EPSY 6325 Theories of Counseling



EPSY 6325 Theories of Counseling -- Group Discussion /Case Conceptualization Assignments 1,2, 3 Kathy is a 35 year old woman with two children (ages 10 and 12). Her husband, John, died in a car accident some time ago. They had been separated for four years before his death. She came to counseling because she feels sad, has difficulty trusting others, particularly men in romantic relations, and wishes she could be more open to experiencing life and joy. In her words, she “has chosen to live a closed-off existence.” Following her husband’s death, Kathy received a sum of money from insurance that provides her more financial freedom than she has ever had. However, she reports that she is unable to use the money to do positive things for herself such as buy nicer clothes, enjoy the arts (theater, museums) or go back to school to study music. Sometimes she wonders if she deserves those nice things. She also reports that she has difficulty setting boundaries with other people. For example, often times at work they give her the least desirable schedule, and she just accepts it even if it is inconvenient for her and she is unhappy about it. Kathy works as a psychiatric nurse. She is hard working and empathizes with the patients she works with. She considers herself a gregarious person; she has many friends and likes to host social gatherings. At the same time she feels somewhat isolated from others; she feels that she is always ready to be there for others, to take care of their needs. However, she resents that others do not behave towards her in a similar way. During her marriage, for a long time she felt that she was invisible to her husband. However, she believed that John cared for her as much as he was able to, and stayed with him for many years. Kathy projects both vulnerability and strength Kathy was the eldest of 4 siblings; 2 sisters and 1 brother who was the youngest. Kathy’s father, who was alcoholic, worked long hours outside the home six days a week. In the evenings and on Sundays, when he was often drunk, he would have fits of rage and be psychologically abusive to the family. He was very demanding from both Kathy and the mother. From an early age Kathy’s primary role within the family was caretaker of her younger siblings. Her mother was a nurse’s aid, which required her to be absent from home some evenings and on weekends. In these occasions, Kathy took care of her father, was in charge of household chores and looked out for her younger siblings. The mother was affectionate to Kathy and the other kids; however, she was often physically and/or emotionally unavailable (either at work or coping with father’s problems) and relied heavily on Kathy for help. Kathy left high school early (at age 16) and went to work to help the family. As she was growing up, Kathy felt uglier and less attractive than her two younger sisters, who seemed to her much prettier and popular than she was. She also felt very responsible for the welfare of her mother. Kathy was 19 years old when she met John. Following a very short courtship they married, which allowed her to move out of her parents’ home. She reports that at the time she could hardly believe that her, of all people, would get to marry and have a husband and a family. A few years after the marriage, John started drinking regularly, behavior that increased once they relocated to California and he encountered employment problems. When he was drunk, John was verbally abusive and angry towards Kathy and their two children. A few years before coming to therapy, Kathy had separated from John (but never got a divorce) and a few months after the separation, John was killed in a car accident while driving drunk. After her husband died, Kathy realized that while he was alive, even though they were separated for a long time, she did not to seek other relationships (in her words, John served as some sort of shield for her). Now that he has died, she knows that she is free to seek other relationships. She reports feeling very sad and lonely, but at the same time finds it difficult and anxiety provoking to pursue a relationship with a man. She states that she needs to make sure that it will be absolutely safe to open herself to others, particularly a man, so that she does not get hurt. Kathy describes that a part of herself (“her most tender part”) is like a scared child who hides in a cave and does not want to come out until she feels totally safe. She knows that “staying in the cave” prevents her from engaging with others. However, she also stated that it is wise for her not to come out until she is totally safe to do so. When she talks about this, Kathy gets very sad and teary eyed. Instructions for Case Study Assignments Imagine yourself as a counselor who has worked with Kathy. Take into account the information provided above, what you learned about Kathy in her interviews with Rogers (including your own reactions to her presentation in the tapes), and what you have discovered about her life in the course of therapy with her. Your task is to provide a summary of your past work with Kathy.Your description should include: ???????????? (a)????How you conceptualized Kathy’s concerns and life situations, and ??????????? (b)????Specific goals and interventions you used in helping her with her issues. ? Provide a conceptualization of Kathy’s case from each theory separately. In presenting each theory, only include concepts that are applicable to Kathy’s case. Rather than providing general definitions of these concepts, illustrate them with specific information about Kathy’s life and/or counseling experiences. Think creatively and critically to apply the theory to the specifics of the case. For example:if you want to refer to the concept of transference, instead of giving its definition from the book, provide an example of how transference occurred in the counseling process with your client (e.g. the client reacted to me similarly to the way she tends to react to her mother, resenting my authority). Or, rather than stating I helped the client connect with her feelings be more specific and say I used the empty chair technique to have the client speak directly with her father to help her expereince and connect with her feelings of guilt. Use as a model the discussion of Richard presented in the Outline for Case Conceptualization document found in instructor’s web site under Reading Materials. It is better to provide narrative description of these things than to attempt to construct dialogue. ??Do not describe and/or define all the major concepts of each theory; concentrate on those that apply directly to the case. However, make sure that you include a good representation of concepts from each theory.Illustrate specific interventions or techniques you used in working with Kathy (not just describe or list these techniques). Again, apply the techniques from each theory to the specific content of your client's issues. Do not just describe the techniques in general terms. (For example, if you are going to use systematic desensitization spell out the content of the hierarchy of situations to be used; or from the Adlerian perspective spell out "The Question" you posed to your client – Ruth, what would be different in your life if you did not have these anxiety attacks? - as well as your interpretation of the client's answer.)