Francisca Prado.

Florence.

Florence is a 29 years old woman, who has sought therapy presenting a general feeling of
hopelessness and confusion with the direction she wants to take in life. According to her,
this seems to be affecting several spheres of her life, including her partnership and
profession.

She received psychological treatment for about ten years, to deal with symptoms of
depression. Thanks to this process, she had access to get to know different approaches to
heal herself, expressing that they were really effective, and she notices how different is
feeling and perceiving her reality now. During this period, Spirituality and Psychology
transformed in real core beliefs that “allowed her to embrace the life,” expressing as her
current goal: “I want to keep learning how to love and accept myself more.”

She arrived in Melbourne a couple of years ago from Italy, describing her life in her country
as “disappointing” and “hopeless,” mainly because of the cultural characteristics than
maintained her with a feeling of “needing to do something else with her life.” So she
finished her postgraduate studies in Psychology and decided to travel and start in a new
country as a way to “find herself and make conscious life choices.” Concerning this, she
acknowledges interests and professional ventures, but feeling inadequate in social
environments, as well as restricted by her low self-esteem. 

Florence describes her actual emotional state as: “I definitely feel better in here. My
country is a very judgmental space in which I felt I wasn’t able to escape the perceptions
that people used to have about me… Even when now I feel more connected with my inner
essence and desires, I find myself knowing which direction I would like to follow, and I
have so many ideas about what I want to do, but then is like if I feel paralysed and I don ’t
do anything”. This is making her feel “lazy” and “wasting her lifetime.”

Adding to the above, is important to mention she is currently working in a part-time

restaurant, place in which she has been for almost a year. In this space, she met her
partner, whom has been with for ten months. During this period, she has broken up with
him several times, always deciding to come back. She doesn’t really know what is
maintaining her in this cycle. 

She also mentions a frequent consumption of weed (almost every day), habit that she
consider as a help to connect with her inner resources, but a cause of tiredness and swing
emotions.

Florence maintains contact with her grandmother, a woman who raised her since she was
14 years old. Since that age, she stopped the communication with her mother, who felt
betrayed and upset when Florence left the house. She never had any relation with her
father after their parent’s divorce when she was four years old. Explains her relationship
with her grandmother wasn’t good, because she was a violent woman who establish many
norms that didn’t allow her to express, but experiencing gratitude towards the help she had
from her, but still feels trapped in her ability to make decisions freely and in trusting in
herself.

Finally, her mother passed away the last year, situation that has opened a new spiritual
connection and an opportunity to develop a new bond with her.
Case conceptualisation: 

Florence is a 29 years old woman from Italy, who is currently living in Melbourne. She has
sought counselling because she has been feeling hopeless and confused in her
professional and personal life. She has received therapy for over ten years, finding a great
instance to be more aware of herself and to resignify her story. However, she still feels
struggling with feeling insecure and unable to move towards what she wants. So she
would like to find forms to improve her self-esteem and to build a life plan based on self
confidence.

In order to understand Florence in a better way, it is possible to mention a life story of

abandonment and conflictive relationship with her parents and grandmother, having
mentioned she left her mother’s house at a young age, meanwhile, her father was never
present, and living with her grandmother made her feel trapped and not worthy enough.

So, following the Attachment Theory (Bowlby, 1969) it is possible to hypothesise that
Florence, as a child, felt alone and not worthy of love by her caregivers, having from them
an inconsistent attunement, absence (in the case of the father), and the fact she
abandoned her house when she was 15 years old, suggests the bond with her mother
wasn’t, at least, emotionally protective,  neither respectful with her personal boundaries. 

Consistent with the above, the client could be in the explicative category of
Ambivalent/Anxious attachment of Bowlby (1969), which main characteristics are very
similar to Florence’s: such as self-criticism, insecurity, self-doubt and negative beliefs
about her personal value. At the same time, she has difficulties to be supportive with
herself at some moments, needing weed to self-sooth and be able to deal with her
emotions.

According to Siegel (2011), the inner critical voice in the mentioned attachment style,
expands to every relation and spheres of a person’s life. So, it is possible to suspect this
negative beliefs about herself are influencing; from her discomfort in group contexts; to her
demotivation to follow her desires.

Therefore, it would be interesting to explore in sessions about the content of the internal
dialogue when she is socialising, and check if there is a tendency to have pessimist beliefs
and expectations that support the world as an: ”emotionally unreliable place filled with
uncertainty and the potential loss of those she loves” (Catlett, 2017).

It would be also necessary to get more information about the way Florence relates with her
partner, putting special attention on feelings of rejection, and the ability or the struggle with
setting boundaries. As well, it would be interesting to know if there are inconsistencies in
her partner’s figure, and dependency towards him, aspects that could be directly related
with the dynamic of breaking up with her boyfriend, and then restarting the relation, giving
space for a new cycle to begin again.
Considering the above, we can expect some defences from Florence, such as projection
of this ambivalent dynamic, in which she could try to be the perfect client, which means
she could have issues setting boundaries in order to be accepted. But also, could be
triggered by feeling abandoned or not cared enough. This is why it would be relevant to
accept the client unconditionally and promote an environment of honesty and safety.

