What would be the goals of therapy?

EVALUATING OTHER APPROACHES 2

Application: Evaluating Client Profile 4 Using a Reality or Family Systems Approach

In this week’s Discussion, you evaluated strengths and weaknesses of using other approaches with a client. In this Application, you are asked to evaluate a client using a specific approach that was presented this week.

To prepare for this assignment:

· Bring to mind what you have learned in the past 2 weeks about reality and family systems theories and their respective theoretical approaches. Select one of these approaches on which to base this assignment.

· Review Client Profile 4: Lois in this week’s Learning Resources, and think about how you might use your chosen approach with this client.

· Review the course text readings and the media segments for this week, paying attention to how the experts use a specific theoretical orientation, or approach, to evaluate a client.

The assignment:

· In a 1- to 3-page paper, critically evaluate the client in Client Profile 4 using either a reality or family systems approach. Make sure you address:

·

. The strengths and limitations to using this approach with this client

. The specific cultural/gender/age issues that need to be attended to with this client

. The ethical or legal issues that need to be attended to with this client

. The overall therapeutic goal with this client

. How you would proceed with this client:

.

6. How would you begin?

6. What would be the goals of therapy?

6. What specific strategies and/or techniques might you use?

Client

Name: Lois R. Gender: Female Age: 41

Ethnicity: Hispanic Religion: Catholic

Relationship Status: Married

Description of Presenting Issue:

Lois heard you give a talk on abuse and called for an appointment the next day. She said your talk made her realize that she may be experiencing abuse, and she would like your help in improving her behavior so that her husband won’t be so angry with her. Lois has been married to her second husband for three years. When she married, she brought her mother and teenage daughter to live with her new husband. Lois expresses great gratitude toward her husband for allowing her to bring her family with her into his home, and states that he deserves to have the best possible wife because he is so good to her.

Since childhood, Lois has always looked to others to help her and make decisions for her. She cannot tolerate being alone and feels overwhelmed and without direction when she is alone. The focus of her life has always been pleasing and caring for others, asking them to tell her what to do because she feels unable to determine her own direction.

Two major changes occurred in Lois’s life a few months after she married. Her daughter left for college and her mother was diagnosed with dementia. Since then, Lois has felt very sad and lonely. Although she has continued her daily activities and responsibilities, she reports having little energy, having even more than her usual difficulty in making even simple decisions, feeling hopeless, and having little interest in eating. Her husband has responded to this by yelling at both Lois and her mother and demanding that they change. Lois has tried to appease him, but his anger has only escalated and she is now afraid that he might hit her.

Occupation History: Lois is currently a homemaker and caretaker to her mother.

Education History: Lois completed high school and two years of college. She wanted to complete her college education, but was unable to due to financial hardship.

Medical History: Lois did not report any medical problems, but she appears to have a curvature of the spine.

Family History: Lois has two sisters, age 44 and 49. Lois’s father passed away when she was 11 as a result of a massive heart attack.

Alcohol / Substance Use: During high school, Lois tried a variety of prescription medications and illegal substances (marijuana). She became a heavy drinker during her mid twenties, consuming upwards of 6+ drinks per evening, 4–5 times per week. At age 29, Lois joined Alcoholics Anonymous. She remains active and sober in the program, attending one meeting per week.

This week, you will hear a client, Lois, speak about herself and her situation. Afterwards, Dr. Nina Nabors analyzes Lois according to a feminist perspective. Please follow these directions for interacting with this segment: 1. Read Client Profile 4: Lois (available in the Readings section above). 2. From the Course Media, select the title of the segment. 3. Click (Audio Only) Case Study to hear Lois talk about herself. 4. After her section has ended, reflect on this client and how you might analyze Lois according to a feminist perspective based on what you have learned thus far. 5. Click View Expert Analysis: Dr. Nina Nabors and listen as Dr. Nabors analyzes Lois according to a feminist perspective. Click here for a transcript of Dr. Nabors’ analysis.

Transcript of Dr. Nabor’s

Transcribed 12/29/2006 – by Cyber-Com Transcription Services

[00:00:01] – A

NABORS : Greetings. This is Doctor Nabors and I’m going to talk about the feminist interpretation about working with a client, Lois R. I’m going to begin by talking about the strengths and any particular limitations of the feminist approach, which you should actually be aware of, having already read this information in your course material.

[00:00:28] – B

NABORS : The strengths of this particular approach in working with this client really focus on the emphasis on understanding the importance of context in working with clients. You probably read the phrase – The personal is political, in your course materials. And, what that means is that a client’s issues, their thoughts, their behaviors, their values, their attitudes cannot be separate or examined separately from their cultural context. They go together. You know, individuals don’t live in a vacuum and so in order to understand Lois R., the client, I would have to understand her cultural context. That’s-that’s the number one strength.

