Vignette 1: Formation of adolescent identity
Client profile: A 16-year-old girl who was referred for low mood, absence from school, and social withdrawal. She reports feeling “invisible” and fearing being negatively assessed by peers.
Presenting fear: Fear of rejection and fear of not belonging.
FIT formulation:
Intrapersonal: Fear of inadequacy and emotional exposure
Interpersonal: Fear of peer rejection and relational rupture
Existential: Fear of being unimportant or unseen
Systemic: Fear of cultural invalidation and social comparison
Integration strategy:
Application of expressive arts in externalising and identifying fear
Compassion-focused therapy for shame and self-criticism
Psychoeducation on growth in adolescence and social anxiety
Exploring values and meaning in life through narrative therapy
Outcome:
More feeling-expression and acceptance of oneself
Greater peer contact and presence in school
Reframed concept of self from “invisible”
Vignette 2: Workplace burnout and moral injury
Client profile: A 38-year-old professional nurse who was feeling burnt out, depressed, and emotionally detached. She was complaining of fearing errors and fearing not coping.
Presenting fear: Fear of failure and systemic collapse.
Formulation FIT:
Intrapersonal: Fear of incompetence and emotional breakdown
Interpersonal: Fear of disappointing colleagues and patients
Existential: Fear of purposelessness and moral injury
Systemic: Fear of institutional betrayal and unsafe working conditions
Integration strategy:
Emotion-focused coping with guilt and fear
Values clarification and setting limits exercises
Exploratory investigation of system-level forces and moral distress
Application of supervision towards reflection on practitioner anxieties and resilience
Outcome:
Reiterated specificity of professional values and boundaries
Low emotional detachment and better sleep
Reconnecting to purpose and systemic advocacy
Vignette 3: Anxiety after childbirth
Client profile: A 32-year-old first-time mother who reports intrusive thoughts, being hypervigilated, and fearing harming the infant. She comes in feeling isolated and ashamed.
Presenting fear: Rising from a sense of powerlessness and being a “bad mother.”
FIT formulation:
Intrapersonal: Fear of emotional instability and inadequecy
Interpersonal: Fear of judgment from family and professionals
Existential: Fear of identity loss and irreversible change
Systemic: Fear of stigma around maternal mental health
Integration strategy:
Psychoeducation for perinatal anxiety and intrusive thoughts
Compassion-focused therapy in decreasing shame and self-blaming
Application of mindfulness and grounding procedures for the emotive regulation
Exploring transformations in relations of support system and identity
Outcome:
Lowered anxiety and intrusive rumination
Increased confidence and self-compassion in mothers
Strengthened relational support and identification integration
Vignette 4: Transition in late-life and isolation
Client profile: Widowed 72-year-old male who is currently retired. He reports loneliness, existential anxiety, and feeling a burden.
Presenting fear: Fear of isolation and meaninglessness.
FIT formulation:
Intrapersonal: Fear of emotional collapse and dependency
Interpersonal: Fear of burdening others or being forgotten
Existential: Fear of death, purposelessness, and insignificance
Systemic: Fear of ageism and societal invisibility
Integration Strategy:
Life review and legacy-oriented narrative therapy
Exploring grief and relational continuance
Values-oriented objective setting and civic engagement
Application of existential dialogue in discussing death and meaning
Outcome:
Reconnecting to personal legacy and contribution to society
Lowered existential anxiety and depressive symptoms
Reactivated sense of agency and relational vitality
Case study 5: Young adult with OCD traits
Client profile: A 24-year-old university student who exhibits compulsive checking, perfectionism, and contaminatory fear. Reports feeling “trapped” by his own thoughts.
Presenting fear: Fear of harm, failure, and loss of control.
FIT formulation:
Intrapersonal: Fear of imperfection and mental collapse
Interpersonal: Fear of being judged or misunderstood
Existential: Fear of losing autonomy and identity
Systemic: Fear of academic failure and institutional pressure
Integration plan:
Exposure and response prevention in CBT-informed
Reframing of fear as precautionary but wrongly directed
Exploring values and identity beyond academic success
Application of mindfulness in tolerating ambiguity and emotional uneasiness
Outcome:
Fewer compulsions and improved mood regulation
Increased insight into fear mechanisms and self-concept
Greater independence and academic involvement