Use this case study for the paper:
“Meg” is seeking counseling services at the suggestion of her husband of 2 years. She is a 29 year old college professor who was recently involved in a serious car accident where she had to be cut from her vehicle. Amazingly, Meg was not seriously injured in the accident. She experienced minor burns from the seat belt and a few bruises on her legs. You notice that she has a number of fresh superficial “scratches” in circular patterns to her upper arms as well as a pattern of scarring in these areas suggesting possible past history of self-injury. When you ask her if she sustained the scratches in the accident, she laughs and replies: “ No, the cat must have scratched me”.
Meg was found to be responsible for the auto accident; she was apparently texting while driving, ran a red light, and struck another vehicle. In the other vehicle was a mother and two young children. The mother and one child were not hurt, but the other child, a 4 year old sustained a serious head injury and remains in intensive care at a local hospital.
During this initial session, Meg noted that she has become very withdrawn and anxious since the accident occurred . She reports having vivid, horrific nightmares every night in which she is being chased by a man with a knife who eventually catches her and kills her.
Historical background provided by Meg: Meg is the only child born to her mother and father. Meg’s father was actively alcoholic and physically abusive to the mother throughout their 7 year marriage. Meg notes that even though her father was not physically abusive to her, she has clear memories of him constantly criticizing her and referring to her as a “fat piglet”. The father eventually left the family when Meg was 6 years old. Meg was sexually assaulted by her uncle from age six until age 9 during the years when she and her mother lived with the mother’s sister and her husband. Meg noted: “ after my dad left my mom and me, we never heard from him again. My mom was struggling financially and so we had to move in with my aunt and uncle. I didn’t tell my mom about the sexual abuse; I was worried that if I told, we would have to move out and I knew my mom couldn’t make enough money as a waitress to support us. Finally, when I was nine years old, my mom re-married and we moved from my aunt and uncle’s house”. Meg described her step-father as “ a caring, wonderful man.” Meg’s step-father died suddenly of a heart attack when Meg was 13 years old. Meg appeared tearful as she said, “My mom had a breakdown. She was so devastated that she arranged for my step-father to be buried with no funeral, no obituary notice; not even a memorial service. I never got to grieve or say ‘good-by’ to the only man who was a loving, supportive male figure in my life”.
Meg’s mother remains unaware of the sexual abuse history. They have a strained relationship and have minimal contact.
During high school Meg had trouble making and keeping friends but excelled academically. She received a full scholarship for her undergraduate and graduate degrees. She completed her doctoral degree 2 years ago and has been a psychology professor at a prestigious university since then.
Meg describes her career as a professor as “ the best part of my life”. She notes that has no hobbies outside work and does not have a peer group of friends apart from her work colleagues. Meg stated that when she is not at work she struggles to “know who I am” and says that when she is alone she feels “hollow inside”.
When asked about her relationship with her husband she replied: “ he is my best friend. I wouldn’t say I’ve ever really felt attracted to him, but he gives me a sense of security. “
Meg admits to periods of binge eating in times of r stress however denies she has an eating problem. She noted, “ I only make myself throw up when I gain more than 5 pounds”.
When asked about the auto accident and her feelings about having injured a child, Meg became tearful and started to pick at the scratches on her arm. She stated: “ I’m sorry it happened, but I’m not the only person who texts while driving. I think if the mom in the other car had been paying attention, she could have swerved and missed my car. “
Regarding her husband convincing her to attending counseling, Meg noted: “ I don’t really think I need any help. After all, I am a psychology professor so I know a lot about this counseling stuff! I do wish I could stop the nightmares. Could you maybe just refer me to someone who can prescribe me some strong sleeping pills?”
Meg describes she and her husband as “social drinkers”. She added, “ we’ve been having a lot of arguments recently because my husband thinks that I’m drinking more than I should. I’ve told him that if I have 3 or 4 glasses of wine to help me fall asleep every night, it’s better than the Oxycontin he’s been taking for the past year for his migraine headaches!”
6 Points of discussion in the paper:
Briefly describe the assertions of one of the following theories ( no more than 5 sentences):
You must choose ONE THEORY from the following: Ego Psychology/ Psychodynamic Theory, Object Relations Theory, Attachment Theory, Relational Theory/Therapy, Interpersonal Psychotherapy, Adlerian Individual Psychology, Ecological Systems, REBT, DBT, Existential Theory/ Therapy, Humanistic/ Person-Centered Therapy, Motivational Interviewing, Constructivism Narrative Therapy, Solution-Focused Therapy, Experiential ( Gestalt) Therapy, Crisis Intervention.
Identify one client presenting problem to address in the paper.
Describe the likely source of the problem. In describing a problem do not describe an event or situation but instead how that even/situation has resulted in a problem or challenge for the client. Example: Instead of: “ Jason lost his job” describe how the loss of his job has impacted Jason: “ Due to the loss of his job, Jason has experienced significant financial hardship, resulting in him moving in with his parents with whom he has had a very strained relationship for years”.
Discuss the role of the therapist:
Be specific to the theory chosen and how that therapist approach could be helpful to the client you have chosen to write about. ( does the theoretical approach you are writing about utilize a direct approach? Indirect? Is the therapist like a “coach” to the client? etc.) If is not enough to state that the therapist should be “ empathic” or “warm and caring”.
Discuss specific techniques/interventions:
Address the specific client problems you have identified and how you will use each technique ( include expected result for each technique) ( Example: The CBT technique “re-attribution” encourages a client to accurately assign responsibility for a life event, ongoing situation, etc. to the person(s) actually responsible. I will encourage Jane to develop realistic attribution of the sexual abuse she experienced by her uncle. Through the use of re-attribution, she will be able to cease self-blame and will be able to assign blame for the abuse to her uncle.) You must apply at least three specific techniques for the theory chosen *** Note: each technique must be associated with the theory that you are applying to the client case.
** Note: You might identify a diagnosable problem for your client ( i.e. clinical depression, generalized anxiety, delusional thinking, etc.) You may acknowledge in your paper that a referral to a psychiatrist could be indicated. However, do not state that the therapist will “ refer client to a psychiatrist” as one of your three required techniques/interventions.
Discuss ethical considerations specific to the theory as applied to the client case:
For example: CBT focuses minimally on expression of affect as part of the therapeutic process. In therapeutic work with Jane, who is a survivor of recent abuse, it may be advisable for her to express and process her emotional reactions to the abuse. If the therapist strictly follows the CBT model, the therapy could lack a component important to client healing. An ethical consideration would not be “ foster maximum client self-determination” or “ respect the dignity and worth of the client”. Those are part of the social work Code of Ethics but do not describe an ethical concern or consideration a therapist should consider when utilizing a particular theoretical approach.
Discuss strengths and short-comings of the theory:
Be specific to addressing the particular client problems. Example: “ Person-Centered Therapy emphasizes the client-therapist relationship, which could be helpful to Debbie due to her history of experiencing several failed relationships. However, because the approach is very non-directive, the most urgent presenting problems described by Debbie as affecting her life might not be explored thoroughly enough to create lasting change.”
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