Counselling treatment plans for case study- Steve - Essay Example

? Counseling treatment plans for case study-Steve This is a study about a counseling treatment plan for a client d Steve. The study will include the most appropriate intervention that can be applied in dealing with Steve’s case. The plan will start by giving biographical information about Steve that is missing and comment on his positive attributes. The study will then describe Steve’s presenting problems and comment on what the problem does not involve. Thirdly, the study will list assessments that may be needed to provide valuable information about the client. In the fourth section, the study will give an account on how the problems might have developed. The study will then focus on the case formulation, goal setting, and intervention plan in the fifth, sixth, and seventh section respectively. Counseling treatment plans for case study- Steve Biographical Information Steve is a thirty-year-old man who has been married for a period of two years. Before he got married, Steve had courted his wife for five years, after which they agreed to settle down in marriage. During their courtship years, Steve and his fiancee quarreled over minor issues. This resulted to numerous disagreements, which consequently led to separations that were short-lived. Steve and his fiancee could then settle their differences after some time. Since settling down in a marriage, Steve has had disagreements with his wife. Steve does not have any serious health problems except for the fact that he gets easily angered. He works as a senior accountant in a tours and travel company. Steve was brought up by his two parents who often had a disagreeable marriage. At the age of fourteen years, the parents separated, and Steve was left under the care of her mother. He had constant conflicts with his mother, which stemmed from his dissatisfaction. He was never happy that the father was not around. Steve has never had any problems at work, or any irritability. Mood swings and regular feelings of anger have resulted to conflicts between him and his wife to the extent that fights have erupted. Steve has not succeeded in changing his feelings of anger, which have precipitated his dissatisfaction. Previously, he has never consulted a counselor or a therapist for any assistance with his problem. He only consulted a doctor who directed him to a counselor. Steve admits that he shares many interests with his wife, but argues that the wife seems self-centered. Steve reports that he has never had any alcohol or substance abuse problems. Steve has neither had friends who mislead him; he considers his friends as people who have contributed to his success. Steve’s positive attributes Apart from the fact that Steve constantly quarrels with his wife, he has some positive attributes that can be deduced from the interview with him. Steve is not a proud person since he normally apologizes to his wife whenever he goes wrong. This shows that he accepts his wrongful deeds and does not deny that he makes mistakes by fighting his wife. Another positive attribute that Steve has include decisiveness and courage since he can be able to confront a therapist for assistance. He is also candid about his problems as he openly talks about them to the therapist. Steve is also humble; his humility enables him to apologize to his when he wrongs her. Steve loves his wife and wants to make up things with her permanently. He can also be regarded as sincere since he talks of his desire to make a permanent breakthrough in his marriage. He is also hopeful that the solutions he will get from the therapist will help him deal with his marital problems once and for all. Presenting problems Steve has several presenting problems, which he describes as the difficulties that he goes through in his marriage. The major problem that poses difficulty in Steve’s life includes Marital and partnership breakdown. This can be evidenced by the constant disagreements and conflicts with his wife. Steve’s marriage faces significant challenges, which stem from the conflicts with his wife. Steve undergoes distress that is mainly caused by the dissatisfaction he has in his marriage. This is what makes him seek treatment from a counselor. From his experiences, it is clear that Steve has relational problems. His relationship with his wife is impaired, and they are not in agreeable terms. Another notable problem that presents itself in Steve entails the high temper that has made him confront his wife physically. Physical fighting has led to separations; however, these separations tend to be short-lived as they only stay for a short period. The fact that he gets angry to the extent of physically abusing his wife indicates that the client is unable to control his anger. He does not explore other ways of solving the disagreements with his wife. Instead, he opts to be violent, which only worsens the situation as witnessed in the numerous separations since courtship. The client has perceptional problems; he views his wife as a self-centered and cold person who does not have any concern for his feelings. This shows the resentment he has towards his wife, which tends to contradict the fact that they share many interests. He also has negative self-attitude since he considers himself as a person who will never get satisfaction. Such a belief tends to influence his behavior; it can be regarded as a principal reason why his marriage faces immense instability. Steve also has the problem of uncertainty as he deems that he would not have another person if he separates with his wife. This portrays the extent to which he experiences desperation. There are several considerations, which Steve’s presenting problems do not have. First, only one side of the story is told. Steve narrates the marital problems he faces alone as his wife is not present to enquire from her. As a result, the authenticity of the issues can be doubted since Steve may be exaggerating. For the exact problems in marriage to be known to the therapist, both sides involved in a marital conflict should seek counseling. In addition, the problems do not involve the attempts that Steve has made in combating the marital challenges he undergoes. The problems do not also involve any complaints that