Case Study – 2 Day Individual Program: James, 64, male, semi-retired transport manager

Overview

3 months after

Anxiety		Psychological abuse		Eating disorder		Suicidal thoughts
Depression		Physical abuse		Self-harm		Suicidal acts
Loneliness		Sexual abuse		Addictions		Obsessive thoughts
Low mood		Emotional neglect		Disliking the body	✓	Compulsive acts
Social withdrawal		Physical neglect		Perfectionism		Panic attacks
Not feeling good enough		Bullying		Alcohol over-use		Periods of physical illness
Not knowing what to feel		Caring for others		Drug over-use		Anger
Feeling afraid		Striving to please		Sport over-use		Disrupted sleep

Other: 

Before

James is 64 years old, male, British, married and semi-retired. James lived with his parents as an only child until the age of 26 and was successful academically but socially withdrawn. He pursued a successful career in the transport industry and thrived at work but felt less confident regarding his social life. Now semi-retired, James has found filling the winter months challenging as the darker nights limit his ability to keep busy by being out and about. James undertook the Garden Gate Intensive 2 Day Program as he felt anxious/less able to cope during the winter months and wanted to explore issues possibly related to Seasonally Adjusted Disorder.

Measures taken to attend to well-being

Occasional sessions with psychotherapists over the years, occasional use of anti-anxiety/anti-depressant pills. James had 2 sessions of counselling with Anne Lindley-French before the 2 Day Program and has had none since.

Well-being self-assessment

James completed this self-assessment, showing how he felt during each decade of his life.

Age 0-10

Anxiety		Psychological abuse		Eating disorder		Suicidal thoughts
Depression		Physical abuse		Self-harm		Suicidal acts
Loneliness		Sexual abuse		Addictions		Obsessive thoughts
Low mood		Emotional neglect		Disliking the body		Compulsive acts
Social withdrawal	✓	Physical neglect		Perfectionism		Panic attacks
Not feeling good enough		Bullying		Alcohol over-use		Periods of physical illness
Not knowing what to feel		Caring for others		Drug over-use		Anger
Feeling afraid		Striving to please		Sport over-use		Disrupted sleep

Other:

Age 11-20

Anxiety		Psychological abuse		Eating disorder		Suicidal thoughts
Depression	✓	Physical abuse		Self-harm		Suicidal acts
Loneliness	✓	Sexual abuse		Addictions		Obsessive thoughts
Low mood	✓	Emotional neglect		Disliking the body	✓	Compulsive acts
Social withdrawal	✓	Physical neglect		Perfectionism		Panic attacks
Not feeling good enough	✓	Bullying		Alcohol over-use		Periods of physical illness
Not knowing what to feel		Caring for others		Drug over-use		Anger
Feeling afraid		Striving to please		Sport over-use		Disrupted sleep

Other:

Age 21-30

Anxiety		Psychological abuse		Eating disorder		Suicidal thoughts
Depression	✓	Physical abuse		Self-harm		Suicidal acts
Loneliness	✓	Sexual abuse		Addictions		Obsessive thoughts
Low mood		Emotional neglect		Disliking the body	✓	Compulsive acts
Social withdrawal		Physical neglect		Perfectionism		Panic attacks
Not feeling good enough	✓	Bullying		Alcohol over-use		Periods of physical illness
Not knowing what to feel		Caring for others		Drug over-use		Anger
Feeling afraid		Striving to please		Sport over-use		Disrupted sleep

Other:

Age 31-40

Anxiety		Psychological abuse		Eating disorder		Suicidal thoughts
Depression		Physical abuse		Self-harm		Suicidal acts
Loneliness		Sexual abuse		Addictions		Obsessive thoughts
Low mood		Emotional neglect		Disliking the body	✓	Compulsive acts
Social withdrawal		Physical neglect		Perfectionism		Panic attacks
Not feeling good enough		Bullying		Alcohol over-use		Periods of physical illness
Not knowing what to feel		Caring for others		Drug over-use		Anger
Feeling afraid		Striving to please		Sport over-use		Disrupted sleep

Other:

Age 41-50

Anxiety		Psychological abuse		Eating disorder		Suicidal thoughts
Depression		Physical abuse		Self-harm		Suicidal acts
Loneliness		Sexual abuse		Addictions		Obsessive thoughts
Low mood		Emotional neglect		Disliking the body	✓	Compulsive acts
Social withdrawal		Physical neglect		Perfectionism		Panic attacks
Not feeling good enough		Bullying		Alcohol over-use	✓	Periods of physical illness
Not knowing what to feel		Caring for others		Drug over-use		Anger
Feeling afraid		Striving to please		Sport over-use		Disrupted sleep

Other:

