Question

Utilize either of the following theories: Gestalt, Behavior, or CBT

What theory or theories will be most appropriate for this client? What are the main concepts regarding the theories? How can the client’s problem be understood utilizing the theories? Ex: “The client reports difficulty in x, y, and z problems. According to the psychoanalytic theory, the client may be exhibiting these symptoms due to her early childhood experiences….” Expand from there to thoroughly examine the problem through the theory lens. Describe what the suggested theory (or theories) says about the possible cause or origin of the primary problem(s) discussed. If you choose to explore multiple theories, limit it to 2 so the study remains consistent and clear in its direction.

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

In the case CBT and behaviour therapy are the most appropriate interventions.

The client reports difficulty in x, y, and z problems. According to the psychoanalytic theory, the client may be exhibiting these symptoms due to her early childhood experiences, where her father was rigid, authoritative and maintained a distent relationship with her.Due to this she developed inhibitions regarding expressing her in front of her parents and always worked in favour of 'getting approval' from them.There is supression thoughts of sexuality, interpersonal relationships and constant fear of rejection. It becomes important to acknowledge and cater to the inhibited childhood experiences.The underlying conscious experiences and resultant feelings as well as current behaviour such as life dissatisfaction, psychosomatic complaints, anxiety, sleep disturbances.Additionally, the patient cries over trivil issues and has been depressed.

Cognitive behaviour therapy is recommended as it considers the interrelationship of thoughts - feelings- behaviour.The thoughts patient has such as her ageing is making her feel insecure. These underlying unsatisfactory feelings must be acknowledged and should be discussed in detail , about how they effect her daily life.Aslo to emphasize that she has to accept what she is along with her strengths and weaknesses.

Behavioural therapy: This therapy can be used to amplify the feelings of her awareness about herself that she has initiated on the professional front.She might experience 'empty nest syndrome' that her children are getting young and might leave her alone.New strategies can be incorporated as a daily routine addition focussing on ' new concepts' in life.