From The Therapist's Couch

We all have our ways of dealing with stress, and some manage it better than others. It seems that there are broadly two ways people "go" when stress gets the upper hand. There are those who tighten up and rein in; and those whose system breaks into uncontrollable outbursts of emotion.

Of course, these two ways of reacting are two sides of the same coin, and some people vacillate from one to the other. But the split is there, all around us: the anorexic versus the compulsive eater, if you like, or depressive versus manic behaviour. Most people just go on with their ways of dealing with stress, but sometimes it becomes impossible and help is sought.

This was very much the case for the woman who requested therapy because of the feeling that she was being governed by "rules" she couldn't control. By both nature and nurture, she was essentially someone who reined in rather than evacuated out. She had a neat, measured presence and always mulled things over before putting thoughts into speech. Her daily life was similarly prepared - each day was plotted before it unfolded.

This way of being hadn't, in itself, caused her any conscious distress. But several months ago two events precipitated an avalanche of worry: her job was suddenly at risk, and her closest friend was diagnosed with cancer. She responded to the acutely stressful unknown by organising her already well-ordered life with an increasingly exacting routine. Cleanliness became something she found herself consumed by, and within months she found it impossible to leave the house if her bedroom wasn't "just so" and her kitchen pristine.

Before too long, a host of controlling thoughts greeted her when she awoke, and escorted her through the day. Obeying the letter of their law brought some relief, but this internal tyranny soon increased its territory of control. Food became a part of its agenda, and my patient was soon marking her days with rigid plans about what to eat and when.

It was this last issue which brought her to therapy. She was painfully aware that although part of her longed to be released from the internal thought-police, another part was clinging to her need for this debilitating defence as tightly as a child clutches a security blanket. For several months our work explored both causes and purpose of her controlling symptoms. She made regular bold stabs at shooing the life-sapping rigidity away, but the habit had got into her system, and all challenges were smothered by its dominant grip.

Then one day she brought an unexpected hat-trick of synchronicities to therapy: a dream, a film and a flyer found in a local paper, which together snowballed into just the ammunition she needed. The dream was very short: in it she was trying to cook a meal without a recipe book. The film was Babette's Feast, a superb exploration of the battle between repetition and variety. The flyer was advertising a cookery course which aimed to encourage spontaneity.

This moment proved to be a breakthrough. She decided to enrol on the cookery course in order to remind herself of the wider need to abandon the "recipe book" habit. Less specifically, but more importantly, she became more forceful in challenging the tyranny of obsessive thoughts. Loosening this defence was a long-term struggle, but it soon paid dividends: her response to unpreparedness and so to stress became markedly different. There was more internal slack, less rigid obsessing. A lifetime of control had opened the door, a little, to the unknown.

health@independent.co.uk