One client, many lenses
Short fictional cases, each read through the images of the person that run through the atlas. For supervision groups and for building a formulation you can stand behind.
After the redundancy
Maren is 52 and spent twenty-four years as a project engineer with one firm until a restructuring ended her post eight months ago. She describes herself as "flat" most days. She has stopped going to the climbing wall she used to visit weekly, lets calls from former colleagues go to voicemail and spends long mornings scrolling job sites without applying. Sleep is broken, and she says she feels "useless" and "a burden" to her partner, who is still working. She grew up the eldest of three in a household where her father's moods set the tone, and she learned early to be the competent one. She is angry with the firm but says that anger is "pointless" and quickly changes the subject. Her GP suggested talking therapy, and she has come, she says, "to get back to normal", though she is unsure what normal now means. She is not at risk, has good physical health and is curious about why this has hit her so hard.
Learned repertoire
A behavioural therapist would see a loss of the routines and contacts that used to bring reward, followed by withdrawal that removes still more reward and deepens low mood. A cognitive therapist would add that the redundancy has activated beliefs such as "my worth is my work", which colour how she reads each empty day.
First focus: Map how Maren actually spends her week and how her mood shifts with each activity.
Typical intervention: Activity monitoring and graded activity scheduling (Behavioural activation)
Might miss: The lens may treat the loss of a long working identity as a problem of reinforcement and not attend to the grief and meaning it carries.
Held by: Behavioural activation, Cognitive therapy
Mind in conflict
A contemporary Freudian therapist would understand the low mood partly as anger at the firm that cannot be owned and is turned back against the self as "uselessness". The redundancy may also revive an older conflict about whether she is valued for herself or only for her competence.
First focus: Notice what happens in the session whenever Maren's anger begins to surface and is set aside.
Typical intervention: Interpretation of defences and of feelings arising in the therapeutic relationship (Psychoanalytic and insight-oriented psychotherapy)
Might miss: Emphasis on inner conflict may give less weight to the practical and economic reality of losing a job at 52.
Held by: Contemporary Freudian analysis, Psychoanalytic and insight-oriented psychotherapy
Plural self
An Internal Family Systems therapist would hear several parts: a harsh manager that insists she should be applying, a part that shuts down and scrolls to avoid failure, and a younger part carrying the old sense that she must be useful to be safe. The difficulty lies in how these parts are polarised, not in Maren as a whole.
First focus: Help Maren notice and name the critical voice as one part among others.
Typical intervention: Unblending from protective parts and witnessing an exiled part (Internal Family Systems)
Might miss: Speaking in parts may feel artificial to a client who wants concrete help with a job search.
Held by: Internal Family Systems, Classical transactional analysis
Relational and systemic self
An interpersonal therapist would frame this as a role transition: the loss of a valued role, a shrinking social network and uncertainty about the new role. A Bowen-informed therapist might add that her position as the competent eldest child shapes how she now relates to her partner's continued working.
First focus: Link the onset of low mood to the role change and review her current network of relationships.
Typical intervention: Role-transition work: mourning the old role and building skills for the new one (Interpersonal psychotherapy)
Might miss: Focusing on relationships and roles may leave her bodily exhaustion and sleep less explored.
Held by: Interpersonal psychotherapy, Bowen family systems and genogram work
Embodied self and nervous system
A polyvagal-informed therapist would describe the flatness, heaviness and withdrawal as a nervous system that has moved towards a shut-down, conserving state after a threat to her security and belonging. Safety cues and gentle mobilisation would come before reasoning about the future.
First focus: Track with Maren which moments, places and people bring a little more energy into her body.
Typical intervention: Titration and pendulation between resourced and activated states (Somatic Experiencing)
Might miss: A nervous-system account may say little about the beliefs and family history that shape what the loss means to her.
Organism with an actualising tendency
A person-centred therapist would understand her distress as a gap between the self-concept "I am the competent one" and her present experience, held in place by conditions of worth learned early. Given empathy and acceptance, her own tendency towards growth is expected to find its direction.
First focus: Offer a relationship in which Maren can be uncertain without having to perform competence.
Typical intervention: Focusing on the felt sense of "what this whole situation is like" (Focusing and focusing-oriented therapy)
Might miss: A non-directive stance may feel slow to a client who explicitly asks for structure and a plan.
