Case Study File

The client is a 75-year-old widower who has come to this learner as a confused man. He feels unwanted and useless since he's aged. His wife passed away five years ago and his only daughter, 43-year-old Michelle, has moved an hour away due to her husband's job. Because of this, the client feels he is no longer needed. He is confused as to why he is feeling so depressed. He is also fearful of death from watching his wife suffer for a year before passing away. He also feels guilty because he and his wife had a son 40 years ago who died of SIDS. He continues to blame himself for that.

According to Capuzzi, there are core components of therapy (p. 7). From the beginning of the therapy process, a relationship needs to be established for the therapy to be effective. There needs to be empathetic understanding from the therapist. Next, there needs to be respect for the client by the therapist. There also needs to be genuineness and warmth from the therapist to the client. Lastly, there needs to be a cultural awareness by the therapist.

Case Study

During the first session, this therapist introduced herself and went through the formalities with her client. After discussing the confidentiality policy and tending to the paperwork, she went on to making up a plan of the goals her client would like to accomplish before their last session. By the end of the first session, this therapist and client had developed the following care plan:

Client Goals:

-Develop feelings of importance

-Get closer to his daughter

-No longer feel guilty over the loss of his first child

-No longer fear the end of his life

-Develop a sense of well being

Therapist's goals:

-Help client in determining the root cause or causes of the depression and confusion

-Assist client in achieving his goals

Treatment and Intervention Plan

Before the next session, this therapist thought of strategies to help her client accomplish his goals. After doing some research, she began to devise an approach to help her client evaluate and understand his feelings. She decided to use the Existential Theory for her client's therapy. Some of the major constructs of this theory are death, isolation, culture, and feeling meaningless or meaningful. These constructs will be a good approach to her client's therapy. Although this therapist's main therapeutic approach is existential, she will use methods from other psychotherapy theories to help her client.

Case Analysis

The first problem the client wants to take control over is his confusion over why he's going through this depression. He feels overwhelmed and thinks he is the only one going through this. This learner can help her client understand that his feelings are natural given that he is coming from a culture where elderly people have begun to reflect on their past and whether or not they are satisfied. He is going through what Erik Erikson called the Integrity vs. Despair crisis. This happens in late adulthood. Most seniors can become depressed or satisfied, depending on how they lived. The client should know that most elderly goes through that. (Haley, 1998)

After the client understands that he should not be confused, the next method this therapist will use is the use of Rational Emotive Behavioral Therapy, or REBT, to help him get past his guilty conscious. The best way for REBT to work with regard to this learner's client is if the rational vs. irrational tactic is used as well as the thought changing process. The client feels guilty because he could not save his infant son. The rational vs. irrational approach can be used for every area of the client's problems along with the thought changing process. These two processes help by the client learning to stop the irrational thought and changing it into a rational one. So, if he begins to think the death of his son was his fault, he needs to stop those thoughts and change them into a more positive one. (Jenkins and Palmer, 2003)

The next problem this client would like to overcome is the feelings of worthlessness and isolation. This learner will use the family approach to help the client overcome these feelings. The article from the Journal of Psychotherapy Integration can help this learner tremendously as it focuses on not only the client, but also the client's family and how they can enhance the therapeutic results. One idea is to bring his daughter in for a few sessions to do some role-playing. If the daughter can put herself in his shoes, maybe she can help him to understand that he is still needed. His job as dad isn't over. Another idea to help him overcome isolation is giving him homework between sessions to look for groups or activities at the nearest senior citizen center so he will be with other people his age.

The last problem this client wants to overcome is his fear of death. He watched his wife suffer at the hands of cancer and now fears he will suffer the same way. This therapist has decided to use a method taken from the Gestalt concepts. This learner believes the best tool to use with regard to this approach is the Here-and-Now Orientation. This is a tactic used to help the client focus on the present time. This learner's client is fearing death. With this therapeutic approach, the client can learn to not focus on the past or the future. If he can start focusing on present day, he can fear death a lot less since he isn't focusing on it. (Robinson, 1991)

References

Capuzzi, D., & Gross, D. R. (2007). Counseling and psychotherapy: Theories and interventions (4th ed.). Upper Saddle River, NJ: Prentice Hall.

Jenkins, D., & Palmer, S. (2003). A multi modal assessment and rational emotive behavioral approach to stress counseling: A case study. Counseling Psychology Quarterly, 16(3), 265-287.

Knight, T. (2007). Showing clients the doors: Active problem-solving in person-centered psychotherapy. Journal of Psychotherapy Integration, 17(1), 111-124.

Melito, R. (2006). Integrating individual and family therapies: A structural-developmental approach. Journal of Psychotherapy Integration, 16(3), 346-381.

Richeport-Haley, M. (1998). Ethnicity in family therapy: A comparison of brief strategic therapy and culture-focused therapy. American Journal of Family Therapy, 26, 77-90.

Robinson, J. (1991). Towards a state of being able to play: Integrating Gestalt concepts and methods into a psycho dynamic approach to counseling. British Journal of Guidance & Counseling, 19(1), 44-65.