Session title: Maternal Sexuality, Intergenerational Shame, and Authenticity.

Brief summary of session: presented with increased anxiety and sleep disturbances stemming from a lie she told her daughter, , about her intimacy since her divorce. This connected to 's previous session concerns about sleep and anxiety, but the source shifted. 's guilt and anxiety manifested in somatic symptoms like nausea, chest tightness, and insomnia. The therapist connected this to 's past therapy work on attachment patterns and the intergenerational transmission of shame around maternal sexuality. 's lie stemmed from a fear of her daughter reacting with disgust and betrayal, mirroring her own experience with her mother. The therapist helped recognize a repetition compulsion, unconsciously recreating the problematic dynamic from her own childhood. experienced sadness for herself, her mother, and , recognizing the perpetuation of harmful patterns. Through exploration, reframed the situation as an opportunity to model authenticity and repair for . She identified a desire for authentic motherhood, characterized by honesty and acceptance of imperfection. This cognitive restructuring led to a decrease in her somatic anxiety symptoms. The next session will focus on developing a strategy for to talk to .

SUBJECTIVE

#SOAP

Presentation:

• Chief complaint: presented with heightened anxiety, guilt, and sleep disturbances due to lying to her daughter about her intimacy since her divorce. She experiences intrusive thoughts, nausea, chest heaviness, and insomnia related to this event.
• Quote (chief complaint): "Actually, I've barely slept this week, but not because of the usual anxiety. Something happened with , my daughter, and I just can't stop thinking about it. I keep replaying it over and over."
• Impairments and challenges: 's anxiety and guilt are impacting her sleep, causing physiological distress, and affecting her ability to function effectively as a mother. She is engaging in secretive behaviors to maintain an idealized maternal image, which is causing internal conflict and exhaustion.
• Family dynamics: 's relationship with her daughter is strained by her lie and fear of judgment. She is attempting to protect her daughter from the shame she experienced regarding her own mother's sexuality. This dynamic reflects an intergenerational pattern of secrecy and difficulty with open communication about sexuality within the family.
• Communication patterns: struggles with open and honest communication, particularly regarding her personal life, with her daughter. She defaults to secrecy and lying to maintain a specific image, which ultimately creates internal conflict and distress.
• Quote (communication patterns): "She asked me if I'd been intimate with anyone since her father, and I lied to her. I've never lied to her before."
• Conflict resolution: avoids conflict by lying and maintaining secrecy. This avoidance leads to increased internal distress and perpetuates unhealthy communication patterns.
• Quote (conflict resolution): "I'm exhausting myself trying to be this perfect mother, but I'm lying to do it."
• Family roles: is enacting the role of the 'perfect mother,' prioritizing maintaining an idealized image over honest communication. This role is driven by her past experiences and fear of replicating negative dynamics.
• Quote (family roles): "I'm exhausting myself trying to be this perfect mother"
• Family rules and boundaries: There appears to be an implicit family rule around avoiding open discussion of maternal sexuality, likely stemming from 's own childhood experiences. This unspoken rule contributes to the current communication difficulties.
• Quote (family rules and boundaries): "All I could think about was when I was her age and found out about my mother's sexuality I remember feeling so disgusted, so betrayed."

Psychological factors:

#DiagL #WAM #LEC #PKAE #CSG