INTERVIEW NOTES AND ANALYSIS - Essay Example

?INTERVIEW S AND ANALYSIS SOAP INTERVIEW S Assure her that this is a safe place, no judgment. Therapist explains the Value of setting aside time for herself. She helps the client to discipline herself. She encourages client to help daughter with language skills. Encouraged client to network with other people with children of similar age. Exploring options in relocating Patricia. Client explains that she doesn't trust internet sources with respect to job seeking. Client plans to try housekeeping work allowing her to pay for rent with labor. Therapist makes an effort to organize client's plans and options. Client admits value of therapist taking her in a step-by-step process to organize her goals and problems. Therapist reinforced client's realization that the angry emails are untrue, and undescriptive of her character. Therapist encourages client to break down her objectives into manageable pieces. Therapist acknowledges that the necessary skills are within the client, and to not forget. TREATMENT OUTLINE The treatment plan employed by the therapist in question was centered around permitting the client to fully express their own needs and desires, while providing a gentle encouragement towards the purpose of goal setting. The posture used is encouraging and supportive, displaying a willingness to listen and a personal availability on behalf of the therapist. In part, the strategy employed is a similar to Egan's model of the skilled helper. But there is a sense that certain important details may have been left out of the video recording. But overall the therapist appears interested and attentive towards the needs of the client, guiding her towards self-empowerment in regards to addressing the problems, and planning for the future. Planning in particular appears to be integral to the overall treatment strategy. This session is less about unraveling a particular psychological condition and more about helping the patient take charge of their own life. The environment is supportive of the recovery process. The room appears to be small and enclosed, and likely has been used for some educational purpose, or similar counseling settings. The setting is unlikely to contain problematic distractions, and has a ‘cozy’ feel. This lead to a subconscious impression of security or protection, and should prove a benefit to the session except in cases of extreme, clinical claustrophobia. CRITICAL EVALUATION In regards to the first patient, the divorced mother attempting to reunite with her daughter in Australia, her initial written comments as described in the report suggest issues with self-esteem. It is important to delve deeply into the mindset of the patient, in order to get at the root causes of self esteem deficiencies. And also to identify instances of the irrational thinking by the client that may serve to gratify a neurotic tendency, but is ultimately self defeating. It speaks well of the therapist who is able to procure an acknowledgment that those criticizing the client have a weak position. It is encouraging that with respect to the heat e-mails, she was able to conclude that there was little truth in them, thus minimizing their bearing on her value as a person, and her worth as a parent. This acknowledgment speaks well of the counselor's ability. While not a pressing issue of life and death, improving self-esteem in clients such as this is always beneficial, to the extent that a higher self-esteem is a predictor of less stress over the course of a lifetime. The counselor must help the patient develop coping strategies that will inhibit stress proliferation. (Barker, 2007) Also essential is the facilitation of goals and organization of a coherent plan in that regard. For laypersons, well -structured goals are rarely spontaneous, but most are a consequence of deliberate planning. The counselor is wise to get at the root issue, encouraging the client to define what they truly want. In this case the opportunity to complete their studies, pass their exams and get a visa that will allow them to remain in Australia with more regular access to the client's daughter. It is the role of the therapist to assist the client in designing a coherent goal with benchmarks and endpoints. In so doing, the counselor must allow the client to develop goals as outcomes instead of simply activities to be attempted, in addition to being items of substance that will require measurable effort. The counselor must assist in the creation of goals that are realistic based on available resources and prudent with the potential to yield constructive benefit to the client's circumstances. The goal should yield a sustainable outcome that will result in either tangible assets, or a lifestyle change that can reasonably be maintained. There must be contingencies but without so much flexibility that the process loses coherent definition. The time allotted must be reasonable, and the goal should not thwart or defy the client's existing value system. (Egan, 2007) all this is in accordance with the skilled helper model. And encouraging the client to develop a plan based upon the need to study for her examinations is a sound therapeutic strategy in this case. All of this is intended to improve her focus, allowing her to succeed at these medical examinations which are a necessary step towards her eventual goal of reunification with her daughter. The hateful e-mails are a distraction, which she admits are interfering with the focus she needs in order to succeed at her studies. Hence the necessity in persuading her that the comments are not reflective of her worth as an individual. The skilled helper model includes an active focus on encouraging clients towards a self exploration of the relevant situations affecting their life, and the discovery of new opportunities and the proactive establishment of goals. It stimulates the patient to take charge of their own circumstance and to find the inner resolve to affect their own recovery. The approach is intended to not only inform clients on a systematic approach to resolve current challenges, but also assist them in formulating a lifestyle strategy that will permit them to address future problems relating to the current issue that might someday arise. The goal is to achieve a therapeutic collaboration based on trust, and acceptance – such as when the therapist told