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RUTH: A Case study on ME part 1

Quite a few years ago, I was asked to write a contribution for a Human Givens book by Dr Grahame Browne and Denise Winn called ‘How to Liberate Yourself from Pain.’

 The book was primarily to illustrate how the use of language, psycho education, reframes and mental imagery could shift subjective perception, restore hope and aid healing.

Around that time I was busy training up volunteers for the mental health charity I was founding with my good friend and colleague, Dr Kate Smith. In this context, I was very Human Givens focused, but my model had already evolved to incorporate holistic life coaching and key elements of CBT. It drew also on my traditional training which was largely in the person centred approach with grief work.

 This is part 1 of the true story of a real client told as accurately as I could recount at that time without identifying her. It demonstrates my core approach but omits the life coaching element which was not required for the book. There seems to me to be such a parallel with the symptoms of ME and the more recent experiences of many of those suffering from long Covid.

 I’ll include part 2 in my next newsletter.

I hope it helps…


 Ruth was referred to me by her GP. She had developed ME two years ago at the age of 13, following a severe flu like virus. Depression and chronic pain were now part of the picture.

 Ruth came along to see me in the summer of 2007 and we spoke about her situation.

She complained of a feeling of constant tiredness, from the moment she woke up in the morning. She estimated she slept on average 16 hours a day and on a bad day would stay all day in bed.

 She had a constant headache (level 8/10), pains and swelling in her left wrist and severe back pain (level 9.5 /10). Not surprisingly, she had a very low mood (3/10) saying she hated being around people because of the noise. Lately, she had been very down and crying a lot.

 She described herself as ‘The girl who doesn’t go to school’. ‘I can’t do anything’, she said ‘I have no future. Sometimes I think I don’t want to wake up at all’

 I regard my work as solution focused and psycho educational. The things we do not understand can frighten us very much and I knew that it was important right at the outset, to give Ruth a full explanation of the mind-body connection between depression, sleep and pain.

A completed questionnaire showed she currently had a life that was just not getting her emotional needs met. She felt she had little control; did not feel safe due to her uncertain health. She scored low on status, achievement, emotional connection and fulfilment. In other words, she was tired, bored, lonely and frightened of the future… and in constant pain.

No wonder she was depressed!

I had so much to tell Ruth that it was difficult to know where to start.

I began by describing the mechanism of emotional hijacking; how the emotional brain can switch off the rational, logical brain. I described also the black and white thinking style of the emotional brain and how it sees things in very all-or-nothing terms such as ‘I will never get better’, ‘my whole life is a mess’ and ‘everything is ruined.’

I also described how, in that emotional state, you could find yourself thinking ‘I can’t carry on like this, so I want to die.’

I explained how worry and rumination in the day also affects sleep quality; that dreaming is our way of discharging the emotional arousals of the day and that, if she was dreaming a lot at night, she was not benefiting from the deeper, slow wave sleep which repairs and refreshes the body.

I told her that, because it was still very unnatural for us to be upright, that we tear and damage our muscles during the day and that these quite naturally repair at night in slow wave sleep.

 We discussed how, in sleeping so long during the daytime, she was disrupting her normal ultradian and circadian rhythms, was probably over dreaming, and that dreaming had been shown to be actually very tiring as it uses motivational energy. In other words her get-up-and-go was getting up and going during her excessive sleep.

I made a suggestion that Ruth try to sleep only at night, that the bedroom was for sleep only, not reading or watching TV and that if she felt like resting during the day, she should relax on the settee downstairs.

Ruth got these concepts straight away and was determined to put them into action.

On that first session, I taught Ruth how to relax herself very deeply with a breathing technique and I gave her a notebook to record her internal monologue (the background tape of self talk we run internally which is often very negative)

I also asked her to write down at the end of the day, three things that had gone well, something she was looking forward to, plus any improvements she noticed as a result of doing the breathing exercise.

By session 2, it became clear that Ruth was practising the breathing technique and using it to calm down her emotional thinking.

With a calmer and clearer frame of mind, we could now commence the real psychological work and address the issue of pain…

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