In order to achieve the above, I would base in what Rogers (cited in Pierce, 2016)
syndicates as the attributes more important to create a safe space in which individuals can
become their true Self, and utilise them as core values of my practice:

Congruence: It refers to be authentic and genuine as a therapist. This could help to build a
good rapport client-counsellor, as well as to encourage her to express their thoughts and
feelings freely.
Unconditional positive regard: It implies to genuinely care about Florence, maintaining a
bond without judgment or evaluation, but acceptance.
Accurate empathic understanding: It would imply to understand Florence’s experience and
feelings as subjective and uniques. For this, would be helpful to responding the content
she brings to sessions, considering her as a person able to heal herself and to help her to
recognize her own resources to deal with change. This will be useful to facilitate a
responsabilization that comes from the feeling of being “good enough,” and with the
addressing of skills to be in the present moment and to go towards the direction she is
expecting in life.
 
Summarising, all of this would help to have a good bond between client-counsellor and an
environment of acceptance would be crucial to the success of the process, specially from
the instances the counsellor facilitates spaces of honesty and free expression, so that, she
can contrast these fears with what is really happening in the internal world of the
counsellor. In other words, it will be possible to contrast both experiences and take
advantage of this opportunity to be aware of her emotions and share them with the
counsellor, as well as to build new ways of coping with these patterns.

Then she would be able, through this safety and relaxation, to slowly experience a feeling
of security in the world, getting to know her needs and the security to transform this
knowledge into actions.

It is also relevant to mention some Florence’s resources that can be identified from the
case reading, such as: development of awareness about her emotions (she knows what
she wants, and is able to recognise how hard is to take actions), creativity (she enjoys
writing and expressing), resilience (she has learned from her experiences in order to
improve and feel better with herself), and courage (she has been able to maintain herself
safe since she was 15 years old, making transcendent life choices in order to look for her
wellness).

Since she enjoys with creative scenarios and spirituality has a special role in her life, I
would like to include the technique of a Safe Space or Sanctuary Visualisation of Swan,
(2016), this space could be defined as: “Sanctuary, on a personal level, is
where we perform the job of taking care of our soul.” (Forrest, 1998, cited Swan, 2016).

This implies, through the creation of this new space, she would be able to experience a
new way of being, in which she could feel relaxed and secure. For Swan (2016), this is a
special technique for patients who have experienced powerlessness, because it could
improve the acceptance of her responsibility and show how positive the outcome can be
when she is in control of creating this inner space. Finally, with the help of the counsellor,
she would bring this learning into her present physical experience.

According to Florence’s response to this type of exercise and the needs that are gonna be
identified during the sessions, it would be good to make a new choice about including
other experiential techniques, such as Focusing or other types of Meditation. At the same
time, would be a good tool for her, to design her life plan in a therapeutic space and to
receive guidance during the active process of action.

And last but not least, it would be relevant to identify and allow the recognition of external
protective factors and how Florence can be benefited from the healthy bonds she might
have or build in Australia.

 
 
  
 
 References: 
 
Bowlby J. (1969). Attachment. Attachment and loss: Vol. 1. Loss. New York: Basic 
Books.

Catlett, J. (2017). Anxious Attachment: Understanding Insecure Anxious Attachment.

Retrieved from 
https://www.psychalive.org/understanding-ambivalent-anxious-attachment/

Davidson, S., and Ireland, C. (2009). “Substance Misuse: The Relationship Between
Attachment Styles, Personality Traits and Coping in Drug and Non-Drug 
Users”. Drugs and Alcohol Today 9 (3): 22-27.

Firestone, L. (2013). How Your Attachment Style Impacts Your Relationship. 

Retrieved from https://www.psychologytoday.com/intl/blog/compassion-
matters/201307/how-your-attachment-style-impacts-your-relationship

Ondina, V. (2017).How Insecure Attachment Creates Fertile Ground for Addictions.

Retrieved from 
https://www.psychalive.org/how-insecure-attachment-creates-fertile-ground-fo
r-addictions/
  
Pierce, M. (2016). 3 core conditions for therapeutic change. Retrieved from
https://trueselfcounseling.com/2016/02/20/3-core-conditions-for-therapeutic-c
hange/

Siegel, D. (PsychAlive, 2011, March 3). On ambivalent attachment. Retrieved from 

https://www.youtube.com/watch?v=nGhZtUrpCuc

Swan, T (2016). The Completion Process: The Practice of Putting Yourself Back 
Together Again. United States of America: Hay House.