the client how their sessions were safe and private, that she was free to discuss anything necessary. An emphasis on planning for the future permits the client the ability to transfer new aptitudes and skills into encounters. This provides additional self empowerment towards the formulation of plausible and realistic goals. The interview contained numerous examples of the therapist verbally exploring the client’s plans and doubts, in an effort towards assisting her in goal setting, and planning for the future. This would include the exploration of the best possible home for her daughter, educated in a French speaking school. The therapy encouraged clear and rational decision-making, free from irrational doubts. Using the skilled helper model the therapist will assist the client in projecting plans for the future that yield measurable outcomes, have specificity, and can reasonably be achieved without the violation of the client's values. The client stated that as her daughter near his 13 years she cannot simply make decisions for her as she would a child, and the therapist supported this reasonable premise and encouraged the generation of additional ideas for a collaborative process between the client and her daughter. A therapist utilizing the skilled helper method must also be aware of the listening techniques described using the acronym SOLER. (Egan, 2007), (Nelson, 2007) (S)Face the client squarely, or in some cases at a 45° angle. (O) keep an open posture towards the client. (L) leaned towards the client, this portion of the strategy was used extensively by the therapist during the recorded sessions. Her posture communicated an interest in the client's problems and the appropriate willingness to listen. (E) I contact with the client or patient should be maintained. This was more difficult to gauge, since in the interest of confidentiality the face of the client was not on camera, but it can be inferred from watching the face of the therapist that attentive and appropriate eye contact was maintained. (R) relaxation. On the part of the therapist, they should maintain a posture that puts the client at ease and minimizes the stress of unburdening themselves of the challenges that have brought them to seek counseling in the first place. Much of the discussion seemed to center around what could be considered stage 1 of the Egan process. In which the client's situation is fully explored. Although this exploration could have gone further with respect to a clinical diagnosis, as the written comments state that the client is suffering from depression, as will be discussed in depth in a later section. The stage one process centers around a person centered approach in which a safe zone free of judgment is instituted, as per the counselor's initial statement. When centering upon the person, the skilled helper will provide clarification and identification of not only the challenges that complicate the patient's life, but also opportunities that the patient might not realize they possess. An objective review of the situation is also helpful in motivating the client to take accurate measurement of their own resources. A major objective of stage I is to prod the client into an accurate assessment of their personal resources, unclouded by irrational doubts. The therapist seems appropriately focused on the person of the client, displaying empathy and allowing an appropriate amount of time for the client to express her thoughts. And these are important aspects of the stage I process. The questions are open-ended, which is a necessity to allow the client the ability to fully express themselves. (Nelson, 2007) The second stage of the process centers around aiding the client in solidifying their aims and objectives. What does the client really want? What is the most efficient and realistic way in which these desires can be achieved? Here the goal is less about personal expression, and more about rational strategizing as the skilled helper provides organizational clarity that allows the client's true needs to take shape. (Egan, 2007) An important concern during stage II is timing, organizing the client desires into a coherent schedule or process that will lead to the desired objective. This concept was not explored with detailed specificity during the interview. Many options were discussed in terms of ideal placement of the client's daughter, but there was considerable flexibility in terms of the timeframe involved. But the important items of empathy and discussion of overall objectives, essential steps in part two were achieved. (Egan, 2007) Often this is followed by stage III which could be likened to a form of brainstorming, in which the client may attempt to devise as many strategies as possible, within a short timeframe to create a library of choices which the skilled helper can then help sift through. And considerable discussion occurred in regards to what sort of school would be best for the client's daughter. Given her familiarity with the French language, the language barrier in moving to an English-speaking environment would be considerable. A number of locations were suggested as a possible placement options. But as the client herself has stated, since her daughter is no longer merely a child, any final discussion in this regard must include her. But the discussion of various placement options is still helpful as a way of generating ideas that can be organized for more efficient decision-making later on. According to Nelson, (2007) this form of brainstorming is a necessity in the decision making/problem solving process, requiring a diverse series of alternatives, and diversity in thinking. In order to logically evaluate the best objective, a wide range of objectives must be generated. There was a summary at the end of the recording that attempted to encapsulate the true objectives of the client. The skilled helper method often requires a process of evaluation at the end of the session, for the purpose of summarizing. During the recorded session, the final moments seemed more about providing final encouragement towards the client then wrote summary of what had come before. But this seems helpful, and the client herself expressed satisfaction over the counseling process in general. (Egan, 2007) The skilled helper model can also take race and ethnicity with respect to cultural relevance into account. While the face of