the wife might have had about Steve’s conduct and lack of satisfaction. The case only involves complaints that Steve has concerning how his wife treats him. Moreover, the problems lack any other causes of the difficulties that the client has. The case only involves dissatisfaction as the only cause of the marital conflicts. There might be other causes of the disagreements between Steve and his wife apart from his dissatisfaction. Assessment of client Assessment of a client can be regarded as a crucial step in counseling; it enhances effective intervention. Assessment entails understanding the client’s problems in order to formulate the best ways to assist them (Nicholas, 2000). While assessing the client, current status and the history of the problems should be recorded to formulate the treatment requirements (Barlow, Allen, & Choate 2004). A treatment plan can be effectively prepared upon recording information regarding the client. In assessing Steve, it will be appropriate to assess the client’s needs and recording information that will aid in solving his issues. In completing assessments for the client, it will be essential to break down the assessment into several sections. This will provide an opportunity for the client to release any confidential information that he may want to hide. An informal approach to assessment will be crucial as it seems more comfortable to the client than a formal approach. The common assessments to complete for the client include his contact details (Wright, 1995). It will be essential to note down the client’s phone number; this will enhance communication when the therapist needs to know the progress of the client. Another assessment that should be completed includes the client’s confidant or a person whom the client trusts. Such a person can be a close friend who can be told about the client’s problems. It will also be vital to complete an assessment on whom can be contacted incase of an emergency (Nicholas, 2000). In assessing Steve, it will be considerably significant to complete assessment regarding the employment support network. This entails recording information about the conditions at his work place. This stems from the fact that workplace experiences may have caused the problems that Steve encounters (Barlow, Allen & Choate, 2004). During assessment, it will also be essential to record information about the strengths of Steve. This may entail noting down information about his abilities and possible coping mechanisms that can be clearly realized from the assessment. Moreover, information regarding the barriers to overcoming the problems he has will also be recorded. This turns out to be essential since it will enhance the formulation of the appropriate strategies to solve the problems. To provide additional information about the client, it will be vital to complete assessments about the client’s skills, interests, and personal resources. During assessment, the goals of the client will also be noted down. This is beneficial since it will help to know the methods that the client deems appropriate for solving his problems. Goals will also help to know what the clients wishes to achieve by the end of the counseling sessions (Wright, 1995). Moreover, the assessment will also include information about the body language of the client and patterns of speech. The other information that should be recorded about the client includes medical reports as well as psychological reports about the client. This information can be used to know the progress of the client with previous therapists. In completing the client’s assessment, it will also be essential to complete information about the impact of the problem on the client’s capacity to carry out day-to-day activities. In the assessment, information about the client’s educational and medical records will be gathered. During the assessment, information of about when the client’s problems started will also be recorded (Samuel, 2012). Moreover, the client’s perception of his problems will be compared with what other people say about him. Such comparison can be regarded as essential since it provides an understanding of the treatment needs of the clients. Developmental and maintenance processes. The development of problems in clients may happen through a number of ways. As such, several conditions can trigger the manifestation of a client’s problems. In addition, several issues can maintain the problems and act as barriers to ending the problems (Samuel, 2012). The problems that Steve faces might have developed in a number of ways. First, the problems have developed from Steve's deeply rooted beliefs about dissatisfaction. He has strongly held this belief for a long time. To make the matter worse, he has not made any efforts to try to denounce the negative thoughts he holds towards himself. As a result, he has faced immense challenges in his endeavors to embrace positivity. Steve’s problems might have also developed from his upbringing. Since he was only brought up by his mother, he developed feelings of dissatisfaction at a young age. The fact that he felt dissatisfied with the absence of his father indicates that dissatisfaction started creeping in at a young age. The problem has never ceased, and his attitude has accelerated the maintenance of the problem. His failure to take the necessary steps has also had a significant contribution to the propagation of the problem. If he sought counseling at the early stages, probably during his courtship years, then the problems could have possibly been addressed. Thus, his reluctance to seek the appropriate help has immensely contributed to the maintenance of the problems. Steve’s problem could have also developed from failure to appreciate the positive attributes of his wife. He considers his wife as a person who is cold as well as self-centered. Such as belief has made him maintain negative beliefs towards his wife, and he does not consider the positive attributes. Steve should appreciate the fact that him and his wife share many interests, and they have a satisfying sexual relationship. The client’s problems also developed from his high tempers that make him engage his wife in fights. Case Formulation (Conceptualization) Case formulation entails coming up with essential inferences