Aurora—A Case of Obsessive Thinking
1. Presenting Problem
Aurora is an intelligent, vivacious woman in her 40’s. She is married, has 3 children, and works with her husband in his business. She came in to see me because of a situation that had arisen at work that was simply destroying her life. As her family business expanded, they needed more personnel. One of the people they hired was a very attractive, outgoing younger woman named Sylvie, who showed a fascination with Aurora’s husband. Sylvie acted in a flirtatious way and dressed seductively. She started to flirt with Aurora’s husband, putting her hand on his arm, and acting more familiar with him than was appropriate in a place of work. While Aurora knew that her husband never encouraged this and was often oblivious to employee’s behavior, nevertheless Aurora found herself becoming very distressed and upset with her husband for allowing behavior to continue. At the same time, because Aurora was very intelligent and thoughtful, she felt foolish and guilty over fact that this woman made her feel so badly. She fully understood that her husband had no romantic interest and would never act inappropriately, but the sense of threat she was experiencing hung over her even so.
2. Background Information
Aurora was born in a foreign country and her parents divorced when she was very, very young. Her mother, when she was approx. 3 years old, took her from her country of origin to the United States. The two moved in with Aurora’s grandparents, and for about 8 years Aurora had no direct interaction with her father. Around the age of 11, after urging her mother to let her spend time with her father, Aurora was allowed to do so, and she moved in with him for part of the summer. While Aurora was living with her father, her mother suddenly passed away.
At the age of 12, Aurora’s life was turned completely upside down, and she now found herself living in a foreign country with a father and stepmother that she did not grow up with and an extended family that were virtual strangers. Aurora was always a very adaptive and resilient person, and she was able to make connections with her new family as well as develop very strong social relationships among her peers. One method that seemed to be particularly effective for Aurora was creating routines and structures that would organize her life. She could be assertive, but more often than not, she succeeded by meeting the expectations of others. She routinely avoided conflict, and would try to win over friends and acquaintances by being attentive to their needs. At the age of 16, Aurora lost her father. She had to make another great accommodation to living exclusively with her stepmother and grandparents.
As a young woman, Aurora returned to America and her university education. In addition to her academic excellence, she was also quite athletic, and that is how she met her husband. Both of them were student athletes engaged in the same sport. Aurora described her marriage as very satisfying, and depicted her husband as a very attentive and caring man. At the same time, she characterized him as a very “rational” individual who did not always appreciate emotion. In all their years of marriage, she had never experienced any estrangement or serious conflict with her husband, which made the current situation all the more confounding.
3. MindFulChoice Assessment
I asked Aurora to describe to me what exactly about this situation at work she found so upsetting and what the nature of her distress was. Aurora reported highly anxious with obsessive rumination and thoughts surrounding the possibility that her husband might want to be with this new employee rather than her. She found herself taking a very critical and hostile tone toward Sylvie and she sought to find all manner of faults. On occasion, Aurora would also express frustration and anger with her husband for being oblivious to what was going on in his interactions with Sylvie. Unfortunately, Aurora’s complaints sometimes led to arguments with her husband, who did not understand what made her so irritable. At one point, he offered to have Sylvie discharged, but both agreed that Sylvie was simply representative of a problem and not the real cause.
I focused with Aurora on the thoughts that preceded her anxiety, particularly what she thought might happen if her husband took an interest in Sylvie. Aurora reported that it would potentially mean losing the life that she had built together with her husband and the stability that was so important to her. As we spoke about her thoughts and the feelings that came with them, they formed a picture of fear of loss and abandonment. Even though Aurora could not really say why this particular situation felt so much more threatening than any other, she couldn’t contain her thoughts and words. None of the strategies that had helped her overcome anxiety or fear of failure in the past worked for her now. All she could think about was how everything could be lost and she would be bereft. I suggested to Aurora that she had actually “been here before,” on more than one occasion, and she readily acknowledged that she had experienced profound dislocation with the loss of her mother followed by the loss of her father. Rather than focus on why this particular situation had acquired the power to create the fear of loss, we addressed the way in which Aurora’s thinking perpetuated her anxiety.
4. MindFulChoice Tools
How we think, not what we think—Aurora could identify her past experiences, and relate them to the fears she was currently experiencing. However, it was more important to help her see precisely how her thoughts were causing the anxiety, so that she could intervene and alter the path of her thoughts.
Our choices create our own reality— By choosing to see the interactions between Sylvie and her husband as based in a romantic interest on Sylvie’s part, Aurora was attracted to the possibility that her relationship could be undermined. Using MindFulChoice, Aurora was able to acknowledge that Sylvie’s flirtation was just a matter of immaturity and not a cause for concern.
