After visiting several doctors complaining of chest pains, Jane
was referred to counseling by her cardiologist. An extensive
battery of tests revealed no cardiac problems or indications of
other physiological illness.
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Jane is a 54-year-old Caucasian female. She arrived for
her appointment early, was casually dressed, with meticulous
attention to her hair and makeup. Although smiling and
generally cooperative, Jane seemed unsure of her need for
therapy and hinted at frustration with being referred for
counseling. At times she became guarded responding to
personal questions, noting concerns regarding being
misunderstood and not seeing the relevance of certain
inquiries. It seemed important to Jane that the counselor
understand that in sharing some of her frustrations she was
not complaining, but that “everything’s good in [her] life.”
Jane appeared intelligent yet not particularly
psychologically minded.
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Jane began experiencing chest pain about 12 months ago
accompanied by shortness of breath within the last six
months. She perceives her problems to be caused by
physiological factors and did not initially identify any
problems that she wanted to address in counseling. She
reports that she “feels certain” something is wrong with her
heart and fears something bad might happen to her. She
explains that when the symptoms begin, she is "terrified" of
experiencing a “full blown heart attack” and sits still
until she feels better.
When asked about what was going on in her life at the time
the symptoms began, she said there was nothing unusual,
"just the normal hassles of managing work and home." Jane
did acknowledge that both she and her husband have demanding
jobs and that she is “maybe a bit upset” about some work
related conflicts. She apparently struggles with guilt and
frustration at having to choose between her family and a
career that demands long hours for the possibility of one
day being promoted. She also acknowledged, albeit
hesitantly, some anger based on not yet being promoted,
something she considers to be due to being female and seen
differently than her colleagues.
Jane also noted that as her husband frequently travels, she
is often left alone to manage the household. Her children,
currently in college were described as "a bit high-strung"
and require a lot of her attention. Jane says her husband
and children are concerned about her and are angry that the
doctors have not determined the problem.
Jane is the third of four children (2 sisters, 1
brother). Her father is a retired math professor and her
mother is a homemaker; both are in their 80’s and not in
good health. Jane and her siblings (only one of whom live
nearby) placed their parents in a nursing home near Jane's
house two years ago. She says “it was just best for
everyone.” Jane noted that her older brother and sister have
never been very close to their parents and her younger
sister has three kids at home. She noted that she has
“always been the closest” and has assumed most of the
financial responsibility for her parents' expenses.
Jane has been married for 20 years to Gary, an attorney. She
and her husband first met in junior high school and later
dated while he was in law school and she was completing her
MBA. Jane and her husband have two sons, now 18 and 19. The
oldest son attends a university in Chicago while her younger
son attends a community college and lives at home. She is
very happy to have her younger son with her because there
was a "little trouble, just normal teenage stuff" a few
years ago and he was "not at home for a while." He returned
home about a year ago. Pressed for details, Jane said it was
an “issue” with drugs but "it’s fine now . . . that’s all
over."
When asked what it was like growing up, Jane said her
parents were strict and very religious. A salient early
memory for Jane is being at the dinner table and having to
"earn" crackers to go with her chili by reciting the Ten
Commandments and various Bible verses from memory. She
states that her older brother and sister have “always been
kind of wild and crazy” and that her younger sister “was the
baby of the family.” She noted that her parents always said
that they were proud of her that they “never had to worry
about my behavior.”
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Jane describes her marriage as “comfortable” and
sometimes “boring” just “like any long term marriage” while
qualifying that her husband is good to her. When asked about
their sex life, Jane said that like "most women", the
physical aspect of their marriage is “fine” and has never
been very important to her or she thought to her husband.
She indicated that her husband has always said he is
“satisfied with that part of their relationship.”
Jane recently has become close to a woman, Barbara, who she
met in a creative writing course. She has recently taken up
meditation after Barbara suggested that it might eliminate
her stress and perhaps her physical problems. During a
recent retreat, which she attended with Barbara, Jane
responded strongly to the Buddhist teachings she heard, but
felt "some discomfort" about entertaining these new ideas.
At the same time Jane states that, "Since Barbara and I
became friends, I feel excited about the future again." Some
family members, especially Jane's mother, are concerned
about how much time Jane spends with her new friend.
Jane mentioned having a broad network of family members,
professional relationships, and a strong church community.
However, she reports that "something is different" about
being with old friends and family. She wonders if her
physical problems have affected her relationships. Jane has
never been in therapy, but she has taken various medications
for her physical symptoms, including Inderal for the
palpitations and a low dose of Xanax for anxiety as needed,
both prescribed by her family doctor. According to the
doctors her health is excellent. She reports exercising
regularly.
Jane has been working for the same major accounting firm
since she completed her MBA 20 years ago. She began as a
management intern and has worked up through the ranks to the
middle management position she has held for the last 8
years. She had hoped to eventually become a Senior Account
Manager with the company, but expressed that she had lately
felt distressed about her progress, suggesting "maybe I
don't have what it takes to do that." She now admits to
questioning whether the long hours she has spent away from
her husband and children over the years in hopes of being
promoted has been worth it. She noted that the upper
management are all men, but Jane does not think they are
opposed to having women in upper management.
Jane does experience frustration and some anger about the
difference between the way she and her male manager
colleagues experience their jobs. She explains that no one
expects her male colleagues to remember birthdays and plan
department parties. If “a man ever remembered somebody’s
birthday” she comments, everyone would think it was
“wonderful” and “above and beyond the call of duty.” She
states that she feels that as a female manager her staff
just expects it of her while simultaneously expecting her to
be “a really strong leader."
Jane also acknowledged feeling some guilt about the long
hours she has put into her career, time spent away from her
family. She states that she has “struggled” with her
mother’s feeling that she hasn’t spent enough time at home
with her children. She expresses feelings of being “torn”
between a career she enjoys and being there for her youngest
son before he leaves home.
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