A Longer Case: The Unfinished Novel

Longer case

A Longer Case: The Unfinished Novel

How do you go after something you want when your energy might not be there tomorrow?

What brought him

Tom is 29 and has had ME/CFS for six years, moderate most of the time, with crashes after overexertion that can last days or weeks. He used to teach English. He has been writing a novel, on and off, for four years, and three months ago started seeing Sam. He comes to therapy – by video, lying down, camera optional – because, in his words, “I want things again, and it’s terrifying.”

What the therapist first understood – and what Tom corrected

The therapist heard “terrifying” and initially focused on fear of rejection with Sam – the new relationship seemed the obvious source of anxiety. Tom let this run for two sessions, then said:

The therapist had located the fear in a relationship. Tom located it in a lived pattern between desire and physical consequence. That reframed the work: not “why are you afraid of intimacy” but “how do you let yourself want things when wanting has had real costs?”

What changed in the format

Fifty-minute sessions were often followed by a day of extra fatigue. They tried 30 minutes weekly, then settled on 35 minutes with a written follow-up – a few lines from the therapist summarising what was said, so Tom didn’t have to hold it in his head. They agreed in advance what would happen on crash weeks: Tom could message “not today” with no explanation and no fee, and the next session would start with no catching up required. The therapist also stopped asking deep questions in the last ten minutes, after Tom said those were the ones that kept him awake.

The emotional work that became possible

With the format settled, two strands opened up.

Grief for the teacher. Tom had described leaving teaching as “just what happened.” Over several sessions, in short bursts, he talked about missing his students and the person who had been good at something in public. He didn’t want to resolve it. He wanted, he said, to stop pretending he didn’t care.

Wanting and pacing. The therapist offered a short, adapted Focusing exercise – noticing, without needing a clear bodily sensation, what “the book” felt like from the inside. Tom found it hard at first (“my body mostly just says tired”), then described a sense of the book as “a window I keep closing so I don’t get cold.” That image became useful. It let them talk about wanting as something to open a little at a time, rather than all or nothing.

There was a hard month in the middle. A crash after a weekend away with Sam lasted three weeks. Tom came back flat and self-critical: “This is exactly what I said would happen.” The therapist didn’t argue with him, and didn’t turn it into a lesson. They looked at what the weekend had given as well as what it cost, and Tom decided it had been worth it – and that next time he’d plan a recovery week afterwards, not instead.

The practical action he wanted

• The book: he set a “floor” rather than a target – opening the document on any day he could, even if he wrote one sentence or none. He used dictation on bed days.
• Sam: he wrote Sam a message (drafted in session) about what crash weeks look like and what helps, so he wouldn’t have to explain in the middle of one.
• Money: a benefits review arrived in month four. He asked for help thinking through what to say without either minimising or overstating; the therapist pointed him to a welfare rights service rather than advising on the form.

What remained difficult

• His health didn’t change. Crashes still came, sometimes without obvious cause.
• The benefits review was stressful and took months.
• The novel was about two-thirds drafted at the end of six months – more than before, not finished.
• Some friends still didn’t understand why he cancelled, and he decided not to keep explaining.

How they judged whether it helped

At six months they reviewed together. Tom’s measures: he had written on more days in three months than in the previous year; he had been away with Sam twice, once with a planned recovery week; and – the one he cared most about – he no longer described wanting things as stupid. He also said the shorter sessions were the main reason he’d kept coming. The therapist’s sense was that the biggest change was Tom treating crashes as costs rather than verdicts. They agreed to continue fortnightly.

What this case illustrates

• Growth happening on an unstable base – neither waiting for stability nor pretending it doesn’t matter.
• The client’s main concern – desire and fear – wasn’t “about disability” in the usual sense, but couldn’t be understood without it.
• Format adaptations (length, written summaries, crash-week rules) were part of the therapy, not a preliminary.
• Focusing worked in an adapted, image-led form that didn’t require a clear bodily felt sense.
• Partial progress – a book two-thirds written – counted as progress.

Evidence and status

• This is an illustrative composite written for this site. It is not a case report, not drawn from any individual’s therapy, and not evidence that this way of working produces particular outcomes.
• Post-exertional symptom worsening is a recognised feature of ME/CFS in current clinical guidance (for example, NICE guideline NG206, 2021). This page does not offer medical advice about pacing or energy management.
• The humanistic concepts it draws on are Maslow’s, Rogers’s and Gendlin’s; their application here is this site’s synthesis.

If none of this fits – if your energy is steady, or if wanting has never felt dangerous – the case may still show something about how therapy can adapt its shape to a person, rather than the other way round.

One question to carry: what do you want that you’ve stopped letting yourself want – and what would a small, recoverable version of going after it look like?