Age 51-60

Anxiety		Psychological abuse		Eating disorder		Suicidal thoughts
Depression	✓	Physical abuse		Self-harm		Suicidal acts
Loneliness	✓	Sexual abuse		Addictions		Obsessive thoughts
Low mood	✓	Emotional neglect		Disliking the body	✓	Compulsive acts
Social withdrawal		Physical neglect		Perfectionism		Panic attacks
Not feeling good enough	✓	Bullying		Alcohol over-use	✓	Periods of physical illness
Not knowing what to feel		Caring for others		Drug over-use		Anger
Feeling afraid		Striving to please		Sport over-use		Disrupted sleep	✓

Other:

Age 61-70

Anxiety	✓	Psychological abuse		Eating disorder		Suicidal thoughts
Depression		Physical abuse		Self-harm		Suicidal acts
Loneliness		Sexual abuse		Addictions		Obsessive thoughts
Low mood	✓	Emotional neglect		Disliking the body	✓	Compulsive acts
Social withdrawal		Physical neglect		Perfectionism		Panic attacks	✓
Not feeling good enough		Bullying		Alcohol over-use		Periods of physical illness
Not knowing what to feel		Caring for others		Drug over-use		Anger
Feeling afraid	✓	Striving to please		Sport over-use		Disrupted sleep	✓

Other:

During

James provided the following answers to questions about why he chose the Garden Gate Intensive Program, his experience of doing it and what he thought of it.

How did you feel in the run-up to the 2 day program?

“Not anxious, sleeping well, no dreams of special note. In short, rather better mentally-adjusted than had been the case in several previous autumns, as the days darken. However, I was also suspicious that this better-than-usual state might not last. I was looking forward to the 2 days, as I was very keen to have a really in-depth talk through what I perceived as issues which had been recurring in recent years.”

There are 10 components in the Garden Gate. Which were the most useful for you? Which were the least useful for you?

“The 2 days’ discussion felt to be more of an evolving continuum than components. The Plan at the end was the most useful – it gave me fresh perspectives to think about, which have helped appreciably.”

Did visualising your garden make a difference for you? If so, why? Did you expect this to happen?

“Yes! I didn’t really think it would take the shape it did, but then it was obvious that it would. It was a fun thing to get to that stage and that was surprising.”

Did visualising your garden make a difference for you? If so, why? Did you expect this to happen?

“I found it a helpful concept, a useful means of creating a more positive outlook. No, I hadn’t expected that to happen – so it surprised me a bit.”

What was the most memorable aspect of the Garden Gate for you?

“I came away feeling more ‘validated’ than I had for a very long time – by which I mean that I felt more comfortable in my own skin, and less inclined to be (1) hard on myself as, and (2) anxious about being, “an oddball who needs sorting out.”

What were the most 3 most effective aspects of the Garden Gate for you? Please put them down in order of effectiveness.

1. “The chance to talk (and be listened to) at length – so very different from what can be achieved in an hour. It was in some ways like the release of a pressure valve.
2. It helped me to put several aspects of me into a more balanced context than I’d found myself able to do before.
3. Helped me to appreciate more clearly that my wife’s mental health potentially has a significant effect on my own.”

Were there aspects of the Garden Gate which you found unhelpful, disappointing, ineffective or boring?

“Not to any great degree. I think there was one sub-component of maybe 15-20 minutes which I felt a bit “so what?” about, but I can’t remember now what it was, and it didn’t undermine the overall effectiveness of the 2 days.”

Was there anything you hoped to gain from the Garden Gate which was not forthcoming?

“No!”

Would you recommend the Garden Gate Intensive 2 Day Program to others? If so, why? If not, why?

“Yes, I would, subject to the obvious caveat that it will only work if the 2 parties happen to ‘click’ with each other enough to make it work. A key reason, in my eyes, why it works well is your personality, Anne – which makes the program hum along so well.”

Is there anything else you would like to say?

“No, other than thank you. It will take a year or two to be sure, but I feel moderately confident it was 2 days which will have a lasting effect.”

3 months after

What measures are you currently taking to attend to your well-being? Please include details of self-help, medication, counselling/therapy, intervention from health professionals, periods off school/work, time spent in hospital.

“None that I am doing as a deliberate policy.”

Having completed the Garden Gate 2 Day Intensive Program please put a ✓ next to any of the elements that you experienced now and leave the others blank. Please add any aspects of your current experience which are not listed in the ‘Other’ column.

Anxiety		Psychological abuse		Eating disorder		Suicidal thoughts
Depression		Physical abuse		Self-harm		Suicidal acts
Loneliness		Sexual abuse		Addictions		Obsessive thoughts
Low mood		Emotional neglect		Disliking the body	✓	Compulsive acts
Social withdrawal		Physical neglect		Perfectionism		Panic attacks
Not feeling good enough		Bullying		Alcohol over-use		Periods of physical illness
Not knowing what to feel		Caring for others		Drug over-use		Anger
Feeling afraid		Striving to please		Sport over-use		Disrupted sleep

Are there any other changes in your life, feelings, body, sleep which you have noticed since the program? If so, please use this space to explain what they are.

