Assessment session: Megan

Therapist: As you know, this is an assessment for cognitive behaviour therapy, or CBT for short… [as
before, see Andy’s assessment]. So, what would be helpful is if you could start by letting me know
what has been happening for you recently.
Megan: Umm, … It’s so difficult to talk about … I’m so ashamed … and I don’t know where to start
… Umm.
Therapist: Okay, … it sounds like it’s difficult to talk about … We are used to that … There’s plenty
of time … Would it help if I read out the referral letter your GP sent?
Megan: Actually, that would help … Dr Z has been really kind … she helped me feel as though I
wasn’t the only one feeling like this …
Therapist: Okay, this is the letter your GP sent …
Megan: [Tearfully] I’m so ashamed …
Therapist: It’s okay, your GP was right, you’re not alone … we see so many people who have exactly
these sorts of thoughts about harming others and they are particularly common after giving birth.
Megan: That makes me feel so much better … Dr Z said something along those lines but to hear
someone else say it makes me feel as though it might really be true.
Therapist: It’ll help to get some more details on what’s been happening for you. When did you first
start having these thoughts?
Megan: Well, it was pretty soon after Molly, my daughter, was born. I just felt so anxious all the time
… Was she breathing? How she was feeding? … Everything was just so worrying and all the other
mums in my antenatal group seemed to be managing alright … I just felt like a complete failure.
How hard can it be to look after a small baby? I started to get all these thoughts … [tearfully], really
horrible thoughts …
Therapist: I know it’s hard, but would you be able to say what the thoughts were?
Megan: I’m so ashamed … I’ve been having visions of hitting Molly, or strangling her … I’d never
do it … but I still couldn’t trust myself, so I had to get other people to help me out … The visions
were just so horrible. I feel like I’m going mad. I just feel so much better when someone is with me …
Therapist: Do you have someone with you for much of the time at the moment?
Megan: Yes, mostly Paul my husband, although he’s got to go to work or he’ll lose his job …
[tearfully] … That’s really worrying me. He’s taken so much time off and his work are starting to get
fed up with it … My mum has come and stayed with me but she’s always telling me what to do or
how to do things differently.
Therapist: So, Paul’s been spending a lot of time with you … What’s he like?
Megan: He’s great, he’s been so good. He spends so much time with Molly when he’s at home and he
seems to really enjoy it. He’s been doing loads of nappy changing and feeding, which has really
helped me to cope, especially because I’ve been a bit frightened of being alone with Molly.
Therapist: And how about your mum?
Megan: Oh, I’ve had so many problems with Mum … Sometimes, we get on really well but she’s
just always criticizing me … always has done. She keeps telling me how to look after Molly
‘properly’ and keeps pointing out my mistakes, but it’s not like I need anyone else to point them out …
I know I’m not being a very good mum at the moment. I can’t even go near Molly if I’m on my own
… so, I don’t know if it’s helpful to have Mum around.
Therapist: Actually, it may sound a bit strange but it would be helpful to find out a bit more about how
things were when you were growing up, including how your relationship with your mum was. Is that
okay?
Megan: Yes, that’s fine. Mum’s always been a bit edgy and she was so strict when we were growing
up. It’s been hard to please her really and I think she always favored my sister. I’m the one who’s
always been the pain, the one who messes everything up.
Therapist: Did you just live with your mum and your sister?

Megan: No, Dad lived with us, too … Well, I say that, but basically he really wasn’t around that
much and, when he was, he was half- cut … he’s a bit of a drinker. He and Mum have split up and I
don’t have much to do with him. He’s okay, though, when he’s sober and he’s not critical like Mum.
He’s been to see Molly a bit, so I think I might have more to do with him now … who knows?
Therapist: And, so, has anyone else in the family had any similar difficulties?
Megan: Well, I realise now that Mum has done – I always thought her behaviour was a bit strange at
times but now I think I know why. Her sister definitely had problems, she used to spend hours check-
ing round the house …
Therapist: So, how would you describe life more generally as you were growing up?
Megan: It’s funny, ’cos at the time, I just thought it was normal and that everything was fine but now
I realise that things really weren’t that good. It wasn’t a happy time.
Therapist: How was school?
Megan: It was actually okay. I worked hard … actually, I did quite well at school and I got quite a
few GCSEs.
Therapist: How about friends – did you get on with others at school?
Megan: Yeah, I had quite a few friends at school. It was a reasonably good time … a bit of an escape
from home.
Therapist: And what about after you left school?
Megan: I worked as a legal secretary – still doing that, actually. Well, I was before I had Molly. I
really miss it now … can’t believe I’ve just said that … whoever thought I’d miss work? … I miss
the company and the chat as well as just occupying my brain.
Therapist: It’s quite a change, I imagine. Okay, sorry to shift around but can we jump back to the here
and now and can I ask you a bit more about what it’s like to have these thoughts?
Megan: Yeah, okay.
Therapist: When you get the thoughts, how does your body feel?
Megan: Sorry, I don’t know what you mean.
Therapist: Well, sometimes, when people get the sorts of distressing thoughts you’ve been describing,
they can feel quite panicky and their hearts race and so on.