the client was not visible, it may be presumed that living in Australia there would be no overt racial complications as a result of any external criteria. The chief issues involve those of language. Although, the client did express a concern that her daughter, having been educated in the French language may have acquired "arrogance" presumed to be a common trait among the French. This is viewed by the mother as an obstacle towards her daughter's acceptance within an English-speaking environment. The therapist did not attempt to question the presumption of arrogance, but instead responded with more probing questions to allow the client the chance to fully express her doubts. The attached written summary of the interviews brought up a psychological evaluation that is worthy of further exploration. The client is described as suffering from depression as a result of separation from her daughter, but an additional therapeutic option would entail an in depth exploration of her mindset leading up to this current issue of her daughter and permanent residency in Australia. The skilled helper practice of appropriate empathy and active listening should be used to delve into this putative diagnosis of depression. Often in cases of clinical depression, there is a gradual process whereby a negative mindset stemming from some initial crisis persists over a period of months and years. Only later does this lead to an identifiable case of depression. It would be worth verifying the extent and severity of these symptoms; to rule out whether or not the client is simply "sad". The condition of depression as described in the written report is mentioned as a foregone conclusion. But the counseling session could be strengthened by mention of definitive criteria that leave the counselor to make the conclusion. It is possible that a skilled counselor will recognize the lack of enjoyment and irritability that a depressed patient often feels, but this is not explicitly identified. In favor of a diagnosis of depression would be in the client's female gender, which does serve as a risk factor due to a woman's higher levels of emotional sensitivity. (Perry, 2012) The separation from her child is listed as the cause, but major depressive episodes often require significant time to build into a clinically relevant crisis. More discussion would be helpful in terms of how long the client has experienced the symptoms of depression, whether the onset was rapid, or progress over time? Was there a latency period prior to feelings of depression immediately after separation from her daughter? And what was the client's emotional condition over the past year? In cases where a slow-mounting process leading to a clinical episode builds gradually, it would be helpful to encourage the patient to maintain some form of diary, or journal. This could provide the therapist with evidence of a progression, or lack thereof. Does the client have family members that exhibit a history of depression? This leads to a higher proclivity towards similar symptoms. (Perry, 2012) During the interview recorded, there did not appear to be any clear pronouncement from the patient indicative of true depression. The client should have been able to report whether they had experienced a persistent negative mood and lack of interest in their former hobbies over a period of several months or years. It is not difficult to locate online sources that can provide a detailed list of descriptions that define clinical depression. (Skapinakis, 2008) other than a persistently negative mood, there is the presence of low self-esteem as discussed below. This is of similar to comments that the client has made, as recorded by the written summary - possibly justifying such an interpretation. Depression is often accompanied by feelings of guilt, here the analogy breaks down with respect to the symptoms listed in the interview. The client describes the hate e-mails but mentions clearly how she has overcome any form of guilt or recrimination as a result, realizing that they are not truly descriptive of her. That argues against an essential symptom of depression. (Skapinakis, 2008) Her expression of low self-esteem (according to the written report) is apparent when she mentions how she feels it unlikely that the therapist will be able to help her, but feels the need to discuss her issues regardless. This could be indicative of a feeling of hopelessness, but also a possible indictment of the therapist's professional acumen. But if the client willingly seeks therapy, then there is a presumption of a certain basal level of confidence in the therapist's abilities. The statement that the therapist is unlikely to be able to help her strongly suggests feelings of low self-worth, or an irredeemably flawed personality that the patient feels is immune to improvement. Discussion concerning that statement would be warranted during the therapy session, how long has the patient felt that way? Throughout their recent memory have they had feelings of inadequacy, or is this perception a recent development following separation from a child? There does not appear to be any mention of a lack of enjoyment, nor an intolerance of social interaction. Depressed patients may become lackluster, and lose all interest in former activities that they once enjoyed, as well as people whose company has previously been important to them. (Skapinakis, 2008) The client does not express such a sentiment. Much of the discussion during the interview stands from her desire to reconnect with and provide for her daughter. While there is discussion about what would be best for her professionally, she very much desires interaction and contact with her daughter. And this interview did not entail any details that would be suggestive of a weekend of sex drive or suicidal thoughts. Therefore, it is difficult to conclude that depression is a likely presumption. It may be supposed that the use of this adjective is only in a very general, non-clinical sense of the term. However for professional purposes, in a written report this distinction should be clarified to avoid misinterpretation. Overall, the case study displays a counselor that expresses a confident grasp of the patient and her problems, but a more in-depth strategy of probation would be helpful towards identifying the exact nature of the client's crisis would be helpful. It was noted