Signed off with Stress – A Case Study

Life can sometimes feel simply too overwhelming, carrying out our various roles, trying to do our best to meet expectations and manage the different elements of our lives, it’s no wonder we feel at breaking point at times. 

This case study follows the short journey of one client I shall call Daniel who managed within 4 short weeks to go from being signed off work and wanting sedating so he didn’t have to think or feel or summon up energy for the many tasks in his life to feeling in control and relaxed and ready to make a change. Elements of this article have been merged with other client work to further increase confidentiality.

Contracting session

Daniel, a 33 year old man, married with a new baby girl, with a full-time career in teaching whilst undertaking additional freelance work in the performance industry, arrived for his first session during lockdown number three. He was attempting to work from home, co-parent his new daughter with limited childcare resources, and keep on track with his freelance contracts whilst restricted from his usual ‘downtime’ hobbies due to Coronavirus.

Daniel was in a great deal of emotional distress, he had seen his GP and had expressed his desire to be sedated in order to fully cut off from everything and everyone. Trying to manage his many tasks whilst also battling his inner thoughts and insecurities had gotten the better of him and he could no longer bear it. He had been signed off work for 2 weeks to allow him some time to reduce the pressures on him and he immediately sought counselling with a view to exploring what had brought him to this point and to seek a resolution so he could get back on track.

Daniel spent the session talking through his distress, getting it off his chest, before leaving to spend some time focusing on low-energy, self-care activities for the few days until his first therapy session.

Session one

After a few days of self-care, Daniel returned to the counselling room with a little more energy. We began discussing the pressure he was putting on himself to maintain the high standards he had come to expect of himself in all areas of life, the need to put others’ needs ahead of his own, his guilt for not being able to offer support to his wife with their daughter all of the time despite there being no expectation of this from her. His desire to keep his mother from feeling isolated whilst she looked after his father whom had developed dementia but was resistant to visits due to the risk of contracting the virus.

His daughter had become a responsibility he set himself high standards around in order to feel like a good husband and a good father. 

His friends had become people he needed to entertain to ensure they didn’t become bored of him whilst he had little of interest to share with them.

His mother had become a source of guilt and shame as he felt he should be able to relieve her sadness and shouldn’t express his own contentedness in his own marriage.

His employer and colleagues became individuals who had offered so much and didn’t deserve the extra workload because he had not been able to cope.

His contractors became opportunities lost as he saw himself as unreliable and less likely to be approached for bigger and better work that he longed for.

He was battling with low self-worth across all these areas of his life and left the session in the knowledge that he needed to challenge this opinion he had of himself that had led to the high standards he was striving to achieve.

Session two

Daniel spent the second session discussing his work-life as, although he recognised the pressure he was putting on himself in order to promote a strong, reliable, interesting image to others, he also recognised that his work was a constant barrage of tasks, every ‘ping’ a new e-mail with another task, increasing his To Do list every few minutes and making it impossible for him to feel his work was manageable. He identified that colleagues delegated work to him in order to relieve pressure on themselves and that he had always said yes because he didn’t want to let people down. He wanted to appear helpful and dependable and had a real desire to support them.

He dreaded returning to work and had been given a further week off by his GP.

We explored his right to be supported at work himself. We gently challenged the idea that he would be seen as a ‘lesser’ person if he set boundaries and declined the extra work. He knew that this was not true. Colleagues had reached out to offer him their support in his absence, and his contractors, when Daniel had told them he wasn’t able to fulfil his deadlines due to needing to take some time out, had been fully supportive and given him all the time he needed with a view to continuing their work with him when he was ready. The evidence was there, he simply needed to be able to accept that he deserved the same level of support as everyone else, that it was okay to need it, and that it was safe to do it.

The same could be said in his family life and social circle too.

Towards the end of the session Daniel used an analogy of trying to build his house back up but not knowing where to start as so much needed doing. He went away with the idea of drawing this out and prioritising the work that he needed to do on himself.

Session three

Daniel came in feeling much better. He had drawn up his house and had recognised that at the ground floor was the eye level windows that people could look through and see what he had to show. This was the persona he had been putting on for years. On the first floor was the real him, the person with low self-worth he was trying to hide from, not only everyone else but himself also. He had added a second floor where fear and anger lived. He recognised quite easily that the anger he had towards himself was created by the fear of being unable to keep the lower two floors separate. In order to relieve the fear and anger, he needed to make the two lower levels more compatible. He needed to be comfortable and confident in who he was in order to be able to show others that he was still worthy and he’d already made good headway in accepting this for himself. He had enough to offer without offering so much. 

He was feeling ready to return to work the following week but had identified that the time off had given him a much more relaxed attitude, the entire concept of time meant something completely different, there were no deadlines, there was no immediacy, he had spent hours sitting on the floor with his daughter simply playing and enjoying the time with her, he had taken time to read and relinquish all the pressure he had created for himself. The idea of returning to work therefore, although manageable, was something he realised no longer suited his lifestyle. The fast paced environment he had been working in for many years spilled over into his personal life, things needed planning for, he needed to get things done immediately, he needed to resolve issues and make improvements, he needed to respond to messages from friends straight away, he needed to ensure his mother was catered to, and when things didn’t go to plan (as they likely won’t with a new baby and a global pandemic) he felt he was failing. He needed to slow down and the time out had provided him with the opportunity to do this comfortably. He had an interview lined up for another job the following week. There was guilt here too, betrayal of his manager with whom he got on well with and had just given him 3 weeks off work to look after himself. We discussed again the normalcy of this, he needed it, and he deserved it, he also deserved to cater to his own needs and move on if this helped him further.

Session four

Daniel had a new energy about him in this last session. His interview had gone well but he didn’t feel it was right for him and was looking at alternatives. He had returned to work and didn’t feel the need to discuss it, it was fine. He had stopped trying so hard at home, offering support to his wife where he felt it was needed rather than at every opportunity and his wife had commented that this was much less frustrating! He had taken a walk with a friend and they had discussed topics that neither needed to be entertaining nor particularly interesting, and he’d enjoyed it. He’d been providing a listening ear to his mother without trying to resolve her difficulties and had found she responded well to this – trying to find a resolution to an unresolvable situation was both stressful and upsetting, providing an opportunity to talk about it was much more helpful and he felt more useful to her. He found that there was also opportunity here to share his own struggles and make the communication more equal. I imagine that, in offering him a listening ear, his mum also found some purpose in her day and felt less of a failure herself.

Daniel recognised that there was a need to continue his good work and keep building up his self-belief but at this point he had enough understanding and had implemented enough strategies to keep his improvement moving in the right direction that he could manage this independently. 

Daniel was grateful for the opportunity to talk in the sessions as it was this talking to an uninvolved party that had given him the freedom to be so honest about his insecurities. He could never have shared these with those closest to him whilst he was still trying so hard to make such a good impression. In the short time we worked together, he found the confidence to be himself and the strength to be more open about his struggles with those around him, giving them a much better insight into the caring, kind-natured individual he’d always already been and giving them the opportunity to give him something back, deepening the relationships that meant the most to him and strengthening his belief in his secure place within those relationships.

If you’re finding yourself on the verge of seeking help from your GP for stress related difficulties, perhaps consider seeing a therapist first? It helps to talk.

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