Case Study of Jill: The Helper - Essay Example

? Case Study of Jill: The Helper of Case Study of Jill: The Helper Jill is 27 year old female who has come to me for help and she is a nurse. What concerns me right away about this case is that each time Jill moves, her body language shows she is in pain (she grimaces as she moves and she sits uneasily in the chair). This is an immediate red flag as this could indicate that she is being beaten by her husband. Jill reports that she is unassertive, and that her husband is upset with her because she has no interest in sex. She says that he gets angry and “does things to her.” This is also a cause for concern because she, at this point, gives no elaboration about what these things are and whether they are physical or not. Since she is afraid that he will find out that she has come to counseling, this is also a cause for concern. The ABC Model of Crisis Intervention A: Developing and Maintaining Contact In any crisis situation, there is the need to establish rapport with the client. The rapport must begin with the understanding of the client and the ability of the counselor to show that he or she understands what the client is going through (Kanel, 2007). Kanel suggests that good listening skills and eye contact are what can create a positive situation for the client and help the client trust the counselor faster. Also, Kanel explains that active listening means that the counselor must observe the client while they are talking and be able to listen to the words that are being said. In other words, the counselor must be able to listen to the client and watch their body language as they are talking. In the case of Jill, the first order of business is to develop rapport with Jill so that she develops a level of trust. I would begin talking to her in a friendly matter in an attempt to get to know her before we move on to the problems. I would be asking her about her life as a nurse, what she feels she likes best about it and what she does not. I would ask her about hobbies and about what she likes to do on her day off. I would ask her if she has children, and if she does, I would ask her about her children and what they do in school. If she does not have children, I would ask her if she wanted children or if she and her husband chose not to have children. I would be listening for commonalities between what she says and things I can relate to her that I also do. I would also be listening for issues that come up about kids or whatever. I would be looking for ways to help her understand that this is a safe place for her to be and that she would be safe in this environment. Once I felt that rapport was established, I would ask her what brought her to counseling today. I would think that it is very important for her to voice exactly why she chose to come to counseling today. This is an important aspect of the process because she has to talk about what she needs to do. Secondly, I would want to ask her about the challenges about her husband and what happens when he becomes angry. One of the challenges to therapy can be that the client acts in the way they perceive the therapist wants them to act. Tandos and Stukas (2010) pointed out through their study that in building rapport, the therapist must not give preconceived ideas for the client that make them act in certain ways. I took this to mean that therapists must be open to their clients and to the ways in which their clients react to certain situations. In this way, the therapist encourages the client to act naturally instead of trying to act in a way they think the therapist expects them to act. I also think that it would be important for me to paraphrase what Jill says occasionally to make sure that I understand her correctly. This also allows her to understand that I am listening to her. I would also want to show Jill that I was empathetic to her situation. Kanel (2007) states that the way to do this is to reflect on what the client has said. I would think that this means that I would talk about what I saw in what she was saying about her feelings and combine this paraphrasing to make sure that Jill is feeling very comfortable with me as her therapist. B: Identifying the Problem and Therapeutic Interactions Kanel (2007) suggests that step two is the most important aspect of the ABC Model. The therapist must find a way to talk with the client and get to the bottom of what is really going on with him or her. This is the step where a lot of the beginning aspects of healing take place, because the therapist is trying to understand the prompts or triggers that made the client think that they should make a commitment for counseling. Because there are several issues to be talked about at this stage, the important thing for me to do as a therapist will be to examine each component of the problem that Jill is presenting and to look below the surface of these problems. In a sense, the therapist is helping the client look for answers to their problem and possible solutions. Carrier, Levasseur, Bedard and Desrosiers (2010) state that this is a time when therapists use their own cognitive skills and the theories they understand to help the client. As I move Jill into step two, I would take a more in-depth look into her relationship with her husband. My suspicion is that he is abusive to her either because of anger management issues of his own, or he may be drinking. I also think that he may be abusing her sexually. Jill states that he gets very angry and then he “does things” to her. This does not sound like it is a good thing and it may be the reason for her pain. I would ask her how she perceives her relationship with her husband. This would be a very important step to finding out what is going on in her home. I would be looking for denial or whether she would be telling what is exactly going on with her right now. Kanel (2007) states that if the therapist does not clearly understand the problem, it will be difficult to help the client find coping strategies to further their healing in therapy. I agree with this statement because clients can hide behind one thing that they may think is the problem, but the problem may be something entirely different. So, at this point it would be important to find out from Jill what prompted her to come to therapy especially since she thinks her husband would be upset about her coming to the office. Since