Held by: Person-centred therapy, Focusing and focusing-oriented therapy
Storied self
A narrative therapist would see a thin, problem-saturated story, "useless and a burden", that has crowded out other accounts of who Maren is. The story is shaped by wider cultural ideas linking a person's value to paid work.
First focus: Ask about times in the past months when Maren acted in ways the "useless" story would not predict.
Typical intervention: Re-authoring conversations built around unique outcomes (Narrative therapy)
Might miss: Attention to story may underplay the physiological side of disturbed sleep and low energy.
Held by: Narrative therapy, Cognitive narrative psychotherapy
Person within community, meaning or spirit
A logotherapist would understand the low mood as partly a loss of meaning, since the work that gave her days purpose has gone and nothing yet replaces it. An Ubuntu-informed counsellor would add that withdrawing from colleagues and friends cuts her off from the relationships through which personhood is sustained.
First focus: Explore what, apart from the job, has given Maren's life purpose and connection.
Typical intervention: Socratic dialogue about meaning and values (Logotherapy)
Might miss: A focus on meaning may move too quickly past the anger and grief she has not yet allowed herself.
Held by: Logotherapy, Ubuntu-informed counselling
For discussion
- Which lens felt closest to your own instinctive reading of Maren, and what does that suggest about your training so far?
- Her anger is noted but set aside: how would each lens make sense of that, and what would each do with it in the room?
- If Maren asks you directly for "a plan", how might you respond in a way that stays faithful to the lens you are working from?
After the car park
Jonah is 34 and works in logistics. Five months ago another car reversed into his at low speed in a supermarket car park. No one was hurt and the damage was minor, but a week later, stuck in traffic, he felt his heart pound, his chest tighten and his vision narrow, and was sure he was having a heart attack. Medical checks were clear. Since then he has had panic attacks in cars and, increasingly, in queues and on crowded trains. He has stopped driving, checks his pulse many times a day and carries a bottle of water "just in case". His partner now drives him everywhere and has begun to make excuses to friends on his behalf. Jonah describes himself as the "easy-going one" and is embarrassed that "something so small" has affected him. He mentions, almost in passing, that his father had a heart condition and that the accident happened on the week he was offered a promotion he had not yet decided to accept.
Learned repertoire
A cognitive therapist would see a cycle in which normal bodily sensations of arousal are read as signs of a heart attack, which raises arousal further. Avoidance, pulse-checking and carrying water act as safety behaviours that prevent him from learning that the feared outcome does not happen.
First focus: Build a shared diagram of a recent panic attack from first sensation to final thought and action.
Typical intervention: Behavioural experiments that test catastrophic interpretations of bodily sensations (Cognitive therapy for panic)
Might miss: This lens may pass quickly over why a minor accident, at this point in his life, carried such weight.
Held by: Cognitive therapy for panic, In-vivo, imaginal and interoceptive exposure
Mind in conflict
A therapist working in panic-focused psychodynamic psychotherapy would ask what the panic means personally: perhaps a conflict between wishes for independence, signalled by the promotion, and fears of separation, illness or his own anger. The symptom both expresses and disguises feelings he finds hard to own as the "easy-going one".
First focus: Explore what was happening in Jonah's life and feelings around the first attacks.
Typical intervention: Exploring the personal meaning of panic episodes and their link to separation and anger (Panic-focused psychodynamic psychotherapy)
Might miss: A meaning-centred approach may leave the avoidance itself unchallenged for some time while it continues to narrow his life.
Held by: Panic-focused psychodynamic psychotherapy, Modern conflict theory
Plural self
An ego state therapist would understand the panic as belonging to a frightened state that took charge at the moment of impact and has not stood down, while a more capable adult state is present at other times. The task is communication and cooperation between these states.
First focus: Help Jonah describe how the "panicking" Jonah differs from the "easy-going" Jonah.
Typical intervention: Dialogue with ego states, often within a hypnotic frame (Ego state therapy)
Might miss: Working with inner states may give less attention to how his partner's help is maintaining the avoidance.
Held by: Ego state therapy, Internal Family Systems
Relational and systemic self
A Bowen-informed family therapist would notice that anxiety has moved into the couple system: the partner now overfunctions by driving and explaining, and Jonah underfunctions. A family history of heart illness may carry anxiety across generations that the accident has stirred.
First focus: Draw a genogram that includes illness, caretaking roles and how the family handled fear.
