Question

Please read the following case study and answer the questions to the best of your ability.

Case 14.1: Intake for Hira

Hira called into the agency because she is not "feeling right." She sounds somewhat tearful as she describes an inability to sleep and a loss of weight over a 4-week period. She reports that she experienced a miscarriage four weeks ago and is not sure if she is dealing with a postpartum issue or grief over losing the baby. She is married and has been going out of her way to conceal her mood from her husband. He has begun to notice, however; this morning he asked if she was feeling well. Worried that she will be a burden to him, she decided to call the agency to get help, hoping she will be able to clear this up and feel better. Her mother is living in Saudi Arabia, and she has few friends in the United States. She has not told her closest friend how she is feeling because her husband and her friend's husband work together.

1. What would be a good chief complaint for Hira. What concerns has she presented during this call?

2. Why do you think Hira called today and not some other day?

3. What information did you choose to leave out of the chief complaint you wrote, and why?

4. How would you have addressed Hira's concerns if she was a walk-in at your agency?

Answer 1

1. A good chief complaint that Hira can communicate to the agency is that she is experiencing an inability to develop an insight into her own problems and a lack of resources to support her around this time. She is confused about whether she is experiencing a postpartum issue or grief over losing the baby. She is not "feeling right" and has made all efforts to hide her mood from her husband to avoid an emotional dependency on him. She does not want to bother her husband with her feelings. Hira's closest friend is also unaware of her troubling situation as the friend's husband and Hira's husband work together. So, Hira's husband may get to know about Hira from her friend's husband in office. Moreover, her mother is living in Saudi Arabia, and she has few friends in the United States. So, Hira clearly does not seem to have adequate resources to help her resolve her issues. Additionally, Hira is avoiding the utilization of emotional support from those around her by not reaching out to them.

2. Hira called today and not some other day because it was the morning of the day she made a call to the agency that her husband enquired Hira about her feelings. Hira was trying immensely hard to hide her feelings from her husband to avoid becoming a burden on her husband. So, as an alternative, she called the agency with the expectation to clear up her issue and feel better. It can be said that a postpartum period is natural after childbirth or miscarriage. It lies for 4-6 weeks after delivery. Hira reported that she had experienced a miscarriage four weeks ago. In this period of four weeks or 1 month, Hira developed an inability to sleep and weight loss. A significant amount of time had passed without any solution to her problems. Her problems only aggravated in a month as it started becoming evident in her mood to her husband from whom she wanted to hide her abnormal feelings. This fragile period made it difficult for Hira to hide her true emotions, making it noticeable to her husband.

3. The information I choose to leave out of the chief complaint is Hira's inability to develop an insight into her own problems. Hira's main problem was not her problem, but a deliberate avoidance of reaching out a solution or accepting a solution from others close to her. Considering her situation, Hira's main problem was her deliberate avoidance of emotional support after a miscarriage. She should have reached out to people during such a sensitive time which is predominated by psychological grief (due to miscarriage) and biological postpartum, both of which are involuntary and automatic. This provides the ground for eliminating involuntary and automatic consequences of childbirth or miscarriage as Hira's actual problems which do not fall within the functions of the agency, which works to provide solutions to clients.

4. If Hira would have been a walk-in at my agency, it would have been a better alternative. This would have made it easier to book a formal appointment for her and discuss the issue face-to-face in front of the counsellor. Discussion of the issue face-to-face is always better than stating problems over the phone. Phone calls can lead to technical difficulties and can create confusions regarding the understanding of a person's problems. This makes face-to-face communication a better alternative for clear communication of issues and solutions of the problems. I would have conducted sessions with Hira in which she would have been free to speak and vent. This would have provided emotional support to Hira to pass a fragile time and reverse her situation by the acceptance of the need to receive support from her husband, mother, and close friend.