I was finally on my last therapy session for the day. The last client; I'd seen her twice before at the time. She was extremely depressed and down on life. I'd diagnosed her with adjustment disorder which is a fancy and billable way to say that she was struggling with a big life change. She was married, young and very pretty, pressured to marry when she wasn't ready. She just looked sad all the time and her husband was begging her to see someone to "fix" this problem so she'd get back to doing dishes again.
She was extremely shy during our first two sessions which were all about rapport building and simply getting her to talk and loosen up. She wasn't ready to talk about her past so I decided to keep it all focused on the here and now: skill building, mindfulness, emotional awareness etc. This session was like the last two but this time I introduced "big list." A list with hundreds of ideas of new things to try or things you do already with a suggested added twist. The list is exhaustive to the point of annoyance: plant herbs, complete a crossword puzzle, etc. I told her to pick one for homework.
She studied the list, biting her lip. I watched her face as she read. Suddenly, she gets an uncomfortable look and says "masturbate?" I nod my head "yeah, that's definitely something that can make you feel a little better, keeps you grounded and provides some safe pleasure for awhile." She continues to look at the list and shakes her head with a look of disappointment, handing it back to me. She says, "I don't know, nothing looks right." I paused and let her feel the discomfort for a moment.
"You pointed out masturbation... maybe that's one to explore" I finally said. She explained uncomfortably that she already does that often, especially since her and her angry husband have been having trouble at home.
We talked about it. I tried to normalize it as much as possible to make her comfortable with idea and to just pick something. We processed the depressive thoughts she was having in the moment, preventing her from taking action to feel better. Nervously, she listened, wringing her hands and struggling to maintain eye contact. I told her the key is to do something different, something out of the box. I made a few suggestions: masturbate in the bath tub, in the car or even in bed to put on a show for her husband. Her eyes connected to mine when I said the last part, but then quickly looked away. I smiled "putting on a show?" This made her smile and giggle, a response I'd never seen.
She finally agreed to maybe try this idea but was concerned that she'd do a terrible job and he wouldn't like it and only criticize her. We took some deep breaths together and I had her walk me through the steps she'd take. She could barely get the words out. Stuttering, trembling, she manages to give a brief plan to rub her fingers over her panties with her legs spread out.
I stopped her there. "It's ok. You're in a safe place. Let's take some deep breaths. Just close your eyes. Let's walk through this together." She followed my instructions. With her eyes closed and rhythmically breathing I walk her through the plan. I asked her to move her legs into the position she would do to show me, and just place her hand and fingers over her skirt and walk me through it.
She was comfortable with that and had a guilty smile on her face. She put one leg over the arm of the comfy chair and started to paw between her legs. "Come on now, you want to get better don't you? You need to take this seriously."
