Course Project

Roberta Simpkin

PSY400 - Counseling Theories – M2:A3

Kelly Rabenstein

July 11, 2009

Course Project

Case Scenario

Client name: Sabina

Sabina is a 22-year-old, married Catholic woman from Sri Lanka residing in the U.S. for

the past 5 years. She has come in for counseling because she reports feeling sad and teary-eyed

often over the last 2 years. She reports a loss of energy, poor appetite, and disturbed sleep though

she has not lost any weight. She thinks there is nothing she can do to get better. She continues to

spend time on her hobbies. Her hobbies are painting and knitting. She says she felt okay for only

a two-month period a year ago when her parents visited her from Sri Lanka.

A medical practitioner referred her for counseling, but medical tests did not reveal any

organic dysfunction. Sabina has not had any major medical problems in the past, but there is a

family history of major depression. She has not been diagnosed with depression before. She has

never thought of hurting herself or committing suicide and does not think that she is suffering

from depression. She is just tired all the time, although she denies any manic symptoms. It has

also been noticed that Sabina has difficulty making everyday decisions and does nothing without

the approval and consent of her husband. She fears being abandoned by her husband and not

being able to care for herself. She has no skills to build a career and is afraid of offending her

husband if she talks to him about it. She hates being at home all day but feels that she is not

capable of changing it. She feels irritable, tense, and restless until her husband comes home. She

claims she tries really hard to make friends because nobody likes her. Her family complains she

tends to be clingy and thirsty for approval. Manifestations of this are observed even in the

counseling sessions.

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Sabina has been married for 5 years and loves her husband. Her parents introduced him to

her. They fell in love and were married when she was 18 years old. Her husband is 10 years

older than she and works as an accountant. She denies any physical spousal abuse and says that

he is nice to her. She reports complete satisfaction from her marital relationship. Her relationship

with her family is formal, but supportive. Her parents visit her occasionally and are interested in

her life. She reports no childhood abuse or any family turbulence. Sabina is fed up with her

constant depression and wants to lead a normal life. She would like to get a job, but is afraid to

do anything about it.

Week 1

I am apprehensive about meeting Sabrina for the first time and I don’t want to do

anything that will hinder the counseling process. During this meeting, I am only to watch how

my supervisor, Jim, handles the client and I will take notes as I observe the interaction between

him and Sabina.

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1. Even though Sabrina has not been diagnosed with depression, there is a history of it in

her family. I think Jim should keep this in mind because she does not work, she relies on her

husband for everything, she has no skills, she hates being home alone all day, and she is afraid to

talk to her husband about all this. I think the most important skills that Jim should have to ensure

that Sabrina comes back next week are to realize that Sabrina comes from a different culture than

his. He needs to keep this in mind because she may not know how to articulate her needs. He

has to have the skills to empower her to help herself. He needs to make statements like, “You’re

a smart and likeable person.” He needs to help her find the way to know herself. (Counseling

and Psychotherapy).

2. Based on Sabrina’s background, I think the initial issues or anxieties that we will face

while establishing rapport with Sabrina are that we do not want to hurt our client, we have to

learn from our own issues, we are afraid of failure, and we worry there may be a mismatch with

our client and us (Counseling and Psychotherapy).

3. I think the specific aspect of confidentiality or informed consent that would be

difficult to explain or talk about with Sabrina would be if she had not been through the informed

consent process. She may not know of her rights. The informed consent document should

explain to Sabrina the counseling process as a partnership between her and us to agree to work

on areas of dissatisfaction in her life (Informed Consent and Confidentiality).

Week 2

My supervisor Jim and I will use the Psychoanalytic and Adlerian approaches in Sabina’s

case by confronting our client with observations made, clarifying any issues, and interpreting

information that provides insight into our client’s conflicts (Psychoanalysis 8). Another

perception we will observe is identifying Sabrina’s strengths and using these strengths to

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compensate for her weaknesses. Drawing attention to her behavior may help break the behavior

pattern (Adlerian Therapy).

Based on what we know, it has been noticed that Sabina has difficulty making everyday

decisions but Alfred Adler believed that people are capable of making positive decisions for

themselves (Adlerian Therapy).

The goals of therapy would be to identify Sabrina’s strengths to her and work on finding

ways to help her know herself.

