Below is a case study highlighting a hypothetical Kelowna client who sought after counselling services at Unyielding Health & Wellness for overcoming suicidal ideation and rediscovering a sense of purpose.
Background Information
Client
Emily: A 34-year-old graphic designer in Kelowna, BC
Presenting Issue
Emily sought counselling at Unyielding Health & Wellness due to persistent feelings of hopelessness, passive suicidal ideation, and a lack of desire to participate in life. She frequently expressed thoughts like, “I don’t want to live like this, but I don’t want to die,” and struggled with motivation to engage in work, social activities, or self-care.
Emily felt overwhelmed by financial stress after a freelance contract ended as well as isolated after moving to Kelowna from Vancouver for that same job. She was resistant to therapy, fearing stigma and disliking the idea of medication as in the past she experienced less-than-ideal medication side effects (e.g., weight gain and blunting of life from antidepressants). Her goal was to find meaning and regain control over her life without feeling like a “failure.”
Background
Emily had been grappling with depression for several years, exacerbated by her recent move to Kelowna, where she struggled to build a social network. The loss of a major freelance contract triggered financial strain, leading to thoughts like, “I’m worthless if I can’t succeed.” She described feeling disconnected from her creative passions, once a source of joy, and avoided social events, fearing judgment.
Her passive suicidal ideation emerged as a desire to escape emotional pain, coupled with existential questions like, “What’s the point of living?” Emily’s resistance to therapy stemmed from a previous negative experience with medication and a belief that she should “handle it alone”. Her sister, who lived in Kelowna, encouraged her to seek help, attending the first session with her to ease her anxiety.
Therapeutic Approach
The counsellor, a Certified Canadian Counsellor (C.C.C.) with the Canadian Counselling and Psychotherapy Association (CCPA) at Unyielding Health & Wellness, used an integrative approach combining Rational Emotive Behaviour Therapy (REBT), Cognitive Behavioural Therapy (CBT), and Existential Therapy. The goals were to challenge Emily’s self-defeating beliefs, develop practical coping strategies, and help her reconnect with a sense of purpose and meaning in her life.
Initial Assessment
Process:
- Using Existential Therapy, the counsellor explored Emily’s sense of purposelessness through open-ended questions like, “What does a meaningful life mean to you in Kelowna?” Emily identified creativity, community connection, and personal growth as core values, but felt distant from them despite being able to name them.
- With CBT, the counsellor identified cognitive distortions, such as Emily’s all-or-nothing thinking (“If I’m not successful, I’m a failure”) and catastrophizing (“I’ll never find joy again”).
- REBT pinpointed irrational beliefs driving her hopelessness, such as, “I must be perfect to be worthy,” and “I should handle my problems alone.” The ABC model (Activating event, Belief, Consequence) clarified how these beliefs fuelled her suicidal ideation and disengagement.
- The counsellor assessed Emily’s passive suicidal ideation, confirming no active plan but noting the risk of escalation due to her isolation and stress. A safety plan was introduced, listing coping strategies (hobbies, favourite foods & shows, and supportive contacts).
Outcome: Emily felt validated and understood, reducing her fear of stigma. She agreed to weekly sessions with goals to reduce suicidal thoughts, rebuild confidence, and reconnect with her values through small, actionable steps.
How REBT Can Help
Goals: Challenge irrational beliefs to reduce Emily’s hopelessness and passive suicidal ideation, fostering self-acceptance and resilience.
Process:
- The counsellor used REBT’s disputing technique to challenge Emily’s belief, “I must be perfect to be worthy.” Through Socratic questioning (“Does one setback define your entire worth?”), Emily recognized this as self-defeating, adopting, “I can be valuable while making mistakes.”
- Another belief, “I should handle my problems alone,” was disputed with questions like, “Does seeking help make you weak, or is it a strength?” Emily practiced rational self-statements, such as, “Asking for help is a step toward growth.”
- Homework included journaling three daily instances where she showed resilience (e.g., completing a small design task) and practicing self-compassion affirmations during low moments.
- In sessions, role-playing helped Emily counter self-critical thoughts, such as reframing, “I’m a failure” to “I’m learning through challenges.”
Outcome: Emily’s suicidal ideation decreased in frequency, and she reported feeling less overwhelmed by self-criticism, gaining confidence in her ability to cope.
How CBT Can Help
Goals: Modify cognitive distortions and develop adaptive behaviors to manage Emily’s depression, reduce passive suicidal ideation, and increase engagement in daily life.
Process:
- Using CBT, the counsellor guided Emily through thought records to reframe distortions. For example, “I’ll never find joy again” became, “I can find small moments of joy, like sketching or walking by Okanagan Lake.”
