What Therapy Can Look Like
Every client’s story is unique, but many of us carry similar questions, struggles, and longings beneath the surface. These vignettes offer a glimpse into the kinds of journeys I’ve supported: people navigating anxiety, disconnection, relational pain, the impacts of trauma, and the desire for deeper self-understanding. While names have been anonymized and details made nuanced or invented or to protect privacy, each story reflects real themes and real healing. My hope is that you’ll find something relatable here, something that reminds you that change is possible, and that there is hope.
Client Vignette: Reclaiming Calm and Clarity Amidst Relationship Stress
When A. first came to therapy, she felt like she was constantly holding her breath. A university-educated professional working in government, she was used to managing deadlines and expectations with poise. But lately, tension had been building beneath the surface. She found herself increasingly irritable around her partner and some colleagues; quick to frustration but hesitant to speak up. The stress sat heavily in her body, showing up as tightness, anxiety, and fatigue.
At first, A. described feeling “off” but couldn’t quite name why. As we got to know each other, our sessions became a space for her to slow down, breathe, and explore what was happening beneath the surface. Together, we gently tracked the sensations in her body, using a blend of Internal Family Systems (IFS) and somatic awareness to begin understanding her internal landscape. We noticed the parts of her that were trying to keep things together, and the deeper parts that were holding sadness and anger.
A turning point came when she began to recognize how much of her emotional weight wasn’t just about her partner at all. Old patterns rooted in her relationship with her parents were quietly influencing how she responded to conflict, vulnerability, and unmet needs. With growing compassion for herself, she started to connect with the anger and sadness that had long gone unspoken, and to see those emotions not as problems, but as signals pointing toward what really mattered to her.
Over time, the therapeutic relationship deepened. We shared laughter, silence, and moments of insight as A. slowly learned to trust not only me but herself. She began showing up with more honesty in her relationship, speaking her truth with calm confidence. The anxiety eased. The tension softened. She described feeling lighter, more connected to herself and clearer about how she wanted to move through the world.
By the time our work came to a close, A. had cultivated a deep sense of presence and self-trust. She felt more grounded and more able to respond, rather than react, to the challenges in her life. Calm, curious, and connected, she stepped forward with a new understanding of what it meant to truly show up, for herself, and for those she loved.
Case Study: From Pressure to Presence – Rebalancing a Life Built on Achievement
When J. arrived in therapy, he was feeling out of balance and quietly exhausted. A university student, J. carried a deep drive to be the best that he could be. There was a constant pressure to maximize his potential, live up to expectations, and always do his best. On the outside, he looked composed and accomplished. Internally, he felt exhausted, stressed, and stretched to his limits.
He had started to notice that his way of living, pushing hard, setting high bars, and rarely pausing, may not be sustainable. He wasn’t sleeping well, found himself easily frustrated, and struggled to feel truly satisfied with anything he achieved. At the same time, he did not want to sacrifice his dreams or his future. He deeply understood the difficulty of finding academic, career, and financial success in the world and was driven to do their best. He came to therapy not because everything was falling apart, but because, despite checking the boxes, something was missing. He wanted more clarity, more balance, and more ease.
In our early sessions, we focused on building a sense of connection and safety. J. was thoughtful, reflective, and open, but also hard on himself. Together, we took time to understand the parts of him that were pushing so hard, to validate their good intentions, and to soften around the shame, distractions, and fatigue that had crept in. Using a mix of Internal Family Systems (IFS) and humanistic approaches, we created space for J. to explore who he was beneath the pressure. There was room for laughter, reflection, and being truly seen.
A key insight came when J. recognized how deeply some of his critical parts believed that constant achievement was the path to worth and fulfillment. These parts were not enemies. They were protectors. When J. began to understand this, something shifted. He started to appreciate the effort these parts were making and to realize that he did not have to get rid of them in order to feel better. He could listen to them and also begin to widen the lens of what success and well-being could look like.
As our work deepened, so did J.’s self-awareness. He began to reconnect with what truly mattered to him. It was not just about performance, but presence. Not just outcomes, but meaning. Therapy supported him in moving toward a more integrated life, one that honored his drive without letting it take over.
By the time we ended our work together, J. felt calmer, clearer, and more grounded. He had a stronger sense of who he was and what he valued. He was learning to move through life with more balance and intention. He described feeling more alive and more whole. He was able to appreciate the richness of his experiences without the constant urgency to prove himself. He had not abandoned his values. He had expanded them. And in doing so, he found a way forward that felt both authentic and sustainable.
Case Study: Reclaiming Self-Trust After Trauma
When S. came to therapy, she felt cut off from herself. A working professional in her early thirties, she carried herself with competence and care in many areas of life. But underneath, there was pain she hadn’t fully been able to name. She described herself as feeling out of sync, like she was drifting from her own center. At times, she leaned on substances to help her cope. She felt angry, disappointed in herself, and unsure how to break the pattern.
What brought her to therapy was a growing awareness that things could not continue this way. Past experiences of relational and physical trauma had left a mark. She didn’t fully trust herself. She noticed how often she would disconnect during difficult moments, checking out and feeling far away from what was happening around her, then blaming herself afterward. There was a quiet but urgent desire for change.
