Client Profile: "Sarah"
"Sarah," 32, presents with "high-functioning anxiety" and "obsessive thinking." Her stated goal is to "fix her relationship" with her "emotionally volatile" father, which she identifies as a primary source of stress and a trigger for people-pleasing.
The Therapeutic Pathway
The therapist's goal is to collaboratively move Sarah from simply managing symptoms to understanding their adaptive roots, and finally, to empowered behavioral change.
The 5-Part Assessment Framework
A structured inquiry to explore Sarah's adaptive responses and build a foundation for new relational patterns.
1. Communication & Relational Schemas
Clinical Rationale: To establish a baseline for Sarah's communication style and identify the core "rules" that govern her relationships.
Sarah's communication adapts to perceived threat. Her "unwritten rules" create different levels of emotional safety.
- "Describe the 'unwritten rules' of communication in your relationship with your father. What topics are 'safe,' and which are 'landmines'?"
2. Exploring the Fawn Response
Clinical Rationale: To explore "fawning" as a trauma-informed survival strategy, linking her anxiety to a learned pattern of appeasement to mitigate threat.
The fawn response is a cluster of strategies. A trigger (like an anticipated call) activates the entire system.
- "When you perceive tension from him, what is your very first, automatic impulse? Is it to fix, to soothe, or to apologize?"
3. De-Enmeshment (Accountability)
Clinical Rationale: To assess her differentiation of self and challenge the enmeshment where she assumes responsibility for her father's feelings.
Sarah's "obsessive thinking" is a protective function, but it's disproportionately focused on managing her father, leaving little room for her own needs.
- "How much of that mental energy is spent anticipating your father's reactions, replaying conversations, or worrying about his choices?"
4. Assessing Assertiveness
Clinical Rationale: To understand the specific cognitive, emotional, and somatic barriers to assertiveness in this relationship.
Sarah's learned definitions ("assertive = aggressive") create high perceived risks for setting even small boundaries.
- "What's the difference, in your mind, between being 'assertive' and being 'aggressive' or 'selfish'? Where did you learn those definitions?"
5. Coping with Emotional Immaturity
Clinical Rationale: To help Sarah shift her perspective from *changing her father* to *managing her own responses* to his limitations. This involves grief, acceptance, and reparenting.
Sarah's stated goal is currently focused on an external change (her father). The therapeutic work is to grieve this and shift the focus.
- "When you've needed emotional support, validation, or a true apology from your father, what has historically happened?"
- "This 'healing' you're seeking—how much of that goal involves him changing versus you changing how you relate to him?"
- "What would it be like to grieve the father you wish you had, in order to more clearly see and build a relationship with the father you actually have?"
Trainee Reflection & Discussion
Use these questions to guide your case conceptualization and treatment planning for "Sarah."
- Pacing & Safety: Given Sarah's high anxiety, which of the five sections would you start with, and which would you save for later?
- Psychoeducation: What is the first piece of psychoeducation you would offer Sarah? (e.g., explaining the 'fawn' response as a brilliant, adaptive strategy).
- The "Grief" Conversation: Sarah's goal is to "fix" the relationship. How would you handle the discrepancy between her goal and the therapeutic goal (Section 5) of acceptance?