For many years as a psychotherapist, I’ve been privileged to accompany clients on their journey towards self-exploration. Some cases leave a bigger impression than others, both on the client and on the clinician. Today, I want to share something that happened when my client Rachel began to see me. Rachel was a born-again Christian survivor of verbal and physical abuse who was filled with fear and rage towards her father and the whole world in general.
Rachel’s is not an unusual story. Most of us cling to the safety of status quo, unwilling to venture out of our comfort zone. We tell ourselves that staying within our confines is our path to happiness and security, when in fact, as Rachel’s experience will show, our bliss might be just outside our comfort range.
I’m going to take you through her process step-by-step, noting what didn’t go well for her, what she got stuck on, and what finally worked, as she began to take advantage of new experiences and opportunities, and the process of change itself. If you are considering therapy, have an inkling that something is amiss, want to make a change or simply want to know more about how therapy works, read on. It’s my hope that through Rachel’s story, you will feel less alone.
The Beginning: Meeting Rachel
When she first walked into my office at Bellevue Hospital in New York City, the way Rachel carried herself gave me a pretty good idea of what lay ahead. Her shoulders had a rounded look; her eyes darted nervously around the room. For a woman in her mid-30s, she conveyed a sense of tight-wound anxiety. Rachel appeared to have it all – a decent job as an accountant, a one-bedroom apartment, and a small group of friends she’d known for years. She also had a history of intricate relationships, marked by conflicts, separations, and often plenty of amorous feelings. But Rachel and I were only a few minutes into our first session together when it was clear that, underneath the surface, her life was something of a dead end.
‘I feel like the rest of my life is slipping by,’ Rachel told me. ‘For so long, I’ve been the one who chooses the safe option, the guarantee, the security. And I want to stop living that way. I have the impression that my life is flying by.’
It is an insight that I have many times come across in my practice and one that is, all too often, seen as the start of a process of change. For Rachel it was the seed from which grew a whole new way of looking at things. That wasn’t enough to change who she is.
Identifying the Roots of Rachel’s “Safe” Approach
The more we learnt about Rachel’s history, the clearer it became: having grown up with an erratic father and a mother constantly on edge, predictability had gradually morphed into a safety net for her, long before she entered the world of dating or work. Taking risks, she’d learnt, was bound to end in pain or failure
‘I remember always striving to be the good girl,’ Rachel told me, ‘not to rock the boat, not to upset anyone, to do everything right … if I wasn’t that person, maybe it would be OK when I got back.’
This strategy, essential to her survival as a child, had now become a brake on her adult experience. The ways in which Rachel achieved certainty had become so submerged in her psyche that she’d carried them into every aspect of her world: her choice of jobs, her partners, even her hobbies. In a strange way, this way of life had perhaps provided her with an illusion of stability. But she had shutted out of her life almost everything that could be new and rewarding.
The Therapeutic Approach: Challenging Beliefs and Encouraging Exploration
I recognised that there were decades of belief built up and it would take a longer-term and layered therapeutic process to challenge her beliefs, build her confidence and start to expose her to new experiences. This was our method:
Cognitive Restructuring: We began with Rachel’s core beliefs related to risk and safety. During the process, she gained some cognitive distance and was better able to observe how her past informed her perspective on the present. We worked through reframes and recognised that safety often comes in the uncomfortable waters of uncertainty. This ultimately becomes the wellspring for opportunity and progress.
Mindfulness Practices: Bringing Rachel into the here and now through mindfulness techniques gave her a sense of established certainty as we worked together to help her to sit with uncomfortable feelings without seeking to change or avoid out of habit.
Gradual Exposure: we made a fear ladder and identified a sequence of small steps or subgoals that Rachel could try (presumably with support), starting with something you might describe as a mildly challenging task (learning to eat a new food), progressing to something bigger (taking a highway, driving to a new city), then something even bigger (driving to Washington DC), and so on.
Positive Reinforcement: When Rachel did something I know she found difficult (like moving out of Psychology or turning right to go to the student union, instead of taking the shortcut through it left), we gave her plenty of acknowledgement and praise.
Values exploration: We began to work with her on exercises that helped her identify her values and long-term goals; this process would often reveal desires and hopes that were outside of her comfort zone and, by extension, were overshadowed by her need for safety.
Now we continue the story of Rachel and show you more clearly how these three therapeutic strategies played out in practice, the struggles she had, and how she began to make things work. That means you too. Here are the next instalments of her saga and then you’ll be on your own!
SLOPES – SUMMIT So the answer had to come from Rachel because it ran through her. Coming up the walkway to her home, things seemed to be changing if only in their complexity. Her style had developed. When Amy Dant methylene blue-Colazal-doxaxycyl-clindamycin drugs began to cause serious side effects, Cicely easily found other treatment alternatives. The more the treatment failed, the less she held on to cherished plans for her life. Her resilience grew.
When one treatment didn’t work, she quickly tried another. She became more fearless, relentlessly learning and willing to try new things. As she took increasing risks, her acceptance of herself and the difficulties of her life and her body grew. She acknowledged her role in creating her situation but was equally aware of her power and responsibility in creating change: That’s the part that I never expected to happen.
Probably when I started treatment, like the first month or so – that was pretty grim. I don’t remember details from about the first few months because it was so horrible. And still things come back in my memory and I think: ‘how was I ever able to handle all this?’ It really was horrible. But even then, I thought: ‘It‘s worth it. It‘s worth anything it takes to get through this.’ And I mean that with all my heart. I thought: ‘I have my kids. I would do anything for them.’ And also, I had these long-range plans. Yeah, that kind of disappeared.