[00:01:14] – C

NABORS : A second strength of the feminist approach is the focus on power and power dynamics. As you perhaps again are already aware from reading your course material, traditionally, therapists have held an enormous amount of power in therapeutic relationships with clients. The therapists are viewed as the expert in the case, the authority. And, clients, then, are viewed as sort of passive recipients, if you will, of this knowledge.

[00:01:48] – D

NABORS : Feminists therapists believe that there problems with that particular attitude or that approach because, one, the client feels like then it’s, you know, all on the therapist to help them to change, for example, make them change, if you will. And, you know, and if they continue to feel hopeless, then they won’t change, etcetera. Also, of course, it puts a client in a very vulnerable position and so feminist therapists are very aware, are very sensitive to this issue of power and thus in working with client are determined to help the client understand that really they are the expert in their own lives. And, so, the feminist therapists attempt to decrease that power differential in the therapeutic relationship.

[00:02:35] – E

NABORS : Another strength of this approach is that it actually can be used in conjunction with other theoretical approaches, so, there are feminist therapists who are also psychodynamic or insight oriented in their perspective, or are cognitive behavioral – but use an overall feminist approach in working with the clients. And, so, due to that, there really aren’t any limitations, if you will, in using the feminist perspective with-with clients.

[00:03:08] – F

NABORS : In terms of specific issues that I would address with this client, related to culture there are three major ones and they actually all are similar in terms of – of the issues I would address. They’re ethnicity, gender, and religion. As a Latina, Lois R. has been raised with particular expectations about her role in her community. The role of caregiver, the role of-of someone who sacrifices, you know, their own needs, if you will, for that of their family, their children, their significant other. And, so, it would be important to explore whether or not Lois was raised with these cultural expectations. These expectations are similar for women in general in our society. And, so, those two, certainly ethnicity and gender, would interact or intersect, if you will, with this client.

[00:04:19] – G

And, thirdly, the case suggests the client is Catholic and again in Catholicism, there are those expectations for women that are similar in terms of being viewed as followers, and who are supportive, if you will, and whose focus should be on, on that of others as opposed to on themselves. So, those three aspects of culture would be very important to address with this particular client.

[00:04:48] – H

NABORS : There’s one particular legal issue that I would need to address with this client as well, and that’s the issue of a potential for elder abuse within the home. In reading the case description, it appeared that the client has fears that the husband will abuse not only herself but her mother. While there is no particular mandate for therapists to report abuse of adults, there most certainly is a mandate for a therapist to report suspected abuse of vulnerable populations and which, which elders are one of. And, so, that would certainly have to be a legal issue that I would need to address with the client early on in therapy.

[00:05:36] – I

NABORS : In terms of the overall goals with this client, the overall goals would be to educate the client. So, education of the client’s cultural context. And, actually, I would – the goal would be to educate the client and her husband. So, you know, they of course, want to know what’s going on. You know, why the client is distressed. And, so, the goal would be to educate them both about the emotional distress which, which appears to be depression. And, to assist this couple with dealing with this situation in an appropriate manner. So, that’s the overall therapeutic goal, to diagnose the problem, to educate the client and her husband about the problem, and of course, to assist the couple with figuring out the best solution for addressing this distress.

[00:06:30] – J

NABORS : In taking this client on and in agreeing to work with the client in therapy, there are a couple of concerns or things that I would want to address right off with this client. I mentioned a few minutes ago that the client may have been socialized based on her ethnicity, her gender and her religion, to believe that women have particular roles in society – that of caregiver, of follower, if you will of a person who was more passive, more dependent in-in relationships and that – that view men then has more of the authority, if you will.

[00:07:14] – K

NABORS : As a female therapist, I have a concern about how then the client would view my role. Would she view me as someone similar to her in terms of being more of a follower that my perspective may be less valued or, you know, how would those expectations that she was raised with, or may have been raised with, with rather impact how she viewed me as a therapist and my ability to assist her with her distress. And, so, that would be certainly something that I would want to, to keep rolling around in the back of my head as I work with this client in terms of how my gender, you know, might interact or impact my work with that, this client.

[00:08:06] – L

NABORS : Okay, in terms of how we’d proceed, I would begin by explaining my approach to the therapy to the client. I think it’s very important for clients who are new to therapy to know more about therapy, you know, what it is and, and specifically, my particular approach to the therapy. And, so I would talk about the whole issue of context and understanding the idea that she is the expert in her own life, etcetera.

[00:08:35] – M

NABORS : I also would probably talk a little bit about research and, you know, you know, if there are alternative approaches that I think might also be helpful. It’s useful for the client to have options, if you will, in making a decision about what’s the most appropriate approach to-to therapy, and so, you know, it might be useful to talk about some brief therapies that the client might find helpful. So, to give the client some options.

[00:09:03] – N

NABORS : I would then do an evaluation of the situation, including any potential suicidal ideation. I mean, it certainly appears to me that the client is experiencing depression. I would certainly want to-to check, to find out if she has actually had any thoughts of ending her life. I also would do, would want to evaluate whether or not she has had any thoughts about returning to substance use as a way of coping with her, with the, her situation. And-and a more thorough evaluation of again that potential for elder abuse, which I mentioned earlier.

