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This is the first of two part series exploring a recent mental health counseling case, first from the therapist’s perspective and process. Part two will share experiences expressed by the client. Identifiable information has been changed to protect confidentiality.

Part 1

Grace and I have been working together for just about a year. When we met, Grace, a registered nurse in her late 50s who enjoys knitting, reading, writing and friendships, showed signs of post-traumatic stress disorder (PTSD) and chronic depression. She also reported having a painful chronic illness that had been draining her finances, making her unable to afford her sky-high rent on her disability income. She was very, very scared of becoming homeless.

My instinct was first to secure Grace’s fundamental need to stable housing before addressing her emotions. However, Grace expressed a degree of terror over each realistic option that baffled me – it looked to me like she did not trust herself enough to live on her own because of a depressed mindset.

So I shifted my attention to her fear, focusing on traumatic events from her youth. My typical interventions for stabilization – practicing deep breathing, helping clients focus on aspects of the whole picture that they might be unable to see, and providing a secure presence in the midst of uncertainty – did not seem to budge the intensity of her feelings of hopelessness and helplessness.

It was not until I started to better understand the world of her chronic illness, Sjogren’s Disease, that she seemed to start to make gains. Her terror did not just stem from her past, but from the ongoing horror of her body failing her and the isolation of society’s denial of her reality. I learned that what I had thought was the depression talking was actually a brutal self-assessment of her physical capabilities.

My training to be a therapist made me familiar with mental and emotional anguish and taught me to treat mental illness as something that can be reckoned with, something that can be healed. But a physical chronic illness has no ending. It has no final healing. It’s hard to look at directly. That’s exactly what Grace needed, though – a direct acknowledgement and understanding of her real limitations. So I did some research and challenged my own discomfort; now we can work through her Sjogren’s Disease instead of around it.

Being in a relationship, whether it’s professional, fraternal, or romantic, with someone experiencing a chronic illness requires us to understand the ways that illness impacts them. How can you help? By developing a deeper empathy for Grace and everyone who suffers from an “invisible illness”. By educating yourself about Sjogren’s Disease at By reaching out more often to the homebound. And by advocating for societal support for people living with chronic illness, such as affordable supportive health care.

This is just my perspective, though; Grace has been courageous enough to share her story for herself. Stay tuned for part two of this post.

Learn more about mental health counseling for individuals, couples, families and children. See Catholic Charities Family Services.

Read the client’s perspective of this story here.

Sarah Strenio, MSW, is a Catholic Charities mental health counselor working towards licensure.