In my practice I often meet clients experiencing crisis, whether midlife, spiritual or existential, and sometimes it’s a combination of all of these. Laurinda (not her real name) was such a person. Laurinda came to see me once she was on the verge of complete emotional and physical collapse. The immediate trigger of the breakdown had been the fact that she had missed an important meeting at which she was to have given a presentation to a professional group, but after hearing a bit more of her story, it was obvious that Laurinda was perpetually stressed from attempting to manage not one, but two, professional careers, hosting a book discussion group, guest blogging for several websites related to her professional work, and micro-managing the affairs of an elderly family member – all while ignoring a medical condition with orthopedic and neurological overtones that had emanated from a birth defect. She was also abstinent from prescription drug abuse and “allegedly” – she told me somewhat wryly – actively working a twelve-step program. To top it all off, Laurinda was attempting to preserve a long-term but now shaky relationship with a long-term partner who had recently suddenly exploded, said she couldn’t take it any more, and moved out.
It was immediately apparent to me that Laurinda was in a state of almost total exhaustion, and she was experiencing extreme anxiety, not able to sleep, basically “phoning in” at work, and at a complete loss as to what to do. To immediately alleviate her acute distress, I obtained her permission to coordinate care with her internist, and together we formulated a plan which included a medical leave of absence from her work, bed rest for a time, non-dependency producing medication to bring her anxiety down to a manageable level, a course of acupuncture to help her body deal with the effects of a perpetual stress response, and formulation of a plan to improve diet, sleep and healthy physical activity. I also met with Laurinda and her partner and together we negotiated an agreement for Janice (again, not her real name) to return to the home they had shared for the past twenty or more years. Janice was encouraged to see a therapist of her own as she worked through a number of issues with which she had been struggling throughout the partnership.
Once Laurinda was physically able to, she and I embarked on a course of therapy that included looking at how her early life experiences, including parental alcoholism and narcissism, bullying by other children in school for being “different”, and feeling pushed constantly to be perfect and not act “handicapped” so that, in her mind, she wouldn’t embarrass her parents, had influenced the development of the Superachiever persona she was so rigidly clinging to in later life. We used cognitive and behavioral strategies to counter the many negative self-images and messages with which she had been punishing herself emotionally and physically since her teen years, when family dysfunction had first begun to take its toll on her.
Before we did all that, though, Laurinda was introduced to the practice of mindfulness. Practicing mindfulness proved extremely difficult for her at first because her ever-present Inner Critic and Inner Judge would often intrude into her practice sessions with biting, sarcastic comments like “What are you wasting your time doing this stupid thing for?, and “Would you please get back to work? You have so much left to accomplish, and you’re so far behind! It’s disgraceful!” In fact, at one point in the process, we had to retreat from the standard mindfulness of breathing technique to an easier exercise for her: deep, controlled breathing with focused concentration on reporting details of her immediate environment. The purpose of this was to get her focused on something else besides her own extremely self-critical thoughts. Laurinda worked diligently on developing a more mindful outlook on life, and gradually she became able to move inward to begin contemplating the big questions she had never before stopped and taken time to ponder.
Those questions took Laurinda to places she had never before dared to go before, because they dealt with core issues and core fears that are common to many of us, although we seldom dare go there ourselves. She found herself able to recognize, for the first time, the vicious cycle of engaging in ever more frenetic activity, amassing more degrees and credentials and impressive sounding titles, and acquiring more members of the “Laurinda fan club” – she actually admitted that she had very few close friends – and then, in exhaustion, having to stop dead in her tracks, leaving Janice to pick up the pieces, was slowly killing her. And, each time she worked herself to exhaustion, she had left more commitments unmet, more deadlines forgotten, and more people who had depended on her to “be there” angry and resentful.
One day, well into our relationship, Laurinda called me with a stark revelation she had come upon during a period of contemplation on a question often considered in mindfulness practice: “What is this?” The question, not specifying the “This”, suggests numerous avenues of contemplation: she chose to interpret the question as asking, “What is this life I’m living?” The answer? “I realized, “ she said, “that, although I always thought of my life endeavors as building a resume – attesting to my competence and achievements – I was really building an obituary because I was working myself to death.”
Ever the therapist, I asked, “And how do you feel about that?”
“I’m not sure how I feel about it,” she replied, “except that I’m scared. I’m scared of some pretty big things. Things like insignificance, impotence, and nonexistence. I’m deathly afraid of not mattering to anybody, of being powerless, and, worst of all, of not being at all. I don’t know what to do about it.”
For Laurinda, this revelation was earth shattering – but it put us back at a new starting place. From then on, we supplemented our cognitive-behavioral and mindfulness-contemplative work with concepts from existential therapy, working on tasks like making sense of what had happened in Laurinda’s life up until this point, helping her “re-group” her strengths into forces to build up true self-esteem rather than continually beat her down, and finding hope for a better future. Since the crisis she had experienced was a spiritual one of sorts – a major reason for her fear of death was that she had been unable to fashion a concept of a Higher Power that she could understand and accept – I suggested she return to her self-help twelve-step group and work with a sponsor on coming up with a notion of spirituality that made sense to her. She is still working on that, and reported to me recently that she imagines it will be a lifetime journey.
Gradually, Laurinda has been able to transition from two careers conducted rather haphazardly to one in which she excels, to rely on other family members to participate in caring for their elderly relative, to repair her relationship with Janice, and to develop more realistic expectations for herself. At least a few moments spent in quiet, mindful contemplation every day have brought her some serenity. Rather than building a resume – or an obituary – Laurinda is working on building a solid, positive self-concept and healthy relationships, and feeling more at peace with life. When considering the question, “What is this?”, her answer now, on most days, is “This is life, here and now, it is what it is, and this is okay.”
Reflecting on one simple question can truly be life changing. What’s your question?
The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.