about the client’s problems by understanding the nature of pathological as well as normal development. Drawing inferences may involve going above the relevant facts in a case by addressing concepts that seem complex. An effective case conceptualization should aim at linking the client to the treatment plan. Moreover, the case conceptualization should be geared towards providing a basis for shaping the treatment to the needs, desires and expectations of the client. Through case conceptualization, it can be possible to design a model with which the case will be addressed (Greenberg & Goldman, 2007). The client’s overt difficulties, emotions, behavior, and irrational beliefs can be dealt with using the Persons six-step case formulation model. Persons advocated the six step model, which clinicians should adopt to come up with an effective cognitive behavioral therapy (CBT) case formulation. The six steps include creating a problem list, assigning DSM diagnosis, selecting a primary diagnosis, applying an empirically supported and nomothetic formulation, integrating individual client characteristics, and hypothesizing mechanisms and considering background for the onset of the problems. These steps can be applied in dealing with Steve’s problems (Persons & Tompkins, 2007). Creating a Problem List. According to Persons & Tompkins (2007), in this step, the therapist and the client create a biopsychosocial problem list; this includes the problems that characterize the client’s life. This step helps in selecting the most appropriate and feasible approach to treatment of the client's problems. Moreover, the client and the therapist will be able to anticipate the barriers that may arise in the counseling process by having a list of the client’s problems. In creating a problem list, several factors should be considered and evaluated. These factors include evaluating the client's’ injurious behavior such as ideas of committing suicide, occupational functioning, and parenting skills. Moreover, it will be essential to gather information on the interpersonal functioning that has to do with the quality of social support networks at the client's disposal. During creation of a problem list, the client’s physical fitness as well as medical history will be noted down. Risky behaviors such as alcohol and substance abuse will also be evaluated to understand the extent to which they have contributed to the client’s problems. Other factors to consider at this step include spirituality, culture, and moral developments of the client and how they have affected his behavior (Geldard & Geldard, 2008). At this step, it will be crucial to evaluate and assess the motivational factors in Steve’s life. This may include assessing the extent to which he portrays the readiness to adopt the upcoming change. Assessing motivational factors is vital in recognizing the behaviors that may interfere with the therapy. Five-Axis DSM Diagnoses After compiling the problem list, DSM diagnoses will then be assigned along the five axes. In the first axis (Axis I), clinical disorders such as serious mental disorders of the client will be noted down. Axis II will entail the personality and the pervasive conditions that Steve has. Axis III will include medical conditions while Axis IV will entail the environmental and psychological factors. Axis V is regarded as the global assessment of functioning (Persons & Tompkins, 2007). In this step, the therapist notes down the challenging personality dimensions that may act as a hindrance to the effective treatment of the client. This is essential as it helps in the generation and formulation of hypothesis in the case conceptualization endeavor (Thompson, 2003). According to Eells (2007), during this stage, the environmental and psychological difficulties in Axis IV, and general assessment in Axis V help in setting realistic goals. At this stage, the therapist will note the expectations that Steve has from the counseling process and strive to match them with the counselor’s expectations. This is because Steve may be having unrealistic expectations that may not be easily and effectively achievable. For example, the client may tend to think that bringing change in only one area will solve all other problems that he has. Thus, it will be essential to have expectations that allow for a reasonable pace. This way, both Steve and the therapist will gain motivation in the counseling process. Primary diagnosis According to Westbrook, Kennerley & Kirk (2011), this entails selecting an anchoring diagnosis; this is shaped by the diagnosis of the problem that brings immense distress to the individual and contributes to most of his problems. Primary diagnosis can be regarded collaborative since both the client and the therapist work towards achieving similar goals and objectives. Through the selection of primary diagnosis, it will be possible to know the basis of formulating the treatment plan for Steve. During this step, Steve may disagree on the appropriate diagnosis that should be prioritized. In such a case, it will be essential to try and solve the disagreements with Steve in order to focus on the treatment process. The primary diagnosis should be re-evaluated to assess other disorders that the client may have. This helps in the selection of treatment goals and determining whether the client has other complex problems. At this stage, the therapist should recognize other diagnosis that the client may be having from other sources such as medical practitioners. This will be essential in knowing what should be supplemented with the diagnosis (Persons & Tompkins, 2007). Nomothetic Formulation After selecting the anchoring diagnosis, the therapist will then conduct research to determine whether a nomothetic diagnosis exists for the treatment of Steve’s case. In this step, the therapist can decide to adopt cognitive behavioral therapy formulations that account for the problems faced by Steve. Nomothetic formulation will help in developing the hypotheses on the psychological mechanisms that maintain the client’s disorder. As such, it will be possible to target these mechanisms in the treatment of the client (Greenberg & Goldman, 2007). In Steve’s case, nomothetic formulation would seek to evaluate how his dissatisfaction results