Question

If this client were to be seen on an ongoing basis, describe the types of change or outcomes one could realistically expect to see in this client, in light of the problems mentioned earlier using the identified approach in therapy. Be specific and show how the process of therapy with this counseling approach would lead to the outcomes intended .Utilize either of the following theories: Gestalt, Behavior, or CBT

Background Data

A brief description of data from the intake form is provided here:

            Age: 39

            Sex: Female

            Race: Caucasian

            Marital Status: Married

            Socioeconomic Status: Middle class

            Appearance: Dresses meticulously, is overweight, fidgets constantly with her clothes,

            avoids eye contact, and speaks rapidly.

            Living Situation: Recently graduated from college as an elementary-education major,

            Lives with husband (John, 45) and her children (Rob, 19; Jennifer, 18; Susan, 17; and

            Adam, 16).

Presenting Problem

Client reports general dissatisfaction. She says her life is rather uneventful and predictable, and she feels some panic over reaching the age of 39, wondering where the years have gone. For 2 years she has been troubled with a range of psychosomatic complaints, including sleep disturbances, anxiety, dizziness, heart palpitations, and headaches. At times she has to push herself to leave the house. Client complains that she cries easily over trivial matters, often feels depressed, and has a weight problem.

History of Presenting Problem

Client’s major career was as a housewife and mother until her children became adolescents. She then entered college part time and obtained a bachelor’s degree. She has recently begun work toward a credential in elementary education. Through her contacts with others at the university, she became aware of how she has limited herself; how she has fostered her family’s dependence on her own life. As a part of the course, she participated in self-awareness groups, had a few individual counseling sessions, and wrote several papers dealing with the turning points in her own life. One of the requirements was to write an extensive autobiography based on an application of the principles of the counseling course to her own personal development. This course and her experiences with fellow students in it acted as a catalyst in getting her to take an honest look at her life. Ruth is not clear at this point who she is, apart from being mother, wife, and student. She realizes that she does not have a good sense of what she wants for herself and that she typically lived up to what others in her life wanted for her. Ruth has decided to seek individual counseling to explore her concerns in several areas:

• A physician whom she consulted could find no organic or medical basis for her physical symptoms and recommended personal therapy. In her words, her major symptoms are these: “I sometimes feel very panicky, especially at night when I’m trying to sleep. Sometimes I’ll wake up and find it difficult to breathe, my heart will be pounding, and I’ll break out in a cold sweat. I toss and turn trying to relax, and instead I feel tense and worry a lot about many little things. It’s hard for me to turn off these thoughts. Then during the day I’m so tired I can hardly function, and I find that lately I cry very easily if even minor things go wrong.”
• Ruth is aware that she has lived a very structured and disciplined life, that she has functioned largely by taking care of the home and the needs of her four children and her husband, and that to some degree she is no longer content with this. Yet she reports that she doesn’t know what “more than this” is. Although she would like to get more involved professionally, the thought of doing so frightens her. She worries about her right to think and act selfishly, she fears not succeeding in the professional world, and most of all she worries about how becoming more professionally involved might threaten her family.
• Ruth’s children range in age from 16-19, and all of them are not finding more of their satisfactions outside the family and the home are spending increasing time with their friends. Ruth sees these changes and is concerned about “losing” them. She is having particular problems with her daughter Jennifer, and she is at a loss how to deal with Jennifer’s rebellion. In general, Ruth feels very much unappreciated by her children.
• In thinking about her future, Ruth is not really sure who or what she wants to become. She would like to develop a sense of herself apart from the expectations of others. She finds herself wondering what she “should” want and what she “should” be doing. Ruth does not find her relationship with her husband, John, at all satisfactory. He appears to be resisting her attempts to make changes and prefers that she remain as she was. But she is anxious over the prospects of challenging this relationship, fearing that if she does she might end up alone.
• Lately, Ruth is experiencing more concern over aging and losing her “looks.” All of these factors combined have provided the motivation for her to take the necessary steps to initiate individual therapy. Perhaps the greatest catalyst that triggered her to come for therapy is the increase of her physical symptoms and her anxiety.

