her bring in her "to do list" and her schedule. Then go through the list and determine which of the items are essential.

If she can't seem to see which are most essential, use the Eisenhower Matrix. That is a fairly simple tool that forces a person to list how important and how urgent any particular task or activity is relative to one another. This exercise of prioritizing and then agreeing that some activities are indeed extra is an important admission or recognition.

If you are familiar with the Eisenhower Matrix, items that are neither urgent or important (relative to all the other items) can be deleted. For people that are in effect mental hoarders, they may be uncomfortable with deleting an item, so have them create an "archive" folder. All those extras don't go away, but instead are "temporarily" archived.

A great reason to conduct this exercise using the Matrix, is that it may give you some insight into her thought process. If she tries to squeeze everything into the highly urgent, highly important corner of the matrix, that will demonstrate a form of irrationality, a lack of critical thinking skills, etc. Even so, unless she places every single item as 10 importance and 10 urgent, there will be some relative aspect of certain tasks/activities that are more important and others that are less important.

-2- The second area I would focus on is her ability to say "no" to new demands. Even if she fills out the Eisenhower Matrix and admits there is relevance in the importance of one task/activity over another...and even if she acknowledges that she needs to delete/archive or simply stop trying to take on activities that are not important/urgent, she may be in a position where she never learned how to say "no". This is a common problem. Many people are unable to politely say no and in the moment of being asked to take on a new task/activity don't even consider their current responsibilities or workload. They say "yes" to anything almost immediately, because they lack the ability to say no.

Each month, keep reinforcing and scaffolding her learning. If in a session she agrees to cut out X or Y activity, the next month see if she actually did cut out those activities and then ask if she added Z activity and for what reasons.
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#2

Postby lmwalls » Thu Oct 26, 2017 6:30 pm

great advice. thanks! sometimes it helps to get other's perspectives.
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