during the written summary that a client experienced sharp anger towards those that she felt were responsible for her current troubles, involving the separation from her daughter, in particular her husband and his new girlfriend. There is the statement that she appears to blame then for her challenges, which implies that she herself is not to blame, and is almost entirely satisfied with her choices in life. Yet she also has stated initial doubts that the therapist will be able to help her. This might be indicative of an external locus of control, (Lefcourt et al. 1991) describing a presumption that outside forces are the key determinants of one's work and success. And that these external forces are therefore responsible for most if not all setbacks in the life of the patient. (Lefcourt et al. 1991) An exploration of this viewpoint is warranted on the part of the therapist. An external control locus can impede the patient's ability to recognize their own culpability for setbacks the challenge them. A more balanced view is logical, were adequate consideration is given to both internal and external forces as indicative of the sum total of an individual’s life. This area merited more thorough investigation on the part of the therapist. To clarify, the patient seems to exhibit a low internal locus of control, and a high external. By extension, a person with a high internal control locus believes that the outcome of their lives is largely under their own control, and they take responsibility for their actions. (Abrahamson et al. 1978) This seems the reverse of the patient in question, expressing a tacit assumption that all others are responsible. It would be beneficial to take her back through the circumstances of her marriage and separation from her ex-husband, and attempt to identify whether and to what extent her own actions might have contributed to the current separation and circumstances. It appears as though the counselor is making progress towards patient progress. One of the critical premises of Egan's model of the Skilled Helper is the promotion of skills that help a client move forward towards higher functionality. Egan's model is a three stage cyclical process of motivational skills followed by an evaluation. Her encouraging the patient to formulate their own goals is compatible with this method, which is collaborative and consensus–building, rather than authoritarian. The skilled helper model is nonetheless not one of the formless submission, nor is it coercive. But the goal is to enter a partnership with the client, collaborating in the formulation of goals and behaviors that will empower them to take charge of their life and circumstances. Guiding the client towards the realization that studying for their medical examination is of immediate importance is an example of the Skilled Helper model in practice. The therapist appears proficient at cutting through distractions and irrationalities and guiding the patient towards a new understanding of themselves and their own potential. The professional guidance available through a trained counselor serves as an objective lens that can penetrate delusions and insecurities that might lead to unrealistic expectations on the part of the client, impeding their attainment of perfectly reasonable goals that would enhance their life. Also noteworthy is the therapist's acknowledgment that some insecurities are inevitable. Thus there is an allowance of personal time that the client takes for herself in which she is permitted to "worry". This serves to isolate and categorize any irrational tendency, drawing power to it and in so doing working to marginalize that thought process. Strategies such as this allow the client an outlet for insecurities in a way that argued repression could not. It is rarely a sufficient treatment option to simply order the client to cease and desist a particular thought process or pattern of neurotic behavior. The therapist must analyze, isolate the behavior and provide an objective sounding board that will allow the client to deconstruct the underpinnings of irrational behavior. The problem must be broken down into manageable bites that are amenable to therapeutic strategies accompanied by the client's willingness to change. Allowing for this "worry time" should provide an outlet that will permit the client to eventually overcome the need for personal time simply as a means of indulging the tendency to fret. For certain types of personalities, those burdened with doubts, uncertainties, and insecurities the approach used by the therapist in this interview can prove a useful motivator and method of clarifying ideas. Also important, the therapist assisted the client in generating and evaluating their own choices, in a non-judgmental manner. This does bear similarity to the skilled helper method, but was not identical by rote. The session appears to achieve its desired purpose, but the included written report seemed to make unwarranted clinical assumptions based only on the information provided here. REFERENCES Abramson, L.Y., Seligman, M.E.P., Teasdale, J.D. (1978). "Learned helplessness in humans: Critique and reformulation". Journal of Abnormal Psychology 87 (1): 49–74. doi:10.1037/0021-843X.87.1.49. PMID 649856. Barker, D. B., (2007); Antecedents of Stressful Experiences: Depressive Symptoms, Self-Esteem, Gender, and Coping; International Journal of Stress Management, Vol. 14, No. 4, 333–349 Egan, G. 2007. The Skilled Helper, A Problem-Management and Opportunity-Development Approach to Helping. Thomson Learning Academic Resource Center. Thomson Brooks/Cole. Eighth Edition. Lefcourt, H.M., Robinson, J.P., Shaver, P.R. Wrightsman, L. 1991. Measures of personality and social psychological attitudes.Measures of social psychological attitudes, Vol. 1., (pp. 413-499). San Diego, CA, US: Academic Press, xiv, 753 pp. Nelson, P.J.M. 2007. An Easy Introduction to Egan's Skilled Helper Solution Focused Counseling Approach. Article Copyright Patrick JM Nelson 2007. Perry, M. 2012. How to Diagnose Depression? HealthGuidance. Health Guidance for better health. http://www.healthguidance.org/entry/12282/1/How-to-Diagnose-Depression.html. Accessed: 5/22/2012. Skapinakis, P. 2008. Signs of Depression : Depressed? How to Diagnose Clinical Depression. web4health.info. http://web4health.info/en/answers/bipolar-dia-depression.htm. Accessed: 5/24/2012. Read More