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A woman in her late 40s, married, educated, working in a Accountancy firm, presented to a Psychiatrist with inability to sleep well, recent mood changes with mild periods of low moods. Antidepressant medicine was started and few weeks later she revealed episodes of feeling anxious, sometimes progressing to feelings of Panic and worries about future negative events like loss of her job, disease or death of a family member or close friend. Recently she was admitted to an Emergency Center, for suicidal attempt and provisionally diagnosed with Borderline Personality.

Over 4 to 6 weeks after medicine doses were adjusted, she had some stability of her mood and felt safe enough to return to work, at least part time. Weekly Therapy sessions were scheduled for closer monitoring of medication adjustments and to facilitate exploration of psychological factors contributing to current state of Mind.

Present : At workplace, she worked hard to avoid negative feedbacks and focused on compliance with requirements from her seniors. She experienced stress from anticipation of not meeting deadlines for tasks, modules, projects and annual reports. Over the years, the compliance had become excessive, with not being able to say ‘No’ to requests of extra work by seniors and colleagues. The working style and Personality at work was Appeasement oriented. Recently, her fears had amplified, and she had constant fear of not being good enough and felt the risk of losing her job. She had lost multiple opportunities of Promotions at work and felt professionally stagnated in her career. At home, she felt her husband and family have been great support but had fears of losing them. Despite the love and support, she had the nagging fear of criticisms. She worried about failing the expectations of close family members.

Future: Appeared bleak, and hoped for Survival by holding to the job, keeping finances savings and assets and maintaining dependent relationships with close family and friends.

Past: Brought up with ‘Good Parents’ and a sister, she felt gratitude towards her parents. Parents were very invested with the children and ‘Good Samaritans’ helpful to many people in Society with a philanthropic outlook. Parents made comparisons between siblings to motivate their behaviors. They made remarks (positive and negative) to point out shortcomings to correct and help the Growth of Persona.

Assessment and Realizations: My patient had Internalized ‘High Expectations’ from parents. Parents had set up through Role Modeling how to live in the Society successfully. The Comparative remarks made her feel constantly monitored and after an initial phase of Motivational effect, it seemed like Criticisms. Criticisms have an impact of inducing Shame (especially in a Young Mind). Avoiding Shame, hypersensitivity to Criticism, anxiety of being negatively perceived and misperceived created episodes of Rejection sensitivity. Guilt about not being good enough accompanies desires to feel accepted and Loved. The impact of these dynamics within Psyche, created resentment, impressions of low Self Worth and a disconnect with intrinsic Self Value and Self Security. Appeasement of others, Dependencies on others and Self-doubts caused more Shame and Inhibitions of Self Competencies and Self Expression.

Growth, Healing and Outcome: Over a period of six months, she stabilized her Lifestyle, Workstyle and Relationship matters. She made small changes to her existing mode of functioning. She gained more Self Control and felt ready to address her fears and dysfunctional dependencies. Stress levels, sleep disturbance, appetite disturbances and Self-care improved. She had a vacation which seemed more like relaxation and freedom. All previous Vacations had seemed like ‘another type of Work’. Over next six months, she experienced healing from previous resentments, anger, envy and other Confusions in the Mind. Her Response-ability and flexibility to evaluate and decide improved and Indecisiveness (in critical areas of work and Life) faded away. Two Promotions, one within the organization and the next as a global head for International Operations, helped in overcoming her chronic feelings of Career Stagnation. She became more Self Invested in her Mind and its Potentials. As Self Belief grew, Trust matters in relationships improved and her Relationship matters became more equitable, sociable and balanced.

For her, Life mattered more than before, and her future Focus moved from Survival to Optimism.