to his behavior of violence against his wife and brings disagreements between them. The formulation also seeks to unmask the far reaching consequences of his behavior and the harm it is likely to cause if it persists. According to Greenberg & Goldman (2007), nomothetic formulation incorporates other valuable components that help in resolving the complications and challenges faced by the client. It combines a number of appropriate approaches to the problem in order to enhance the conceptualization and treatment of the client’s problems. In addition, it will be possible to determine previous approaches that have worked well and those that have not worked. As a result, less time will be spent as there is some previous knowledge of the treatment approaches. Individualizing the formulation. The next step involves the application of the formulation to Steve’s case. This will be done after looking at the unique problems that the client faces. Individualizing the formulation will be possible at this stage because the client’s problems are already known. Moreover, the therapist has adequate knowledge on the relationship between the problems and how each leads to the other (Greenberg & Goldman, 2007). Besides, the therapist has already developed a model that will guide the treatment as well as the conceptualization of the client’s problems. The therapist can develop a model for treatment of the problem after knowing the problem that the client encounters (Thompson, 2003). Hypotheses about the Basis of Mechanisms Maintaining the Disorder The sixth step involves developing hypotheses on the origins of the mechanisms that enhance the maintaining of Steve’s presenting problems. The therapist evaluates the client’s family as well as social history. This way, it will be possible to understand the exact origins of Steve’s problems. As such, a comprehensive treatment plan for Steve can be adopted. His family life will be evaluated and his upbringing and the impacts it had on his behavior. For Steve, the therapist will inquire about the development of his beliefs that he will never be a satisfied person. Specifically, the therapist will probe when exactly the client started to experience beliefs of dissatisfaction (Leahy, 2003). The precipitants of the behavior will also be assessed; this way, the therapist will understand the triggers of Steve’s behavior. Knowing such situations will help in avoiding them in the future. Goal setting. There are goals that I seek to achieve by the end of the counseling sessions. First, I want to provide Steve with the appropriate mechanisms to deal with his marital problems and end the disagreements with his wife. Moreover, another goal is to solve the conflicts between Steve and his wife; this will reduce the strains and stress in his marriage. In addition, the counseling will strive to help Steve manage his anger since more anger will only destroy his marriage. Other treatment goals include helping Steve to develop new strategies, which will address the changes that he needs in his life. This is because striving to achieve changes through the usual methods may not be fruitful. In addition, the counseling will strive to look at the client’s problems both honestly and realistically. Another goal includes challenging Steve to look at his problems and difficulties in new dimensions. This way, it will be easier for Steve’s marriage to undergo tremendous positive changes that are desirable. Moreover, the goal of counseling will be to assist Steve understand and appreciate the positive attributes of his wife and learn to consider her feelings. Intervention Plan An intervention plan helps the therapist to learn more about the challenging behavior of the client and how it can be solved. At this stage, the questions on behavior have already been answered. Therefore, the counselor figures out how to help the client resolve his problems and overcome the challenges (Leahy, 2003). In Steve’s case, intervention will aim at ensuring that he adopts behavior that will enhance peaceful coexistence between him and his wife. Cognitive behavior therapy enables clients to have an understanding of the feelings and thoughts that have an impact on their behaviors. It can be employed in the treatment of disorders such as depression and anxiety. Although cognitive behavior therapy can be considered as short-term, it helps clients learn and change destructive thoughts that negatively affect behavior (Westbrook, Kennerley & Kirk, 2011). The use of CBT can be applicable in Steve’s case since it will help him change the feelings he has towards himself and his wife. During the first treatment session, Steve will be asked to open up to the counselor on the problem that he faces. This can be done through the creation of rapport between the client and the therapist. In the second session, Steve is likely to speak openly about his other problems, which he might have failed to mention in the first session. This will help the counselor to understand what other burning issues the client might have. In the third session, recommended ways of dealing with the problems will be addressed. This entails proposing to Steve the appropriate strategies to deal with his issues. For example, the therapist will urge Steve to denounce the negative feelings he has that he will never be satisfied. The fourth session will entail the evaluation of the client’s progress. This entails assessing whether the proposed strategies have worked or are working. During the fifth session, the client will report any progress that he thinks he has witnessed since the start of the sessions (Blocher, 2000). The sixth session may include a termination of the counseling engagement. The counselor will urge Steve to continue employing the strategies that will help him save his marriage. 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Counseling Techniques: Improving Relationships With Others, Ourselves, Our Families, and Our Environment. New York: Psychology Press. Wright, N. H. (1995). Marriage counseling: a practical guide for pastors and counselors. San Francisco: Gospel Light Publications. Westbrook, D., Kennerley, H., & Kirk, J. (2011). An introduction to cognitive behavior therapy: skills and applications, 2nd ed. London: Sage Publications. Read More