Rosa was referred by her general practitioner to a psychologist for burnout complaints and psychosomatic symptoms. She is a fifty-five year old woman originating from Azerbaijan and living in the Netherlands since 1994. Her complaints started three years before the referral, when she dropped out of work as a quality officer in a pastry factory. At her workplace, Rosa was very dedicated and often worked long hours. The factory, originally a family business, was taken over by an investor. This led to changes in the corporate culture resulting in exploitation, misbehaviour and loss of quality of the pastry. Rosa was unable to cope with these changes and this led to a halt of her work. She developed stress reactions that manifested themselves in allergies, bad sleep, fluid retention, and weight gain. In addition she also suffered from anger outbursts at unexpected moments, which she found very shameful.
In the initial phase of her treatment, Rosa insisted on speaking about the losses she experienced in the pastry factory out of the conviction that this was the main cause of her complaints. She casually disclosed that she had destroyed biscuits made in the factory in various stores. Although she felt ashamed, she also explained this behaviour as an act of justice, as she found that the quality of the biscuits had deteriorated after she left her work. In this way Rosa expressed her anger and coped with the loss of her workplace. At the time that Rosa dropped out of her job, huge numbers of refugees fleeing the civil war in Syria were entering the Netherlands. They were housed in temporary accommodations and also in her place of residence. Meeting them in the shopping centre and seeing empty looks in the eyes of some of them filled Rosa with horror and physical disgust. Although being a refugee herself, she confessed, she did not have empathy for the newcomers.