Treated Counseling Client Analysis - Essay Example

? Case Report: Treated Counseling Client Case Report: Treated Counseling Client Assessment Instruments and Procedures My client’s recollection of his childhood appears to indicate that he suffered from some degree of emotional as well as physical neglect. His indication that he does not keep any of the cultural attributes of his Aborigine ethnicity is a sign that he does not feel attached to his culture or family members who would be the ones to inspire pride in his culture. My client also indicated that his parents abused drugs when he was a child and that he did not have the chance to complete his high school education. This was probably because his parents used the little money they had to fuel their drug habits. My client also mentioned living in foster homes for some time during his childhood because of the irresponsibility of his parents towards him and his brother. My client obviously has abandonment issues as a result of the emotional and physical neglect he suffered from his parents. It is likely that my client developed a belief that his right to be loved or cared for was dependent on how well he behaved or conducted himself. This may be the reason why he strove not to engage in drug abuse like his brother even though they were both facing similar challenges. My client developed the sense that if he remained in control of his life, he would have the opportunity to determine how others would treat him. Moreover, he was helpless against his co-dependent behaviour. It is likely that when he separated from his mother, began to experience depression, and then his father died, he felt that he was losing control over his life. This spurred the panic attacks that have left him feeling that he will not be able to accomplish anything substantial in his life. My client also appear to experience panic attacks whenever he senses that he is somehow going to lose control of another part of his life. Young adults who have gone through troubled childhoods do not develop the ability to trust others because their first relationship[s with their parents proved to them that even family members are untrustworthy. Adults who have had troubling childhoods also learn to accept pain as a normal part of life, and may subconsciously resist others’ attempts to help them. This is probably what initially caused my client to resist attempts by the Head Space organisation to get him to attend counselling. My client felt frightened, and did not trust his own feelings. I diagnosed that he was suffering from Generalised Anxiety Disorder. He reported that he felt that his mind was constantly filled with thoughts and having a pervading sense of doom. He also emphasised that he was unable to enjoy his own company and felt overwhelmed by the turn that his life was taking. He told of debilitating panic attacks that literarily made him unable to function normally. He also appeared to be feeling guilt over things that were not of his doing- such as his father’s death. I felt that the best way to treat my client’s anxiety and GAD disorder was through a change of diet and using cognitive behavioural therapy. I also incorporated tactics such as how to calm down quickly, encouraged him to create valuable relationships with other people, inspired him to change his view of the existing problems, and introduced relaxation techniques in the treatment program. To achieve this, I frankly spoke with my client about the behaviours he was portraying that appeared to indicate some distress on his part. I was also encouraging and supportive and showed him that I was willing to undertake a counselling program to help him identify the causes of his distress. Assessment Outcomes Even though I had the option of recommending benzodiazepines such as Valium and Xanax, or antidepressants such as Buspirone, Zoloft, and Effexor, I decided on using cognitive behavioural therapy to treat my client’s GAD disorder (Jongsma, Jr., and Peterson, 2006). Therapy does not present the same possibilities of falling into addiction which can happen with drugs. In addition, cognitive behavioural therapy centres on the client’s thought patterns, and seeks to establish what it is that is causing them to be so anxious, or fearful and how they can transform these thought processes. Cognitive behavioural therapy also allows the client to see the same situation in a different and less terrifying way (Thwaites and Bennett-Levy, 2007). During counselling, I helped my client to recognise habitual negative thoughts that were contributing to the build up of his anxiety. For instance, I indicated to him that he could change his habit of constantly imagining the worst possible case scenario in every situation by asking himself questions like, “What is the chance that this worst-case development will actually materialise?” Cognitive behavioural therapy is basically a combination of strategies and techniques that are used to help people to overcome emotional issues (Knaus and Carlson, 2008). The cognitive branch of the therapy has to do with learning and thinking. In this part, the client is taught about coping strategies. He then implements what he has learned by means of repetition so that it becomes a habitual practice that comes automatically. Once