crisis intervention is short term, I would need to get straight to the point with Jill because something happened to bring her into a crisis process rather than for her to go to a regular counseling situation; she may be asking for help. It may be essential to her healing to understand the relationship with her husband and to and to identify whether this is the source of her physical pain. I also might try having Jill create a picture of a tree based on her foundational issue. As an example, I would ask her to describe her relationship with her husband as a tree. I would then examine the tree as Kandel (2007) explains in her book. I would want to know what the various parts of the tree represented. I would pay particular attention as to how she created the tree, the soil she used, whether it had roots, whether it had branches and so forth. I would ask open-ended questions to gain an understanding of Jill’s cognitive processes and how she handles what she is going through now. Jill currently presents that she is not assertive enough and I would want to gain a better understanding of what this means to her. Using the tree may help her observe what she is feeling and be able to talk about it easier. I would be looking for ways to help Jill understand a definite reason for why she is feeling like she is not assertive enough. A final aspect of assistance for Jill may be to look at the ABC Model of Emotion described by Briddon, Baguley, & Webber (2008). This would be helpful because it allows the counselor to zero in on the emotions that the individual is feeling. This model looks at the triggers that the individual is experiencing more closely and looks at the physical, cognitive, and behavioral changes that the individual goes through during the crisis. This may uncover more relevant information for Jill and me as we worked together. I would be looking for signs of abuse, suicide, or situations where Jill may present a danger to herself or others. C: Coping Kanel (2007) states that in this final stage, the counselor is examining the various coping skills and strategies that the client has from the past and from their current situation; the counselor will also help the client identify new ways of coping in her situation. I also like the idea of talking to Jill about her past coping skills. Kanel suggests that if the client does not remember how she coped, the question, “Well you must have done something or you would not have made it this far” (p. 88) is a great question. I would use this question with Jill if we get to this point. I would be most interested to know how Jill has worked with her husband on other occasions when he has “done things to her”. Again, this indicates that there may be some problems for her with domestic violence. If there is domestic violence, there may need to be a different method of working with Jill. Sabina and Tindale (2008) state that most literature suggests that women who experience domestic violence do not have well developed coping skills. They also state that women who have a variety of material resources are more able to leave a domestic violence situation than those who do not. If Jill is in an abusive situation, there may be other resources that she will need. Kandel (2007) suggests that by the time a client reaches the third level in the model, they have discussed many situations and may be able to examine new coping skills. However, they are more prone to accept coping skills they come up with rather than those that are suggested to them by the counselor. This is very important because with Jill, I would talk with her about the coping skills she has had and what she will do now. I would only suggest to her coping skills after she had exhausted ones for herself. In this way, she would be open to the new coping skills and may have insights into things she could do herself. Because this is a crisis situation, Jill will need outside referrals. At this stage, I would offer support groups, but I would suspect that Jill will reject the idea since she felt her husband would be angry with her because she came to this counseling session. I would also suggest to her that she may want to start regular therapy sessions. If she is having problems with her husband, she may need a battered woman’s shelter, but it may be difficult to help her understand why she should leave her husband. Kanel (2007) suggests that there are five goals for interventions with battered women and these would be used with Jill if it was necessary. Conclusion The case of Jill may result in a domestic violence case. If this is the situation, as a counselor I would make sure that she has resources she can go to after she has a session with me. I would make sure that there are a variety of issues that are discussed with her and I would use the ABC model because it would help keep the session on track. I would make sure that we discussed behavioral issues and eventually ethical issues would need to be addressed. There would be a need for confidentiality to be explained and for Jill to understand that her life with her husband may come to an end and she may have a new life that will be worth moving to for herself. She may find her assertiveness in one session or several sessions. This would depend on Jill and what she would do if she does make such a drastic change. References Briddon, J., Baguley, C., & Webber, M. (2008). The ABC-E model of emotion: A bio-psychosocial model for primary mental health care. The Journal of Mental Health Training, Education, and Practice, 3(1), 12-21. DOI:http://dx.doi.org/10.1108/17556228200800003 Carrier, A., Levasseur, M., Bedard, D., & Desrosiers, J. (2010). Community occupational therapists' clinical reasoning: Identifying tacit knowledge. Australian Occupational Therapy Journal, 57(6), 356-365. DOI:10.1111/j.1440-1630.2010.00875.x Kanel, R. (2007). A guide to crisis intervention. 3rd Edition. Belmont, CA: Brooks/Cole Cenage Learning. Sabina, C. and Tindale, R. S. (2008). Abuse characteristics and coping resources as predictors of problem-focused coping strategies among battered women. Violence Against Women, 14, 437-456, DOI: 10.1177/1077801208314831 Tandos, J., & Stukas, A. A. (2010). Identity negotiation in psychotherapy: The influence of diagnostic and rapport-building strategies on the effects of clinical expectations. Self & Identity, 9(3), 241-256. DOI:10.1080/15298860902979331 Read More