Leah returned for her second session. She arrived describing a stretch of feeling overwhelmed and "like I'm treading water," juggling long nursing shifts, a young family, and a house that never feels on top of. Her opening was that "nothing is working" and she doesn't know where to start.
Rather than mapping the problem in detail, we worked in a solution-focused way. When I asked what she would notice if she woke up tomorrow and things were suddenly more manageable (her version of the miracle question), she described getting up ten minutes earlier without dread, having a calmer handover at work, saying yes to one small thing for herself, and going to bed without a running list in her head.
We looked for exceptions. Even in a hard week, she identified two days that went "a bit better." On both, she had prepped the night before, taken a proper break on shift, and messaged a friend. She was surprised to notice she already does things that help; they just get lost in the overwhelm.
On a scale where 10 is coping the way she wants and 0 is the worst it has been, she placed herself at a 4, and said she has been as low as a 2, so she is already above her worst. When I asked what a 5 would look like, she described protecting one evening a week and asking her partner for help with bedtime.
No risk concerns: denies SI/HI. This is stress and overwhelm rather than clinical depression.
Goals she named: feel less like she is treading water, do more of what already helps, and take one small step toward a five this week.
Direction: Solution-focused brief therapy. Build on her preferred future from the miracle question; amplify the exceptions she already has (prepping the night before, breaks, connection); use scaling to define a concrete, small next step toward a five; and highlight her existing strengths and resources rather than analysing the problem.