the client’s brain accepts them as a habit, this leads to a transformation in memory processes and so allows the client to start acting, thinking, and feeling in a different way. With my client, this took a lot of patience and practice; moreover, I started to notice small changes as the counselling sessions progressed. The behavioural part of cognitive behavioural therapy calls for the client to be involved in an active and planned therapy group where people voluntarily take part in practical activities that may trigger mild cases of anxiety. This works in ensuring that the level of anxiety that is experienced by people in public is gradually reduced. The behavioural groups have to be structured in a gradual and hierarchical mode, and should consist of constant cognitive reminders before and after the clients have worked on their particular anxiety hierarchies. Counsellor’s Conceptualisation of the Presenting Problem Anxiety is something that affects all living human beings and actually has an adaptive function (Dugas and Robichaud, 2006). Anxiety basically prepares a person to be ready to handle the possibility of a threat. The feeling of panic is indicative of the activation of the fight-or-flight mechanism when danger is looming. Many of the physical characteristics of panic attacks, such as those experienced by my client, can be viewed as being the activation of the primary physiology needed to propel into action the strenuous action of fighting off danger or fleeing from it. Anxiety involves a preparation of the fight-or-flight system, which will ensure that this mechanism is easily activated when needed. In people who have the Generalised Anxiety Disorder like my client, physiological arousability acts in concert with stressful life situations such as a troubled childhood to engender intense anxiety. My client developed the fear of being alone, unpopular, unloved, and unwanted when he was just a child due to the drug abuse that did not allow his parents to be emotionally available for him. His father’s later death would exacerbate these feelings and cause him to start experiencing extreme emotional reactions such as chronic anxiety as a result. Children who experience anxiety usually have difficulties in reacting in normal ways to ordinary developmental challenges and many not do well in school (Haarhoff, 2006). My client, who is of Aborigine ethnicity, had to deal with other issues during his childhood that may have exacerbated his anxiety. For instance, he had to deal with probable incidences of subtle racism or segregation from the mainstream population. In most Aboriginal communities, such stressors cause the adults to seek for ways to escape their predicament by using drugs and alcohol (Townend, 2008). My client’s assertion that he had no real connection with his community also proved that the stress associated with being marginalised had some negative consequences such as destroying social bonds within the community. My clients troubled childhood, incomplete secondary education which left feelings of inadequacy, and alienation from his community as well as family members, left him suffering from constant and intense anxiety which can lead to the occurrence of panic attacks. For such an individual, the tendency to feel that threats are always present, and always be on-guard is understandable. Depression can also develop as a result of the mind of such an individual always being inundated by chronic anxiety (Clark and Beck, 2011). My client exhibited this in his tendency to worry about what he has so far been unable to accomplish. For instance, he always wanted to get a good education but was unable to as a result of not completing his education. He also feels inadequate when compared to the friends he often played soccer with because they have moved on to play for bigger teams while he has remained stuck where he is due to his lack of resources and influential friends. He is also very intimidated by people who have been more educated than he has and fears to approach them for any kind of assistance as he does not want to be seen as being ‘needy’ or a problem to the society- which is what he has always despised. My client also carries guilt and shame for how his family turned out and still has to reconcile himself with the choices that they made and the unexpected death of his father. The difficulty in stopping this trend of constant worry has interfered with my client’s ability to focus on other issues such as applying for a university course. This further adds more worry to his already taxed mind and can negatively affect his performance even if he does succeed in enrolling in university. Even if my client were to experience a situation in which his anxiety was triggered by a reasonable danger, he would be unable to stop worrying long enough to think of practical ways in which to solve his problem. Intervention Plan or Recommendation Individuals such as my client, who suffer from generalised anxiety disorder, usually experience exaggerated anxiety through their daily lives even when there is nothing to incite it (Bennett-Levy, 2006). My client, for instance, was unable to use the public transport system due to panic attacks sometimes, worried about seeming redundant, worried about what he