??????????Since this is a client you have worked with, you will know what transpired in the counseling process. Therefore, it would not be appropriate to report what kind of questions or areas in the client's life you would have liked to investigate further, according to each theory. In contrast, what you are asked to do is to imagine that you pursued those areas with the client and therefore, you are now ready to report what you learned from the client and how you used that information to conceptualize the client's case and to come up with specific interventions, according to each theory. Make sure to write the responses in the past tense.?You may write the paper in a question/answer format or in an essay format. If you choose the essay format, as much as possible discuss issues in the order they are presented in the questions Case Study #1 Due on June 15, 2015 Theories: Psychodynamic, Objects Relations and Adler Explore Kathy’s current and early relationships as they relate to issues of attachment and autonomy. Describe the ideas and feelings about her sense of self that Kathy might have developed in the context of these early relations.Discuss how these ideas and feelings about self may influence Kathy’s current problems; identify patterns (adaptive or maladaptive) from early relationships that Kathy may be repeating in current life. Identify and describe defense mechanisms (at least 2) embedded in Kathy’s presenting concerns and explain how these symptoms and defenses may relate to Kathy’s difficulties. Describe changes in Kathy’s feelings and/or behaviors that would indicate personal growth and positive therapy outcome from the perspective of this theoryDescribe specific interventions (from the perspective of this theory) that you used to help Kathy achieve the identified goals.Adlerian Identify how her presenting concerns (and symptoms) relate to Kathy's ability to successfully meet specific life tasks.Describe the content of Kathy’s faulty logic. Discuss experiences in her family constellation that might have led Kathy to develop specific ideas included in her faulty logic. Describe the connection between the content of the client’s faulty logic and the problems she faces in current life.Identify the possible underlying purposes of Kathy’s problematic behaviors (symptoms) and describe how these behaviors may prevent Kathy from successfully meeting the life tasks.Describe the goals of counseling and changes in Kathy’s feelings and/or behaviors that would indicate personal growth and positive therapy outcome from the perspective of Adlerian theoryThe last two stages in Adlerian Therapy process are labeled Insight, and Re-orientation. Briefly describe the purpose of each of these two stages, (b) identify and describe one technique or intervention specific to each stage and (c) explain how it would be used in counseling Kathy to achieve the purpose of the stage . Insight Description/Purpose Technique or Intervention Description/IllustrationRe-orientation Description/Purpose Technique or Intervention) Description/Illustration Case Study #2 Due on June 22, 2015 Theories: Rogerian, Existential, Gestalt, RogerianAccording to Rogers theory, how would you explain that Kathy’s new life situation (ex-husband death, and that she is more comfortable financially than ever before) triggers some of the anxiety that she is experiencing? Describe and explain how issues related to self-actualizing tendency, conditions of worth, and incongruence may help us understand Kathy’s anxiety since the death of her husband. ExistentialIdentify and describe how Kathy’s presenting concerns relate to specific givens of existence (at least 2 of them).Identify mechanisms of defense Kathy may be using to deal with the anxiety generated by these givens of existence and describe how these defensive behaviors contribute to the problems she is experiencing. To what extent is Kathy experiencing normal versus neurotic guilt in general and specifically regarding using her money to do things for herself (e.g. buy nice cloth, enjoy the arts). Explain. To what extent is she experiencing normal versus neurotic anxiety regarding her relationship with men? ExplainDescribe the goals of counseling and changes in Kathy’s feelings and/or behaviors that would indicate personal growth and positive therapy outcome from the perspective of this theory.Describe specific interventions (from the perspective of Existential theory) that you used to help Kathy achieve the identified goals.GestaltIdentify areas in Kathy’s life where she may have unfinished business and describe how these lingering issues may hamper her ability to be fully in the here-and-now in her life.Identify and describe the defenses she is using to resist contact with herself and othersDescribe the Gestalt interventions you used to help Kathy resolve her unfinished business and re-connect with parts of herself (at least 2) . Case Study #3 Due on June 30, 2015 Theories Behavioral/Cognitive Beh., SFBT, Feminist Behavioral/Cognitive BehavioralIdentify Kathy’s irrational thoughts (a la Ellis) and maladaptive thought patterns (a la Beck’ -distortions in processing information – al-tleast 2). Describe how these irrational thoughts and information processing distortions relate to her presenting concerns.Describe the behavioral goals of counseling and changes in Kathy’s feelings and/or behaviors that would indicate positive therapy outcome from the perspective of this theory.Describe specific behavioral and cognitive behavioral interventions that you used to help Kathy achieve the identified goals (at least 3).Help Kathy develop a self-management program related to one of the behavior change goals. Identify each of the 5 steps in the program and describe the activites in each step.Solution Focused Brief Psychotherapy (SFBP) Identify one of Kathy’s presenting concerns that could be addressed using the SFBP approach. Describe two interventions from SFBP that you used in therapy with Kathy. Articulate how you expect the interventions will help her address the identified issue.Feminist Therapy Identify aspects of Kathy’s presenting concern that are amenable to be addressed from the perspective of feminist therapy. Describe how issues of power related to internalization of traditional gender roles may have contributed to Kathy’s presenting concerns. Describe specific interventions from the feminist perspective used in therapy with Kathy (at least 2).Conclusion -- What is your take??Now that you have “worked” with Kathy from several theoretical approaches to counseling, discuss the strengths and weaknesses of the various approaches in working with her. Base your discussion on both your emotional and reasoned reactions to each theoretical approach. Among other things that you may think of, consider the following: What aspects of each of her presenting problems seemed more amenable to be dealt with from each theoretical approach? Identify approaches you think Kathy would have been most receptive. Explain your answer. Identify approaches you think you would feel most comfortable implementing with a client similar to Kathy. Explain. (Take into account characteristics of both yourself and the client). ................
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