Brett is a 36 year old man who works as an accountant for a small family business. The business is failing and Brett will probably have to begin the process of “winding it up” in the near future. His commitment to the business and his friends, the business owners, has intensified the level of stress he is feeling as a result of the business collapse. He has taken a week off work on sick leave and feels too “stressed” to return to work.

In this scenario, the professional counsellor uses a Person-Centred/CBT approach. For ease of writing, the Professional Counsellor is abbreviated to “C”.

Background

Melinda, Brett’s wife, contacted C because she was greatly concerned for her husband. She was worried that Brett was depressed as he was refusing to go to work. She stated that he had agreed to attend counselling if she organised an appointment, however he did not think it would help him.

Brett had worked as an accountant in small businesses for the last twelve years. About eight years ago he was working with another business that required him to close it down. He described that experience as extremely distressful. He felt that the process had involved a loss of loyalty from organisations associated with the business and that he saw this as a “personal attack” against him. He also felt he had been exposed to people who would do everything they could to get as much as possible from a “crumbling company”.

Brett reported the following symptoms: decreased motivation particularly in relation to his work, unusual outbursts of anger, anxiety whenever he thinks about his work or attends his workplace, and difficulty sleeping. He stated that these symptoms commenced when he realised that the business he was working for might begin to fold and have increased to the point that he is finding it difficult to complete his usual tasks and “doesn’t want to do anything”.

Brett attended four appointments with C over a ten week period.

Session Details

In the first session, Brett reported that he felt he was “depressed” (using his own understanding of the term). He stated that the depression began as the retail business he was working for started deteriorating. He also described feeling depressed in the past on about 4 or 5 other occasions when he had experienced significantly negative events in his life.

One of these events was that while he was working for a printing firm six years ago, it began to fold and he was required to do the work to “wind it up”. During that time he felt betrayed by people he had trusted and he felt “conned” and tricked by many “colleagues”, and as a result, he had felt like a failure. He stated that he was now experiencing an extreme fear of having to go through the same experience again.

Brett described working at least a sixty hour week every week and that his whole life revolved around his work, in fact, he had not had a holiday for at least four years. He said that he measured his success in life by the quality and quantity of his work rather than by any other measure, including the income he earned. He talked about how his family of origin had in the past told him to work elsewhere, as he would earn a lot more money. Brett knew that they were right, but he preferred to be involved in the development of a small company, and money was not very important to him.

Brett reported that he felt “a bit silly” having such a big psychological reaction to something that he thought should not affect him at all. C identified his symptoms as a burnout-type of reaction and gave Brett some information, including the causes and symptoms of burnout, to take home and read. C identified the seriousness of the events that had lead to his level of stress and normalised Brett’s reaction. Additionally, C reality-checked Brett’s feeling of ‘failure’ and his high level of concern for not letting his friends, the business owners, down.

To manage the current level of stress that Brett was experiencing, C recommended he continue his temporary respite from work (Brett had stated that he would not be able to cope with returning to work) and that he implement some relaxation strategies. The strategies included:

  1. Regular exercise (Brett had explained that he liked to walk regularly but had not done so for some time)
  2. Doing things that he enjoys and things that he finds relaxing
  3. Use of a relaxation tape each evening (provided by C)

Brett was very concerned about what he should do about his return to work. He said that he did not feel that he could go back. C suggested that he try not to think about the decision concerning his return to work until our next appointment in two weeks, at which time we would work out what his strategy would be. Instead, he should focus the next two weeks on relaxation and self-care. C encouraged Brett to keep any return to his workplace to very brief periods over the next two weeks, and to use his relaxation tape before and during that time if necessary.

In the following session, Brett reported that he felt “more relaxed”, although he continued to feel unmotivated to return to work. He described walking regularly and avoiding worrying too much about work. He also said that he had gone into work for two brief periods during the two weeks and had experienced a high level of stress and frustration when he did, although he reported some comfort from the use of the relaxation tape. This experience reinforced to him that he was unable to return to work in his previous capacity. C used a four step decision-making model to assist Brett to come to a decision about his work.

Step One: What is the problem?

  1. Brett is extremely stressed when he considers returning to work and does not think he can do it.
  2. He does not want to let his friends, the business owners down.
  3. He wants to fight through his anxiety (not be a coward) and return to work

Step Two: What are the options and what are the relevant issues associated with each one?

  1. Resigning from his work – he would feel that he let the owners down and that he might ‘run away’ at the next sign of stress he experiences.
  2. Remaining in the position as he was before his recent leave – he felt he could not cope in this scenario.
  3. A balance between the two previous options: sharing the position’s responsibilities with a colleague, delegating the tasks that he finds most stressful, and working from home as much as possible.

Step Three: What is the best option?

The third option, to take back the work on a different basis.

Step Four: What do you need to do to implement the best option (include possible contingency plans)?

  1. To continue with leave from work for the next two weeks with only a minimal work involvement.
  2. To gradually increase his workload particularly on a work-from-home basis, and to continue to use relaxation strategies when needed to assist this process.
  3. Balance his life better, that is, focus on other things as indicative of success, including:
    1. good relationships with wife and family
    2. improved health
    3. developing hobbies
    4. taking enjoyable holidays

C suggested that Brett develop a written plan for managing and balancing all the aspects of his life (relaxation, enjoyment, hobbies, family relationships, and work) that would be reviewed at the next appointment.

In the third session, Brett explained that he had taken a holiday for a week with his wife and had returned “refreshed” and with new insights into his life. He also stated that his stress continued to reduce. He described a “new conviction” to balance his life more.

C and Brett reviewed his gradual plan for return to work on a work-from-home basis and his delegation of tasks to other employees. Brett had also decided to undertake this plan for another month and then review it again to see if his decision had changed. At that point, he felt he might be able to return to the workplace full-time, or he might decide to resign from his position and move to another area to start again. He said that he realised that when he has no clear direction and feels out of control, he gets very stressed.

He described these things as the triggers for the stress he has felt in this situation and similar situations in the past. He therefore decided to ensure that he always has a sense of direction and control in the whole of his life by taking the focus away from work. C supported and encouraged his continued self-reflection and determination.

One month later, Brett attended a fourth and final appointment. Brett described the stress as almost completely gone. He was working half the time at home and the other half at the workplace, and the business owners were happy with his return. However, Brett had also decided to move to a more rural area in three months and continue to work in the position predominantly from home.

This move is based on his decision to balance his life more and he was excited about his family’s plans. He had commenced playing a sport with friends one night a week and was walking regularly. He stated that he had realised it would take some time to change his measure of success/failure, however, he would continue to address it.

Key Concepts of Person-Centred/Cognitive-Behavioural Therapy Applied

  1. Developing a positive therapeutic relationship using unconditional positive regard and empathy.
  2. The assumption that, given the right environment, the client will strive towards self-improvement and self-actualisation.
  3. Providing education on burnout and managing symptoms.
  4. Reducing the overwhelming nature of the problem by identifying it specifically. This made the problem something that could be addressed more readily.
  5. Normalising the client’s reactions and behaviours.
  6. Implementing a problem-solving/decision-making model.
  7. Application of relaxation techniques.
  8. Reducing sources of stress by prioritising them and delegating them where possible.
  9. Gradual exposure to the stressor (return to work).
  10. Reality-checked cognition’s (letting friends down, being a failure).
  11. Fostered insight into key issues and their possible causes.

Author: Leanne Tamplin

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