With the passing of time, I have come to accept that anything beyond my control or imagination is useless to anticipate. And it’s so hard. It really is really hard.I would describe this evolution as one in which a person becomes able to stay within the ‘window of tolerance’. Depending on how anxious or frazzled you are, there’s an optimal zone of arousal that allows a stroke of creativity, emotions and thoughts to carry you through to the next experience.
Rachel’s First Steps: Small Changes, Big Impact
Instead, we started with minuscule, attainable steps – small changes he could make in Rachel’s life that, while benign, might lead to larger leaps later on.
‘I want you to do something different this week,’ I said during another session. ‘Just something small. Maybe go to a different coffee shop, instead of your usual one, or talk to someone outside of your normal circle at work.’
Her first big goal was to order a different coffee to the one she hadn’t tried before. ‘It sounds stupid when I say it out loud, but I had scary heart beats when I put in my order. I was so nervous I wouldn’t like it and would have wasted my money.’ In our meeting the following week, Rachel was a changed woman. Another first step had occurred.
This is totally normal the first few times people start to challenge boundaries, even small changes really do feel massive. The trick is to notice the reaction and not let that stop you doing what you are trying to do.
“And how did it turn out?” I asked.
Rachel’s face brightened. ‘I loved it!’ she said. ‘I thought I did not like cinnamon in my coffee but, now I know I do. I wonder what else I will like.’
Though tiny, the triumph was crucial. It showed Rachel that getting out of her comfort zone needn’t always lead to things that might go wrong, but could also yield unexpected satisfactions.
Building Momentum: From Coffee to Connections
Emboldened by her coffee-shop achievements, Rachel began to push herself in other directions. She signed up for a library, something she’d always wanted to do but had never felt brave enough to attempt.
‘I was so scared I’d say something stupid,’ she told me. ‘But when I got there, I realised everyone was just there to have fun with books and meet people. No one’s looking down on you.’
This process proved transformative for Rachel, who not only found a new passion, but also started to form connections beyond her usual social sphere – allowing her to tap into new views and experiences.
The Workplace Challenge: Advocating for Herself
Once Rachel experienced change – and comfort with it – in her personal life, we turned to her professional life. While effective, Rachel had never been promoted or given a raise for fear of confrontation, or of being denied.
We role-played different scenarios, got her to articulate her requests, and practise saying them with conviction. When she eventually went to talk to her manager, it was completely different than she expected.
‘He said he was wondering when you would ask!’ Rachel’s voice was barely restrained. ‘They’d been thinking of promoting me to team lead, though they weren’t sure if I’d want it.
After experiencing that with me and seeing it didn’t become a war, that she didn’t get mad and stomp off and slam the door and slash the tyres of my sports car – it broke through to her. She realised, ‘Oh, this is what it really feels like when you’re on my side.’ The experience shifted things for Rachel. She felt empowered to take ownership of her treatment and the management of her pain, confident that her advocating for herself didn’t have to promote conflict and dissatisfaction, but could bring recognition and options she hadn’t perceived before.
The Travel Leap: Embracing the Unknown
Her confidence grew with each session until, at her next appointment, she told me she wanted to consider larger changes: she’d been thinking she might consider travelling alone. She’d never even considered that possibility before, but now it seemed a reasonable idea.
‘I’ve always thought about going to Europe,’ she said, ‘but I never went. The thought of travelling alone scared me, like, what if something bad happens? What if I get lost?’
We worked through these anxieties, coming up with playlists of ways to handle potential problems and reframe the meaning of unexpected events. ‘What if you get lost?’ I asked. ‘Then you can seek out a quaint café, or some unexpected landmark.’
Rachel had been talking about a long-awaited trip to Italy for weeks, and we had finalised the details; the night before she was to leave, she called me in a panic.
“I can’t do this,” she said. “It’s too much. What was I thinking?”
An ‘I don’t know’ is a moment of uncertainty that’s common to anyone attempting any kind of personal transformation – especially right before taking any kind of risky step out of the familiar. I’d reminded Rachel how far she’d come and the many ways we’d practiced sitting with ‘don’t-know’ moments.
“Remember, Rachel,” I said, “discomfort is not danger. It’s a sign of growth.”
The next time I heard from Rachel, she called from halfway through her trip, all breathless and ecstatic about her trekking.
I got lost in Venice today, you know!’ she laughed. ‘And what did I find? A fantastic little art gallery. I never would have found it if I hadn’t been lost!’
This trip was a catalyst for Rachel: she came home energised, trying new things and searching for her next adventure.
The Ripple Effect: How Rachel’s Growth Impacted Her Life
Courage, as it percolated through the rest of Rachel’s life, made its own peculiar ecosystem. Her shifts in self-perception made her more available to others – not just emotionally open, but more skilled at spotting existing bonds. Her relationships deepened with friends and family. She grew more confident in the workplace, piping up in meetings and taking on big projects.
Perhaps most importantly, Rachel’s relationship to uncertainty itself changed: what was once a liability became a resource, an arena for flourishing.
‘I know that getting outside of my own comfort zone used to mean that I needed to do big, scary things all the time,’ Rachel commented in one of our later sessions. ‘I think now that the ideas of “outside of my comfort zone”, “saying yes”, “taking big steps” actually need to be bigger, more inclusive than just big, scary things. For me, it’s more about being open to lots of things, big and small, rather than doing just one specific thing.’
It is this shift in attitude that psychoanalysis aims to encourage. Rather than assuming we must push until we break in some way, proper self-care involves a willingness to become curious about oneself.