- Behavioral experiments tested her fears. Emily committed to attending one social event (e.g., a Kelowna art gallery opening) to challenge, “People will judge me.” She found the experience less intimidating than expected.
- A positive data log tracked achievements, such as completing a freelance pitch or cooking a meal, reinforcing her sense of agency.
- The counsellor co-created a safety plan, listing coping strategies (e.g., mindfulness, sketching), reasons for living (e.g., her sister, her love for art), and contacts (e.g., BC Crisis Line). Emily practiced using this during low moments.
Outcome: Emily increased her engagement in daily activities, attending two social events and submitting three freelance pitches. Her safety plan provided security, and she rated her depression at 4/10 (down from 8/10).
How Existential Therapy Can Help
Goals: Address Emily’s purposelessness and existential crisis, aligning her actions with values to foster meaning and reduce suicidal ideation.
Process:
- The counsellor used Existential Therapy to explore Emily’s questions like, “What’s the point of life?” Asking, “What brings you a sense of purpose?” revealed her love for creativity and helping others.
- Logotherapy-inspired exercises encouraged Emily to envision a future where she felt connected. She pictured designing community art projects in Kelowna, which motivated her to volunteer at a local arts festival.
- The counsellor encouraged small, values-driven actions, such as sketching daily or joining a Kelowna hiking group to connect with nature, aligning with her value of personal growth.
- Reflective discussions helped Emily embrace life’s “messiness” as part of her journey, reducing her sense of being trapped.
Outcome: Emily reported a renewed sense of purpose, volunteering twice monthly and sketching regularly. Her passive suicidal ideation lessened, and she felt more connected to Kelowna’s community.
Integration, Results, and Termination
Goals: Consolidate progress, plan for maintenance, and prepare for therapy conclusion.
Process:
- The counsellor integrated REBT and CBT to reinforce rational beliefs and coping strategies. Emily practiced a “self-coaching” script for low moments (e.g., “Setbacks don’t define me”) and used thought records to manage triggers like financial stress.
- Existential Therapy helped Emily reflect on her growth, embracing creativity and community as anchors of meaning. She set a goal to launch a small graphic design business in Kelowna.
- A maintenance plan included journaling achievements, continuing volunteering, and submitting at least two freelance pitches per month. Emily was encouraged to join a CMHA Kelowna support group for ongoing connection.
- The counsellor reviewed the safety plan, ensuring Emily felt confident using it. Follow-up sessions were offered as needed, with a focus on sustaining progress.
Outcome: Emily rated her depression at 2/10 (down from 8/10) and reported no suicidal ideation for three weeks. She launched a freelance portfolio, joined a hiking group, and maintained regular contact with her sister, feeling more hopeful and engaged.
Results
Emily achieved significant improvements:
- Depression and Suicidal Ideation Reduction: Depression dropped from 8/10 to 2/10; passive suicidal ideation ceased, with a reliable safety plan in place.
- Increased Engagement: Emily submitted five freelance pitches, volunteered at a Kelowna arts festival, and joined a hiking group, boosting her social connection.
- Self-Esteem and Purpose: She regained confidence in her creative skills and found meaning through community involvement, aligning with her values.
- Resilience: Emily managed financial stress with budgeting tools and coped with setbacks using REBT and CBT strategies, reporting a stronger sense of control.
Why This Approach Worked
- REBT: Addressed irrational beliefs like “I must be perfect” and “I should handle it alone,” reducing Emily’s hopelessness and fostering self-acceptance, key to alleviating suicidal ideation.
- CBT: Provided structured tools like thought records and behavioural experiments, helping Emily manage depression and build confidence through small, actionable steps, as seen in effective cognitive interventions.
- Existential Therapy: Tackled her existential crisis, reconnecting her with values like creativity and community, reducing suicidality by fostering meaning.
- Integration: Combining REBT’s belief-challenging, CBT’s practical strategies, and Existential Therapy’s focus on purpose created a holistic approach, addressing emotional, cognitive, and existential needs in Kelowna’s unique context.
- Local Relevance: The counsellor’s use of Kelowna-specific activities (e.g., arts festivals, hiking) and Unyielding Health & Wellness’s confidential environment in the Landmark District alleviated stigma concerns, building trust.
Written By: Timothy Lamont C.C.C.
Disclaimer: The client name, details, and background used in this case study were generated with the assistance of Grok, an AI developed by xAI. AI enhances the results found within the case study, however it can make mistakes. The information and analysis presented in this case study have been critically reviewed and validated by a human therapist, who remains solely responsible for its application. Any resemblance to real persons, living or deceased, or actual events is purely coincidental. Therapists at Unyielding Health & Wellness uphold client confidentiality to the highest standard in accordance with Canadian and British Columbian privacy laws, including the Personal Information Protection Act (PIPA).
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