In our early work together, we focused on slowing down. Therapy became a space for grounding, for honoring her strengths, and for getting to know the parts of her that were trying to survive in the only ways they knew how. Using Internal Family Systems (IFS), we began to gently explore her internal world with patience and curiosity. She had full agency in our process, choosing what felt right to talk about and when. Even amidst the pain, there was room for humor, lightness, and a sense of shared understanding.
One of the most powerful turning points came when S. began to see just how much she had been doing to care for herself all along. She realized that her protectors, those patterns of numbing out or using substances, weren’t signs of failure. They were signs of her resilience. With that shift, compassion began to grow where there had once been self-blame.
As our work deepened, so did her relationship with herself. We attuned to the moments of emotional tension and overwhelm, slowly helping her stay with the discomfort instead of needing to escape it. She began to feel more familiar with her inner world, more present in her body, and more able to respond to difficult emotions with clarity and confidence.
By the end of our work together, S. felt calmer and more grounded. She described a growing sense of trust in herself, not because everything had been resolved, but because she understood herself better and appreciated what she had lived through. She felt more in control, more compassionate, and more connected to who she was and who she was becoming.
Case Study: Strengthening the Foundation Before Starting a Family
When M. and A. came to couples therapy, they were not in crisis, but they were at a crossroads. In their late twenties and early thirties and together for several years, they had started talking more seriously about having children. Beneath the excitement and planning, though, both were noticing subtle patterns of disconnection. Small arguments escalated more than they used to. At times, one of them would shut down, while the other felt increasingly alone in the relationship.
They described their relationship as loving and committed, but something felt fragile under the surface. There was a quiet fear that becoming parents without addressing these tensions might strain the bond they both valued deeply.
Using Emotionally Focused Couples Therapy (EFCT), we focused on helping them understand the emotional cycle they were caught in. Vulnerability often led to misunderstanding instead of closeness. EFCT is grounded in attachment theory and is especially well-suited to couples who want to deepen their connection in times of transition.
In our early sessions, we worked to slow things down and create safety in the room. M. often felt unheard or brushed off, but struggled to express what she really needed. A., on the other hand, often felt overwhelmed and unsure how to respond, so he pulled away to avoid making things worse. We began naming this cycle together, helping them recognize it as something they got caught in, not something either of them was doing wrong.
As we deepened the work, both partners began to access and share more vulnerable emotions. M. spoke about her fears of being abandoned or not prioritized once children arrived. A. acknowledged that his withdrawal came from early experiences of being overwhelmed by conflict. These moments, while tender, brought new clarity and compassion into their relationship.
Over time, they developed a stronger emotional bond. They learned how to respond to each other’s bids for connection with greater presence and care. The tension that once flared during disagreements softened, replaced by an ability to slow down, listen, and stay connected even when things felt hard.
By the end of our work, M. and A. felt more secure in their connection. They reported fewer conflicts, deeper communication, and a renewed sense of intimacy. They felt more confident, not only in their ability to navigate life as a couple, but in their readiness to face the joys and challenges of parenting together. Their relationship, once quietly strained, had become a more solid and nourishing foundation for the future they were building.
Case Study: Healing the Past and Reclaiming Self-Leadership
When T. came to therapy, he was searching for something he couldn’t quite name. In his mid-twenties, he was thoughtful, intelligent, and deeply introspective. He had dabbled in psychedelics and read extensively about healing and transformation, but still felt stuck. There were moments when life felt promising, even expansive. But more often, he found himself slipping into confusion, self-doubt, and old patterns he couldn’t fully shake.
T. had grown up in a household shaped by emotional volatility and instability. Much of his energy had gone into keeping the peace, staying out of the way, or disappearing into his own world. As an adult, he often felt detached or disconnected from his emotions. He would sometimes use cannabis or psychedelics in hopes of reconnecting with himself or accessing insight, but the effects were unpredictable. After a few difficult journeys, he began to question whether these substances were helping or simply reinforcing a cycle of avoidance.
Our early sessions were quiet, exploratory, and patient. Using the Internal Family Systems (IFS) model, we created space to listen to the parts of T. that were feeling overwhelmed, guarded, or skeptical. Rather than rushing into solutions, we focused on building trust—with each other and within his internal system. T. appreciated having agency in the process. He chose when to go deeper and when to pause. Over time, he became more curious about the internal parts that had taken on protective roles throughout his life.
A key turning point came when T. began to notice the younger parts of himself that were still carrying the fear and confusion of his childhood. These parts had never truly felt safe or seen. Through compassionate attention, he began to unblend from those experiences. He no longer saw his substance use as a flaw, but as a signal that something within him was struggling. He also began to experience his psychedelic insights differently—not as revelations to chase, but as emotional content to integrate with care and support.
As our work progressed, T. developed a more grounded relationship with his internal world. He found language for emotions that had previously felt unreachable. He described moments of calm, clarity, and even pride in himself. The internal noise quieted. He no longer felt pulled in so many directions. Instead, he began to recognize a deeper sense of self-leadership emerging.
By the end of our time together, T. felt more in touch with his values, more present in his relationships, and more accepting of where he was in his journey. He continued to explore healing with curiosity and compassion, not urgency. What once felt like a fragmented landscape began to feel more whole.
© 2023 Simon Erlich Psychotherapy