The relationship between the therapist and Sabina would be for the therapist to be aware

of the differences of the two cultures so as not to have the client drop out of the sessions.

The counselor would function in the therapy sessions by being sensitive to Sabrina’s

needs. He should identify any resistance from Sabrina and give her a chance to talk about it.

The counseling techniques or procedures that would be used in this case are for the

therapist to be honest with the client and give feedback in an honest and compassionate manner.

However, discretion is used in what is to be shared with the client.

During counseling, Sabina is likely to experience client resistance. However, in the past,

resistance has been useful, it has protected clients from pain.

The desired outcomes of therapy would be to help Sabrina identify on her own what she

wants to do. (Psychoanalytic and Adlerian Therapy).

Week 3

In Sabina’s case, we would use the Person-centered and Gestalt approaches in the

following way:

Based on her background, establishing a rapport with Sabrina is important to ensure that

she would be allowed to express her struggles. In the person-centered therapy, the therapist

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would work with Sabrina for her to “hear” her inner voice and stop looking at others for purpose.

The goals of therapy are for counselors to bring into therapy themselves. Counselors need to

create and maintain satisfying interpersonal relationships. Also, summarizing or repeating what

Sabrina said helps the counselor group together all of the client’s concerns (Person-Centered

Therapy).

The relationship between the therapist and Sabina is to create an easy rapport together.

This is important to ensure that Sabrina would be allowed to express her struggles. Gestalt

therapy is experiential – it helps the client experience from the inside what the therapist observes

from the outside (Yontey & Simkin, 1989).

In the therapy sessions, the therapist would function as a warm, caring, genuine, and

respectful counselor.

The counseling techniques or procedures that the therapist would use would be a

willingness to deal patiently with uncomfortable and difficult moments in sessions with this

client.

Sabina might likely experience client resistance during counseling.

The desired outcomes of therapy would be for the counselor to be aware of and sensitive

to the expectations and assumptions of the client. The only goal in Gestalt psychology is

awareness, including awareness of the environment, taking responsibility for one’s choices, and

self-acceptance (Yontef & Jacobs, 2000). (Counselor: Person and Professional)

Week 4

In using the Behavioral and Cognitive Behavioral approaches, the counselor would focus

on current problems. In Sabrina’s case, she is tired of being tired all the time, she has difficulty

making everyday decisions, she has no skills to build a career, she hates being at home all day

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but feels that she is not capable of changing it. She feels irritable, tense, and restless until her

husband comes home. She claims nobody likes her.

Based on the information provided to the counselor about Sabrina, the counselor would

believe Sabina to be suffering from depression.

The goals of therapy would be to focus on Sabrina’s current problems.

The relationship between the therapist and Sabina should be for the therapist to help

Sabrina become aware of her irrational and unhelpful thoughts. The therapists’ role is

educational and confrontational. The therapist would confront Sabrina about these unhelpful

thoughts and when Sabrina is aware of how often her thoughts are negative and self-defeating,

she can make a conscious effort to think in ways that are helpful.

The counselor would function in the therapy sessions by monitoring Sabrina’s responses.

The counseling techniques or procedures that the therapist would use are the principles of

counter conditioning to teach Sabrina to relax. Since Sabrina does feel anxious, teaching her to

relax her muscles during stress is the first step. Then the therapist should bring in people in

Sabrina’s life to support his attempts to bring about change in her life.

One thing helpful during counseling would be to help Sabina understand her problem in

terms of the big picture.

The desired outcomes of therapy for Sabrina should be to see how much progress is made

with a variety of situations. (Behavior Therapy). (Cognitive Behavior Therapy).

Week 5

This week, you face ethical dilemmas regarding your interaction with Sabina. You are in

the grocery store when you see Sabina and her husband. Sabina spots you behind your grocery

cart and your eyes meet.

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The choices I have in this situation would be to not acknowledge Sabrina based on her

history and culture and my fear of hurting her. I may say or do something that would cause dire

consequences (Counselor: Person and Professional).

If Sabina acknowledged me, I would be pleasant but I would not acknowledge who I was

or how we know each other in order to protect client confidentiality. (Ethical Principles of

Psychologists and Code of Conduct, APA, 1992).

Keeping in mind Sabina’s cultural background, she may feel ashamed if acknowledged in

public.