did not tell his father before his untimely demise, feet that he will always be inadequate because of his unfinished secondary education, was extremely frightened of his thought patterns, and worried that he is losing control of his life. My first aims, on initiating counselling, were to lessen the incidence of his constant anxiety and assist him to return to his normal functioning levels. I also aimed to help the people at Head Space to be able to cope with my client’s emotional needs. I came up with an intervention plan in which I addressed different issues in my client’s life where I encouraged him to do the ‘homework’ after every counselling session, of implementing the lessons learned during the session. First, I encouraged him to identify the troubling situations in his life such as anger at his parents for not being there for him emotionally in his childhood years, anger at the death of his father, and frustration over his uncompleted education. I then spent some time in discussing the goals that he wanted to achieve in future. I then encouraged him to become aware of his emotions, thoughts, and personal beliefs in regards to these situations. During this phase, I encouraged my client to reflect on what he told himself about what having a troubled childhood, emotionally unavailable parents, or incomplete secondary education meant. I also encouraged him to write in his journal about his construal of the meaning of each situation, and his beliefs about the motives of the people in Head Space, his brother and mother, himself, and other life events. Following this exercise, I was able to identify inaccurate or harmful ways of thinking. I discussed my client’s emotional, physical, and behavioural reactions to the different situations he had written about to assist him to recognise thinking patterns that were contributing to his constant anxiety. In this counselling phase, I encouraged my client to find out if his perceptions in different situations were grounded on actual facts or were merely inaccurate discernments of what was really happening. It was hard to confront negative thinking patterns in my client in this way because he had sustained these patterns of thought since childhood, and they had actually become habitual. It almost appeared that he had emotional connections to the wrong thinking patterns because he defended them as being culturally identified and at one point stated that it was not easy for a person of different ethnicity to understand how a person of Aborigine extraction felt and thought. This stage took the longest time to complete. At this point, after challenging false thinking patterns, I invited some of my client’s friends at Head Space as well as those who knew him when they played soccer together but now only saw him occasionally. They were quite surprised to learn that my client felt as he did, but were quite ready to assist him in overcoming his problems. To help my client and his friends in shifting from the previous narrative to a fresh one, I employed cognitive restructuring methods, and externalised the crisis from my client to anxiety. I also equipped my client with relaxation techniques to use whenever he felt that his anxiety was starting to increase. I also added systematic desensitisation exercises for my client to use in trouncing his weakened social functioning tactics. Slowly, my client started to feel safe outside. Soon after the introduction of this session, he attended a sleepover at the house of one of the friends who he had previously feared to approach due to the discrepancy in educational achievement. The counselling actually exceeded my client’s previous goals as his anxiety levels went from being severe to becoming nearly non-existent. Intervention Procedures The intervention procedures that I used in counselling my client mainly consisted of cognitive behavioural therapy. In the preliminary reliving session, my client informed me that he and his father had always been particularly close even when he consumed drugs. My client then stated that when he was 10 years old, his father bought a beautiful bicycle for his younger brother and stored it in a shed. On seeing the bicycle, my client began to thank his father for the bicycle only to be told that it was not his. That night, he poured paraffin over the bicycle at a nearby riverbank and set it aflame. I became aware that my client had grown silent for a short period of time after revealing this. When I asked him later why he had remained quiet for some time, he did not give an immediate response. I sensed that he was feeling some shame for not revealing this fact to his father before he died. My client’s father had always thought that some neighbourhood urchins had destroyed the prized bicycle. I reassured my client that his actions on that day did not necessarily mean that he was a bad and scheming individual. There were numerous other revelations as these that helped me to understand that my client had few if any good memories of his childhood. This helped me to understand why he had an aversion for thinking about is childhood. Evaluation of Intervention Outcomes According to Gertz, many researchers in the field of anxiety disorders consider cognitive behavioural therapy as being the best practice to use