Binary system of choice— Aurora, given her anxiety, could only see one way to interpret the interactions between Sylvie and her husband. So, she felt threatened whenever the two of them would interact. It was possible to reduce her anxiety and inaccurate forecasting by helping her see that there was another way to see the interactions between her husband and Sylvie.
Pivotal moment for Choice--Attitude— When perceiving any given situation, there is a moment in which we choose how we are going to approach and live through the event. With MindFulChoice, Aurora saw how she was choosing anxiety as the overarching characteristic of her experience instead of accepting the trust and security that she knew to be fundamental qualities of her marriage. Aurora was able to make the choice to develop a positive attitude of confidence that her marriage would endure and thrive because of its solid foundation.
- Remediating Principle:
C— Instead of worrying about things that might happen, focus on what is there right now!: All too often, people will use past, painful experiences to predict what their current situation will be like. In doing so they fail to attend to the real-world distinctions between the events going on in the present and the experiences of their past. When trauma is a part of a person’s past, the pain that it generated can be so intense that they will be hypervigilant for any potential repetition of the trauma. In a manner of speaking, they live in the past and impose that past on their present.
F— Do not believe that if you think it, it is true: A major source of cognitive distortions is impulsive reactions to events or stimuli. When people feel threatened they perceive themselves as needing to revert to survival mode, where reason takes a backseat to emotion. The idea that something is a threat may be based on an inaccurate assessment of a given situation. So, thinking that something is potentially hurtful can become a self-fulfilling prophecy.
M— Every choice you make changes you. We are the sum total of our choices: As we pursue a goal or try to reach a destination, we make a series of decisions that we believe will help us. What we often overlook in this process is the transformative nature of decision-making. As a person chooses to act in a more thoughtful, generous, friendly way, they transform into someone who is more thoughtful, generous and charitable. So, making choices to avoid experiencing anxiety allows us to become more serene individuals. By letting go of the past, we become more self-accepting people.
5. MindFulChoice Intervention
The main goal of Aurora’s MindFulChoice intervention was to help her overcome her anxiety and mistrust. I set out to help her identify the lack of connection between her reactions to the other woman and the actual threat that existed. In effect, I wanted to help her see that what she was doing at this moment in time was responding to another event. The other thing that we dealt with was her feelings of shame. She was embarrassed that she had these feelings and that she was uncomfortable with her husband having this employee. She thought she should be better than that. I helped her accept that old problems can return and can be resolved again, and that that’s not a reflection on her mental health. In other words, an old problem attitude or behavior “playing again” doesn’t mean that she hasn’t made progress on the issue. For example, because someone gets afraid of flying years after they’ve worked through the fear, they aren’t automatically back to square one—they still have the progress they previously made.
After we discussed that, I also helped her look at what beliefs were operating in her situation. One of the things that made her feel guilty was her awareness that her relationship with her husband was very good: they had a healthy marriage and she had no cause to be uncomfortable with Sylvie. So, we examined what she believed about her life. It was a paradox—at the moments when things were going really well she became afraid of losing most important thing in life-her marriage. This was based on her belief that you should always be prepared for everything to be snatched away from you—and so, her anxiety was strongest when things were best.
We talked about how this idea came into existence and it had everything to do with the unpredictable losses in her past. We examined how this idea, this belief, really has no basis or relevance in the present. That was a critical intervention—it was important that she recognize that this was an echo from the past, from the trauma of those unpredicted losses, and that it didn’t mean that she always has to believe that the better things get the more likely she is to lose them. A fundamental goal that Aurora achieved with MindFulChoice was self-acceptance. She accepted that enduring impact of her early losses, and that she could live with them without the fear that the past will repeat itself.
The results of Aurora’s MindFulChoice intervention were very good and her therapy was very successful. She was able to continue working in her husband’s office and being in casual contact with Sylvie without anxiety or needing to have Sylvie dismissed. Her relationship to her husband was as strong as ever and perhaps even stronger, as her husband was able to recognize and accept her need for emotional support.
7. Comparison to Other Methods
In comparison to other therapies, MindFulChoice didn’t require us to explore Aurora’s past or past traumas that she’d gone through—they were transparent. What we needed to find was a coherent way of understanding and processing the impact past events were having on her. Helping Aurora find self-acceptance of her emotional vulnerabilities and eliminate shame or guilt over those vulnerabilities allowed her to have more effective problem solving and more effective conflict resolution. MindFulChoice focuses on how to find the best solutions rather than attempting to resolve pathologies.