Typical intervention: Genogram work and coaching towards differentiation of self (Bowen family systems and genogram work)
Might miss: A systemic focus may say little about the moment-to-moment bodily experience of panic.
Held by: Bowen family systems and genogram work, Relational psychoanalysis
Embodied self and nervous system
A Somatic Experiencing practitioner would understand the panic as activation from the collision that was never fully discharged, so the nervous system keeps preparing for an impact that has already happened. Even a minor event can leave an incomplete defensive response, such as bracing or turning away.
First focus: Build Jonah's capacity to notice sensations of settling and safety before approaching the memory of the impact.
Typical intervention: Titration and pendulation, with completion of interrupted defensive responses (Somatic Experiencing)
Might miss: Concentrating on the body may underplay the beliefs about heart attacks that keep him checking his pulse.
Held by: Somatic Experiencing, Polyvagal-informed therapy, Trauma Resiliency Model
Organism with an actualising tendency
A person-centred therapist would understand the distress partly as incongruence between his self-image as the relaxed, easy-going one and an experience of fear he cannot accept as his own. An emotion-focused therapist would add that fear may sit over other primary emotions that need to be reached.
First focus: Respond empathically to Jonah's embarrassment so that fear can be acknowledged without judgement.
Typical intervention: Empathic exploration and evocative unfolding of a recent panic episode (Emotion-focused therapy)
Might miss: Trusting his own direction may feel too unstructured while his world is contracting week by week.
Storied self
A personal construct therapist would ask how Jonah construes himself and the world since the accident, perhaps as "fragile" against "easy-going", with few constructs left for being both cautious and capable. A cognitive narrative therapist would look at how he is now telling the story of his life and health.
First focus: Elicit the contrasts Jonah uses to describe himself before and after the accident.
Typical intervention: Fixed-role therapy: trying out a written sketch of a new way of living for a fortnight (Personal construct therapy and fixed-role therapy)
Might miss: A focus on constructs and stories may leave the physical intensity of panic insufficiently addressed.
Held by: Personal construct therapy and fixed-role therapy, Cognitive narrative psychotherapy
Person within community, meaning or spirit
An existential therapist in Yalom's tradition would see the accident, his father's heart condition and the promotion together as confronting Jonah with mortality, freedom and responsibility. The panic may be one way of living with anxiety that belongs to being human rather than to the car park alone.
First focus: Make room for Jonah to speak about his father's illness and what the promotion decision asks of him.
Typical intervention: Exploring death anxiety and responsibility within the here-and-now relationship (Yalom's existential psychotherapy)
Might miss: A philosophical framing may feel far from his wish to be able to drive to work again.
Held by: Yalom's existential psychotherapy, Logotherapy
For discussion
- Jonah mentions his father's heart condition and the promotion "almost in passing". Which lenses would follow these up first, and which might return to them later?
- How would each lens view the partner's help with driving, and how might you raise that with Jonah without implying blame?
- If you combined two of these lenses in practice, which pairing would fit together easily and which would pull in different directions?
The same argument
Sam and Alex, both in their late thirties, have been together for nine years and have a six-year-old daughter. They come because "we keep having the same argument". It usually starts over something small, such as plans for a weekend or who is visiting which family over the holidays. Sam raises the issue, Alex goes quiet or leaves the room, Sam follows and becomes louder, and Alex eventually says something cutting before going for a long walk. Afterwards they are polite for a few days. Sam grew up in a family where a parent's criticism was frequent and silence meant you were in trouble. Alex grew up in a household where disagreements were never voiced and a grandparent's opinion settled family decisions. Both say they love each other and want their daughter to grow up without tension. Each privately believes the other "started it". They are tired, a little embarrassed to be in therapy and hopeful that "someone neutral" will help.
Learned repertoire
An integrative behavioural couple therapist would see two partners whose differences were once attractive and are now met with patterns, demanding and withdrawing, that each reinforce the other. Cognitive-behavioural couple work would add the skills of starting and repairing conflict that the couple may not yet use.
First focus: Describe the sequence of a typical argument together in neutral, behavioural terms.
Typical intervention: Empathic joining and unified detachment around the shared pattern (Integrative behavioural couple therapy)
Might miss: A pattern-and-skills view may not explain why these particular moves feel so charged for each of them.