Some other ethical issues that could arise when dealing with clients from different

ethnicities could be that the client may not trust you, body language may be misinterpreted, and

they may internalize their experiences differently. (Person-Centered Therapy).

Week 6

In using the Existential approach in Sabina’s case; the therapist would focus more on an

idea or a key concept and less about specific techniques.

Based on this model, the counselor would believe that Sabina is experiencing existential

aloneness – that she alone can carve her identity.

The goals of therapy would be to explore options for Sabrina for a meaningful existence

and also help her in making the best choices under the circumstances.

The relationship between the therapist and Sabina would be that the therapist help the

client differentiate between two types of anxiety; positive anxiety that helps one to grow and

learn from facing their own pain, and neurotic anxiety which is unhelpful, a result of emotions

that are disproportionate to the situation and unnecessary (Existential Therapy).

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In the therapy sessions, the counselor should help Sabrina find the qualities that make her

unique, help her find purpose and meaning, and help her to use anxiety positively to help her

grow.

The counseling techniques or procedures that the therapist would use are dereflection

(focus on the clients’ strengths instead of weaknesses), paradoxical intention (encourage clients

to do what the clients are afraid of doing - this helps the clients work through the impending and

expected anxiety), and existential encounter (an existential concept that allows therapists to

experience clients’ inner world of joy or pain).

During counseling, Sabina is likely to have questions like “Who am I”, “Where am I

going” and “What should I do?” An individual may be happily married but may still find life

boring, unsatisfying, and lacking in purpose.

The desired outcomes of therapy would be to explore the individuality of Sabrina and the

qualities that make her unique, help her find meaning and purpose, help her use anxiety

positively to help her grow, and help her view death as an eventual event that makes life

meaningful (Existential Therapy).

Week 7

Some key themes that represent the core struggles in Sabina’s life are that she thinks

there is nothing she can do to get better, does not think that she is suffering from depression, is

tired all the time, has difficulty making everyday decisions, is unable to care for herself, and has

no skills to build a career.

Some of the statements in her biography that reveal the themes in her life are: she

married when she was 18 years old, family history of major depression although she has not been

diagnosed with depression before, has difficulty making everyday decisions, does nothing

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without the approval and consent of her husband, fears being abandoned by her husband and not

being able to care for herself, has no skills to build a career, hates being at home all day but feels

that she is not capable of changing, feels irritable, tense, and restless until her husband comes

home, and claims she tries really hard to make friends because nobody likes her.

Her position on the Global Assessment of Functioning Scale (GAF) score, also known as

DSM-IV TR, would be 51-60, the reasons being she has moderate symptoms of depression,

occasional panic attacks, difficulty in social functioning, and few friends.

Week 8

A counselor or therapist using the Integrative Approach (the application of two or more

theories analyzed) in this case, Psychoanalytic, Adlerian, and Person-centered, would state this

regarding Sabina’s case:

1. He would believe that Sabrina is suffering from mild depression based on her history

and symptoms.

2. The goals of therapy would be to help Sabrina identify on her own what she wants to

do, to identify Sabrina’s strengths to her, and work on finding ways to help her know

herself.

3. The relationship between the therapist and Sabina is one of rapport.

4. In the therapy sessions, the counselor would use the skills involved in “listening’ to

capture and understand messages by the client. The focus of the therapist is on

interpreting their client psychologically and trying to understand why the client is the

way they are. The quest is not to judge but to understand their weaknesses so that

their strengths can be used to promote change.

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5. The counseling techniques or procedures that the therapist would use are self-

actualization. Self-actualization refers to being able to fully utilize your potential and

do what you were born to do (Person-Centered Therapy).

6. As she moves toward self-actualization, Sabina is likely to experience during

counseling an openness to experience with distorting it to fit into already established belief

systems during counseling?

7. The desired outcomes of therapy would be for Sabrina to trust in her own judgment, to

“hear” her inner voice and stop looking at others for purpose (Person-Centered Therapy).

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References

Argosy University (2009), Adlerian Therapy, Behavior Therapy, Cognitive Behavior Therapy,

Counselor: Person and Professional, Existential Therapy, Gestalt Therapy, Informed

Consent and Confidentiality, Integrative Approach, Person-Centered Therapy,

Psychoanalysis. Retrieved July 9, 2009, from http://myeclassonline.com

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