Psychosocial History

Client was the oldest of four children. Her father is a fundamentalist minister, and her mother, a housewife. She describes her father as distant, authoritarian, and rigid; her relationship with him was one of unquestioning, fearful adherence to his rules and standards. She remembers her mother as being critical, and she thought that she could never do enough to please her. At other times her mother was supportive. The family demonstrated little affection. In many ways Ruth took on the role of caring for her younger brother and sisters, largely in the hope of winning the approval of her parents. When she attempted to have any kind of fun, Ruth encountered her father’s disapproval and outright scorn. To a large extent this pattern of taking care of others has extended throughout her life.

      One critical incident took place when Ruth was 6 years old. She reported: “my father caught me ‘playing doctor’ with an 8-year-old boy. He lectured me and refused to speak to me for weeks. I felt extremely guilty and ashamed.” It appears that Ruth carried feelings of guilt into her adolescence and that she repressed her own emerging sexuality.

      In her social relationships Ruth had difficulty making and keeping friends. She felt socially isolated from her peers because they viewed her as “weird.” Although she wanted the approval of others, she was not willing to compromise her morals for fear of consequence.

      She was not allowed to date until she completed high school. At the age of 19 she married the first person that she dated. She used her mother as a role model by becoming a homemaker.

Answer 1

The client is 39 years old,

Gender = Female, status= married

Economical status=middle class

She has 4 children aged 19 to 16

Appearance = She was neatly dressed, talks rapidly, avoids eye contact.

She has a problem with her daughter who is rebellious and shows aggression.

Ruth's symptoms = For the last two years she had been suffering from psychosomatic complaints like sleep disturbances, anxiety, dizziness, heart palpitations, and headaches, off-late she has become emotional and cries easily. She has a weight problem.

Her worries; She feels she has spent her life mechanically just by taking care of her husband and children. She is not happy with her past life. She feels she has lost something in her life.

When children are adolescent she joined the college and obtained a bachelor's degree. She wants to pursue a professional career, but she is frightened that it would not be possible for her as it will hinder her family life.

Her children are growing up they like to spend more time outside with their friends than at home. She is becoming lonely. Now she fears that her involvement with the children would reduce.

Past history: Ruth's past history shows that she belonged to a middle-income family her father was an authoritarian type she was very frightened of him, her mother was a housewife. Ruth has chosen to become a housewife looking at her mother. During schooling and college days she had no friends, she never dated, and married the person with whom she had her first relation.

Her symptoms, present history, and past history say that at present while looking back she finds that she is not satisfied with her past life. Her doing graduation shows that she wants to do something better in life. She did not have friends due to her circumstances. Now as the children are grown up they would leave her and she will be alone.

To diagnose her Depression it is important to note the positive side of her personality, 1. She has done graduation that shows that she wants to do something in life. 2. She has started working and written her biography where she has mentioned all important events that were the turning points in her life.

To have in-depth knowledge about what she thinks about herself and others and her circumstances her biography would be of great help.

The plus point and strength of her character shows that she wants to do something to become self-reliant and satisfied in her life she wants to become a professional, but she lacks confidence.

Looking at history the cognitive behavioral therapy will be very beneficial for her as her physical symptoms are of psychosomatic type it can reduce one's she starts talking about what is within her.

Cognitive-behavioral therapy is a talk therapy where the therapist tries to replace negative thoughts with more positive, healthier, realistic, and beneficial thoughts. This therapy can be done singly or in a group. Ruth had already approached a physician but she did not find any medical symptoms for her feeling anxiety and uncomforting feelings she had advised her to seek the help of personal therapy.

If Ruth will be allowed to have CBT in a group she will be exposed to more ideas. She would come to know other's problems and how they dealt with it. When she will meet new people she can open up because all the time she is aware that she had spent a disciplined and structured life. She had looked after other's needs more than hers. Now through interactions with others, she would come to know how to have a balance between the family life and her professional life. She would feel light and she could get ways to look at the problem positively to find the solution.

Her husband does not want her to have a professional life. As talk therapy involves family members as well the therapist can call her husband and make him understand that with mutual understandings Ruth would feel better or else she would suffer from mental illness.

She is worried that she is putting on weight. That can be one factor of her having low self-esteem and lack of confidence. One’s her confidence increases and psychosomatic symptoms start decreasing she can concentrate on her weight.

With sessions and interaction, her progress can be checked the talk therapy sometimes work much more than an antidepressant drug.