in treating panic disorders as well as extreme anxiety. This is because the correct use of CBT enables patients to experience improved emotional functioning. Research has proved that where panic disorders and chronic anxiety is involved, using CBT is actually more efficient than prescription medications in managing symptoms (Gertz, 2013). I believe that I helped my client to understand his symptoms and why he thought as he did. The hardest parts to overcome included convincing the client to speak about his childhood, and the graded exposure to circumstances that he often avoid during the group sessions. I also constantly encouraged my client to challenge his belief patterns. Overview and Further Recommendations My counselling sessions with my client were, for the most part, successful. However, there are aspects of his psyche that, I believe, I was unable to relate successfully with. My client rarely mentioned his community in relation to the hardships that caused his parents to resort to drug abuse in his childhood years. However, it seemed that it was an underlying theme when he spoke of the neighbours who were in even worse situations than he and his brother were. When I tried to get him to speak more about it, he was very reluctant and kept repeating that it was irrelevant. While gaps still exist in the comprehension of the causes of anxiety disorders in the mainstream population, this is more so where indigenous cultural groups for whom the complications involved in assessing contributing factors and implementing prevention tactics are further barriers to achieving general mental health. Even though there are established therapies, such as the cognitive behavioural therapy, that has helped my client, there are still other issues that have to be researched into in order to determine the best way to treat mental disorders in groups outside the mainstream. For instance, in Aborigine culture, good mental health is viewed in a holistic manner. For the Aborigines, good mental health can only be achieved by a balance of being positively involved with the community, one’s family, and the natural environment. In the past, the general community as well as the family of an affected person would come together to help him or her to regain a sense of mental balance. This means that strong communities and families ties were very effective in promoting good mental health among the Aborigines. Obviously, I did not use such a concept in my treatment of my client. It was also somewhat beneficial that the client basically identified with the mainstream methods of treating his generalized anxiety disorder, because it made treating him easier than would have been the case if he had more emotional ties to his indigenous community. However, it is important for culturally based methods of dealing with mental diseases to be researched in to and used in future. My client did not appear to have an emotional attachment to his indigenous community in terms of friends or other social functions. However, even though he appeared to be fully identified with the mainstream, I was aware that the existence of culturally based curative methods would have benefited him even more. In the Aborigine culture, it was the elders who were entrusted with the responsibility of helping those members of the community who experienced mental disorders. Other methods that were used include participating in traditional ceremonies, participating in healing circles, and one-on-one counselling. All these practices filled an emotional gap in the Aborigines that has to-date not been replaced by any alternatives in Western based existences. There is a need for the emotional needs of clients of indigenous ethnicity to be addressed by the suitable indigenous authorities. References Bennett-Levy, J. (2006). Therapist skills: A cognitive model of their acquisition and refinement. Behavioural and Cognitive Psychotherapy, 34, 57-78. Clark, D., & Beck, A. (2011). The anxiety and worry workbook: The cognitive behavioural solution. New York: The Guilford Press. Dugas, M., & Robichaud, M. (2006). Cognitive-behavioural treatment for generalised anxiety disorder: From science to practice (practical clinical guidebooks). New York: Routledge. Gertz, G. (2013). Cognitive Behavioural Therapy vs. Fear: CBT to Treat Panic Disorder. Decoded Science. Retrieved from http://www.decodedscience.com/treating-panic-disorder-with-cbt/30696 Haarhoff, B. (2006). The importance of identifying and understanding therapist schema in cognitive therapy training and supervision. New Zealand Journal of Psychology, 35, 126-131. Jongsma, Jr., A. E., & Peterson, L. M. (2006). The complete adult psychotherapy treatment planner. New Jersey: John Wiley & Sons, Inc. Knaus, W., & Carlson, J. (2008). The cognitive behavioural workbook for anxiety: A step-by step program. California: New Harbinger Publications Thwaites, R., & Bennett-Levy, J. (2007). Making the implicit explicit: Conceptualising empathy in cognitive behaviour therapy. Behavioural and Cognitive Psychotherapy, 35, 591-612. Townend, M. (2008). Clinical supervision in cognitive behavioural psychotherapy: development of a model for mental health nursing through grounded theory. Journal of Psychiatric and Mental Health Nursing, 15, 328-339. Read More