[00:09:48] – O

NABORS : I would also try to get a sense for what her husband’s thoughts were about her coming for therapy. Did the husband know that she had sought out therapy, how did he feel about it – more to get a sense of what kind of support she would have in the home for proceeding with trying to address these issues.

[00:10:07] – P

NABORS : The goals of therapy would be the following presuming an accurate diagnosis and again, just from reading the case, my suspicion is depression, but certainly I would want to do a much more thorough evaluation to determine if that was the case. Another goal would be to empower the client to address her particular fears around abuse, both of herself and of her mother, with her husband, and to empower her to try at least to obtain the husband’s support in dealing with these issues, which are causing marital distress. So, not just effecting the client, but of course, effecting the couple, their relationship.

[00:10:52] – Q

NABORS : The other goal would be to assist the client with evaluating her own life and her life goals and reading the client’s history, it sounds like there are some things the client wanted to pursue but for particular reasons did not. And, so, it would be useful to have the client focus on not just the expectations around caregiving – taking care of her husband and her mother – but, to-to think about, you know, what other things might she do for herself, particularly since her daughter who she had been spending most of her time focused on was now independent and living her own life.

[00:11:35] – R

NABORS : Specific strategies and our techniques that I might use include as a feminist therapist, educating the client about those cultural expectations that I just mentioned a minute ago. It’s very important for the client to understand that she’s not alone in the way she’s feeling about her life, that-that this is, this is not unusual for women who are socialized to believe that their goal, their duty is to take care of others, that their goal or duty is to be a support, a help-mate as opposed to pursuing their own dreams and goals. And, so, it would be very important to educate her about that context, about, you know, what are societal expectations? Society in general, in terms of expectations for women, and her particular community as a Latino and those expectations for women.

[00:12:30] – S

NABORS : And, so, I would, you know, want to educate her about those and then how that impacted her life choices. I would also, you know, in assessing how her husband feels about her coming, try to encourage her to invite her husband to a few sessions to discuss the marital conflict that they’re experiencing and to educate the husband about the client’s distress. While he may be less interested in hearing about societal expectations for women, he certainly might be open to hearing about how the void left by the daughter going to school is impacting his wife and-and, you know, it would helpful to gain his support in helping the client to-to reevaluate her life and her life goals.

[00:13:21] – T

NABORS : Another specific strategy that I would do then is to focus on assisting the client with reaching out to her support system for more support. So, you know, in addition of course to trying to obtain the support from her husband, it would be important to reach out to her family, for example. The case describes the client has two sisters. You know, could the sisters assist her in caregiving for their mother, for example, as well as providing support for the client in dealing with her distress.

[00:13:54] – U

NABORS : Helping the client in terms of getting assistance with supporting her mother from the community, you know, are there centers where the client could get respite care? Or, a support group for caregivers of those with dementia and where she could get more education about dementia as well as maybe learning some strategies for how to deal with the particular types of situations that will arise in caring for her mother.

[00:14:28] – V

NABORS : And, lastly, another strategy would be focused on empowering the client to reach higher, perhaps again in evaluating her life and life goals, looking at some of the choices that she’s made that she can unmake, for example, or make anew. And, maybe completing the degree she started years before, or doing volunteer work. One of the other aspects of feminist therapy that I think is unique is that we – we want our clients to understand that they are not just individuals living in a vacuum.

[00:15:04] – W

NABORS : I sort of talked about this a little earlier – but, are part of a larger whole, a part of a community and as such, we have a responsibility not only to fulfill our own needs but also to give back, if you will. Now, that may be a bizarre message for someone who is been raised her whole life believing that their goal in life was to support others. So, it’s certainly tricky in how you would approach that with this particular client and it would obviously have to be after the client has begun to do some work on herself and so forth. But, giving back in a different way. So, giving back, for example, by volunteering at a battered women’s shelter or in other manner, as opposed to making her feel like, you know, she’s a caregiver makes her feel like she’s connected, if you will and has a higher purpose.

[00:15:58] – X

NABORS : So, these are the kinds of strategies and techniques I would use in focusing on those overall goals that I mentioned earlier. So, this is how I, then, would approach this client as a feminist therapist and I hope that this information has been helpful. Thank you.

Reference

Corey, G. (2017). Theory and practice of counseling and psychotherapy (10th ed.). Belmont, CA: Thomson Brooks/Cole

· Course Text: Case Approach to Counseling and Psychotherapy Chapter 9, “Case Approach to Reality Therapy” Chapter 10, “Case Approach to Feminist Therapy” Chapter 12, “Case Approach to Couples and Family Therapy”

· Client Profile 4: Lois (MS Word format) Be sure to print out this document as you will need to refer to it for the media segment on the Counseling and Psychotherapy Theories DVD and this week’s Discussion and Application assignments.

 

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