Describe the Successful Outcomes Can be Attributed to the following Contributing Factors of the story.

At the time of the treatment, the client was a 29-year-old single woman. She is the primary caregiver of her 4-year-old son who she lives with. She was self-employed working part-time as a hair stylist at home; however, her main source of income was social assistance. Her highest level of education was completing high school. The client was a refugee originally from Saint Vincent and the Grenadines, a southern Caribbean nation. The client came to Canada in 2006, fleeing a physically abusive partner. She has no familial support in Canada and limited social supports.Sociocultural ContextIn St. Vincent, women are often extremely vulnerable to gender-based violence as many are economically dependent on their partners due to the high rate of unemployment among women (IWRAW, 2009). Moreover, reports of gender-based violence are often not taken seriously, leaving women susceptible to repeated incidents of violence (UQAM's International Clinic for the Defense of Human Rights, 2014). When seeking protection or justice for gender-based violence, women are faced with various barriers including a lack of institutions which provide specific services to this population including legal care, psychological support, and health services (UQAM's International Clinic for the Defense of Human Rights, 2014).Gender-based violence is reported around the world including Canada (Ansara & Hindin, 2010; Barrett et al., 2019) and St. Vincent (Yang, 2014). It is pervasive in St. Vincent as the patriarchal structure of society does not adequately address the issue of gender-based violence. Over the past 10 years, over 4,490 Vincentians (4% of the current population) have sought asylum in Canada, the majority being women (Yang, 2014). According to statistics composed by the UN Office of Drugs and Crime, there were 426 cases of sexual violence (rape and sexual assault) in St. Vincent in 2011 (Immigration and Refugee Board of Canada [IRBC], 2013). The rate of sexual violence in St. Vincent in 2011 was 289 cases per 100,000 people. In comparison, the rate of sexual violence in Canada was 77 cases per 100,000 in 2011 (IRBC, 2013). In March 2019, the Human Rights Committee confirmed this ongoing and serious concern in St. Vincent about high levels of violence especially against girls and women, as the state law does not recognize marital rape, and domestic violence seems to go unpunished and unreported (Centre for Civil and Political Rights, 2019). Scholars note that women who have experienced violence are often vulnerable and subject to mental health struggles such as depression, anxiety, and post-traumatic stress disorder (PTSD; De La Rue & Ortega, 2019).3 Presenting ComplaintsThe client was referred to an outpatient mental health community agency in an urban metro city by her family doctor to treat symptoms of anxiety and depression. With respect to depression and anxiety symptoms, the client described having a low mood most of the time and constant worries over finances, parenting, and social situations which have been persistent since moving to Canada. Her low mood and decreased energy negatively impacted her daily functions, including her interactions with her son, as she struggled to support his social activities. This made her feel more depressed about her parenting skills and self-image as a mother. In addition, the client also experienced stress around her finances, as she was self-employed, running a home business as a hairstylist. Her family doctor ruled out any physical health related concerns and made the referral.4 Client HistoryThe client reported a 13-year history of symptoms of anxiety and depression. She reported that her mental health issues began when she moved to Canada. She stated that she did not experience symptoms of anxiety and depression when she was living in St. Vincent. She denied receiving counseling in the past and denied the current and past use of psychiatric medications. She reported she has been hospitalized once for psychiatric purposes in 2008 after an attempted suicide using pills and alcohol. She reported that this attempt was done impulsively and was triggered by traumatic experiences from an abusive relationship with an ex-partner, who she was with at the time in Canada. She reported attempting suicide as a way to escape the relationship.The client also experienced trauma growing up, as she reported she was sexually abused by her neighbor when she was 10 years old. She stated that she had never disclosed the abuse to anyone apart from the therapist upon her initial visit at the clinic and had not fully processed the trauma. The client also reported having been in multiple physically and emotionally abusive relationships, one when she was 16 in her home country, which forced her to flee to Canada, another in 2008 in Canada as noted earlier, and one in her 20s.The client stated that she had no family support in Canada, as her family remained in St. Vincent. She stated that she speaks with her parents on the phone but does not share her personal struggles with them. She reported a close relationship with her aunt, who was like a mother to her. Although conversing with her aunt over the phone approximately once a week, she reported difficulties of sharing her mental health struggles with the family as they did not discuss mental health issues in their culture. With respect to social network in Canada, the client described having two friends, with whom she spoke approximately once a month but did not share her mental health issues. The therapist paid attention to building alliance by closely following the client's story, conveying her understanding to the client, validating the client's experiences, and respecting her goals of therapy. The client's goals were explored and set in the initial session and revisited in the second session. The goal setting led the therapist to provide psychoeducation about CBT as the best-fit treatment for the client at the moment. During this contract period, the therapist took the time to invite the client to ask questions and share any concerns about the therapy in general and the selected CBT approaches in particular. She was open to CBT, noting "this approach could help" as she struggled with negative thoughts, motivation, and engagement in enjoyable activities.Psychoeducation on the CBT model was introduced mostly in the first two sessions but incorporated across the therapy process to strengthen the client's new learning and skill building. The client and therapist discussed how thoughts, emotions, physical responses, and behaviors are all interconnected. The therapist then applied this concept to situations the client was experiencing, to enhance her understanding. BA principles were introduced and discussed, including principles of positive and negative reinforcement, and how avoidant behaviors may have sustained the client's symptoms of depression and anxiety. The importance of activity monitoring and scheduling enjoyable activities into her everyday life was discussed as the immediate positive reinforcement and empowerment can result in an improvement in her overall mood (Dimidjian et al., 2014).Psychoeducation on depression and anxiety including the typical signs and symptoms was discussed in the first two sessions. The client reported that she found this information to be validating as she recognized that she was not "crazy" but was impacted by past traumas and currently experiencing symptoms of psychological illnesses such as depression and anxiety. Providing psychoeducation assisted the client by validating and accepting her struggles and experiences, which seemed to foster alliance building (Young et al., 2014).After this initial alliance building, the therapist checked with the client to see if she would be open to receiving information on how to address stressful moments using relaxation techniques. With her agreement on this therapy task, the client was introduced to two relaxation techniques including diaphragm breathing and progressive muscle relaxation and was encouraged to incorporate these exercises into her daily routine. In the second session, she reported that she found deep breathing helpful when she was experiencing physical symptoms of anxiety including shortness of breath, nausea, and an increased heart rate.Finally, therapy structure and expectations were discussed and collaboratively agreed upon. The client agreed to complete homework assignments and understood the importance of practicing the skills in-between sessions to maximize the therapy effects. She was agreeable to meeting once per week for the first six sessions, and after a mid-term evaluation at the sixth session, the frequency could be adjusted to potentially meeting biweekly until therapy was completed. The client was given an "activity schedule" as a homework assignment, where she was asked to track the activities that she would do throughout her week and rate them from 1 to 10, with 10 being very enjoyable, and 1 being not enjoyable at all. This assignment provided the therapist with a better understanding of the client's day-to-day activities and was used as a baseline measure. This assignment was successfully completed by the client every week throughout therapy, which signaled her commitment to therapy and change. Over the treatment duration, each week she was encouraged to incorporate one or two enjoyable activities into her schedule in attempt to increase positive reinforcement in her environment. Some of the enjoyable activities she incorporated included watching a movie with her son, exercising, getting her nails done, going for a walk, and styling her hair.