Held by: Integrative behavioural couple therapy, Gottman method
Mind in conflict
An object relations couple therapist would understand the argument as a shared unconscious arrangement in which each partner locates disowned feelings in the other. Sam may carry the anger that Alex's family could not voice, while Alex carries the retreat and fear that Sam learned to dread.
First focus: Attend to how the couple use the therapist and the session to recreate the same pattern.
Typical intervention: Interpreting shared projective processes and the couple's unconscious fit (Object relations family and couple therapy)
Might miss: Interpretation of unconscious fit may feel too abstract for a tired couple who want the arguments to stop.
Held by: Object relations family and couple therapy, British object relations
Plural self
A transactional analyst would read the argument as a recurring game in which each partner moves out of an Adult ego state into Parent or Child states learned in their families. The predictable sequence and the "payoff" of distance afterwards are the clues.
First focus: Identify the moment in a typical argument when each partner stops speaking from the Adult.
Typical intervention: Ego-state diagrams and game analysis of the recurring exchange (Classical transactional analysis)
Might miss: Mapping states and games may not reach the attachment fears that make the pattern so persistent.
Held by: Classical transactional analysis, Internal Family Systems
Relational and systemic self
An emotionally focused couples therapist would see a negative cycle, pursue and withdraw, driven by attachment fears: Sam's fear of being shut out and Alex's fear of failing or being judged. The cycle, not either partner, is framed as the problem.
First focus: Track the cycle aloud with the couple and reach the softer emotions beneath each partner's move.
Typical intervention: Tracking the negative cycle and restructuring attachment interactions (Emotionally focused couples therapy)
Might miss: Concentrating on the couple bond may leave less room for the wider extended-family influence on holiday decisions.
Held by: Emotionally focused couples therapy, Bowen family systems and genogram work, Contextual therapy
Embodied self and nervous system
A polyvagal-informed therapist would notice that once the argument begins, both nervous systems shift into defence, Sam into mobilised protest and Alex into flight or freeze, and neither can then hear the other. Repair depends on recognising these states and offering cues of safety.
First focus: Help each partner notice bodily signs that they are leaving a settled state during an argument.
Typical intervention: Mapping autonomic states and practising co-regulation within the session (Polyvagal-informed therapy)
Might miss: State-tracking alone may say little about the meanings each family taught about conflict.
Held by: Polyvagal-informed therapy, Embodied relational therapy
Organism with an actualising tendency
An emotion-focused couple therapist in Greenberg's tradition would see secondary emotions, anger and coldness, covering primary needs for connection, recognition and safety. A person-centred therapist would add that each partner holds within them a capacity to move towards a more open relationship when they feel received.
First focus: Offer each partner the experience of being fully heard before any change is asked of them.
Typical intervention: Accessing and expressing the primary emotions beneath reactive anger and withdrawal (Emotion-focused couple therapy (Greenberg))
Might miss: Trust in an inner direction may underplay the practical agreements the couple need to make about family visits.
Held by: Emotion-focused couple therapy (Greenberg), Person-centred therapy
Storied self
A narrative therapist would see a story in which each partner is cast as the one who "started it", supported by wider cultural ideas about family duty and conflict. Externalising the pattern allows the couple to stand together against it.
First focus: Invite the couple to give the recurring argument a name of their own.
Typical intervention: Externalising conversations about the problem (Narrative therapy)
Might miss: A re-storying focus may not address the physiological flooding that makes listening hard in the moment.
Held by: Narrative therapy, Just Therapy
Person within community, meaning or spirit
A contextual therapist would place the argument within loyalties and obligations that run across generations, so that disputes over holidays may also be questions of fairness to each family of origin. Spiritually integrated or Ubuntu-informed work would ask which shared values and communities the couple want their daughter to belong to.
First focus: Explore what each partner feels they owe their family of origin and what they want to give their daughter.
Typical intervention: Multidirected partiality towards each partner and each family's claims (Contextual therapy)
Might miss: A focus on loyalty and values may not supply the moment-to-moment skills needed to interrupt an escalating argument.
Held by: Contextual therapy, Spiritually integrated psychotherapy, Ubuntu-informed counselling
For discussion
- Each partner hopes for "someone neutral". How does each lens understand neutrality, and what would it mean to take sides in a way the lens allows?
- The couple's families of origin appear in almost every lens. Where do the lenses differ in how present-day and past patterns are linked?
- Which two lenses describe the same sequence of events in the most different language, and what does each language make visible?