“I got through the winter for the first time for quite a few years without any appreciable quasi-Seasonally Adjusted Disorder anxiety.”

Are there any aspects you would like to work on in the future that weren’t included in the program or were included but you felt did not work for you?

“Never say never! Not at present.”

Anne Lindley-French’s interpretation of James’ experience.

James sought counselling to explore whether he had Seasonally Adjusted Disorder as he had experienced lowering mood in the winter for several years. In our first two sessions we explored the patterns of his mood and although the lower mood correlated with the longer nights in winter it did not seem to be solely a matter of environmental circumstances.

James grew up as an only child. He did not attend nursery school and spent all of his time with his mother as she didn’t work. His mother was anxious about him interacting and playing with neighbouring children. His parents did not socialise widely, had limited extended family, and James spent a lot of time with his mother. When James went to school he was seen as very bright however he found it difficult to socialise with classmates as he was not accustomed to it. During his first year at junior school he was moved up a year half-way through the school year, which he strongly objected to. For the rest of his school career he was a year younger than his classmates, which didn’t help him to bond with them. He worked hard and kept himself to himself. James’ academic career was successful and at 17 he left home to go to university. At university he felt somewhat alienated from his fellow students as he was the only 17 year old there and was probably not mentally ready to make the transition and unaccustomed to sharing so much social time with people of his own age. He left university and returned to his parents’ home.

James joined a transport company near his home and enjoyed the work very much. His career progressed well and his professional and social confidence grew. James got married in his early 30s and was happy at home and engaged in his career. James’ career progressed very well and he took senior posts and managed large teams. James retired from his full time role and works as a consultant and advisor. He walks a lot in the spring and summer and engages in civic activities. He is happy when busy but has found it difficult to maintain his mood in the winter months when the nights are longer and the opportunity to be outdoors becomes limited. James and his wife do not socialise at home and do not socialise widely.

When we worked through the 2 Day Intensive Program it became apparent that James had internalised a view of himself as different and somehow “odd” from an early age. Whilst his mother was uncomfortable with him playing with the neighbouring children she had made him go to birthday parties when he was invited. He found this difficult as he wasn’t used to mixing with children, so had grown to dislike parties and social situations. James now feels that spending all of his time with his mother during his younger years created an unhealthy mental dependency on her, although he was entirely unaware of this at the time. Within a few days of starting school he began to feel like an outsider and felt as though he was treated as such from the start. He feels that it quickly became clear to him the extent to which other children were not like him, both socially and academically. James says “Until that moment in life I hadn’t had enough exposure for that penny to have fully dropped.” When he went to university he hoped he wouldn’t be an outsider, but being a year younger and his growing conviction that he was “odd” made it difficult to interact with confidence. His return home undermined his confidence, but this blossomed in the world of work when he worked in an environment and a team which he enjoyed greatly.

James’ career developed very successfully as he is intelligent, pragmatic, has an open and engaging personality and is very likeable. He became comfortable in his professional persona and this in turn shored up his view of his “odd” personal persona and he was buoyant, met his wife and was happily married. James worked very hard and the couple moved around for his work, however at a certain point his wife felt she could not move again and they have remained in a location that James has commuted from, or lived away from during the week. James’ wife enjoys her work but does not socialise from home, meaning that their house is not visited by others.

When James retired from full time work the intensity of being busy reduced significantly, the time spent in his professional persona was reduced and he spent a lot more time at home. It seemed that this had left him in the “odd” space more frequently and he couldn’t override this sense of self as effectively as he had done for many years. This appeared to impact most significantly in winter when he was less able to get out walking and validate his time as being used well.

The most significant aspect of our work is that James is not “odd”, and in fact this was the same outcome that a period of executive coaching for his social reticence had also concluded some years earlier. In effect, James appears to have developed professional and civic personas he is confident in, however the somewhat insular lifestyle choices made in his marriage had never challenged his personal view of himself, or given it space to flourish beyond its “odd” self-concept. Semi-retirement had disrupted the balance in that James was forced to inhabit his personal persona far more frequently, one in which he had never really felt comfortable. This was especially so in winter when being busy by spending time walking became more limited and during the winter holidays when work stops.

My hope for James is that he will explore his personal persona more fully and this will dispel once and for all the myth that he is odd, because he truly isn’t. He appears to have already found a greater level of ease and self-acceptance which have contributed to making the winter months more manageable and lessened the need to be constantly busy. James has an enormous amount to offer socially and more varied lifestyle choices in retirement are likely to benefit him and his marriage.

We would like to thank James for his feedback. His name has been changed to protect his identity. None of his words or circumstances have been changed. James has participated in compiling this case study and has approved it to be shared with others.