Theory and Practice of Counseling and Psychotherapy - Case Study Example

Introduction: The group which I am creating consists of some people who are suffering from various mental disorders like Alzheimer’s disease, amnesia, short-term memory loss, dementia and depression. This group only includes women. These women were normal but after attaining a certain age they started suffering from these mental disorders. Their mental disorders brought about a change in their normal life. The ultimate goal of this therapy is to alter the thinking process of these patients and make them believe the positive aspects of life.  The members of the group are Samantha Wayne, Polly Cromwell, Michelle Burke, Lucy Dawson and Amanda Wilson. For confidentiality I would not reveal their actual names and address them by these code names assigned by me. These women live in the different places which are in and around the city of New Orleans. Samantha Wayne is of 79 years old, Polly Cromwell is of 75 years old, Michelle Burke is of 78 years old, Lucy Dawson is of 76years old and Amanda Wilson is of 77years old. All these women, being septuagenarian, are gradually affected by the above mentioned mental disorders. Samantha Wayne is suffering from Alzheimer’s disease and basically needs maximum counseling sessions.  This disease is normal in ageing patients. It is related to the workings of the brain and the problems are associated to thinking, memory and behavior as well. (Basics of Alzheimer’s disease. n.d, p.6) She had initially become forgetful and this affected her normal life. She lives with her daughter who is a widow and works as a school teacher. During the day, an assistant comes to look after Samantha. But as she cannot remember anything, it is very difficult on the part of the nurse to attend to her. She has lost her appetite and is totally depended on her daughter and the nurse. This disease can worsen up and can be life threatening. As there is no specialist doctor in this field, various physicians, neurologists, psychiatrist and psychologists have to treat the patients suffering from the Alzheimer’s disease. (Basics of Alzheimer’s disease. n.d., p.6). Samantha has to be given a treatment based on her symptoms as her case is worsening day by day.     Polly Cromwell suffers from amnesia and this disease has affected her permanently. This disease implies that the patient suffers from total or partial loss of memory. Amnesia can be of various types and here, Polly cannot remember any information regarding her past experiences. This disease had started to make her forget some events related to her past life but now it has become severe as now she forgets recent events of her life. This amnesia is also known as ‘Retrograde Amnesia.’ (DeGuise, n.d. p 1) This disease is taking a toll on her family. They cannot admit her in nursing home and so, she lives with them. Her family sometimes leaves her alone in the house. This might lead to some accidents if no one is assisting her. This type of situation can be dangerous to her psychological wellbeing. Michelle Burke is suffering from short- term memory loss and her problem has aggravated recently. Although it is related to Alzheimer’s disease, it has certain distinct features. Michelle was having difficulty in retaining information and gradually it worsened to the loss of her short-term memory. Her condition could be accounted as a normal process of ageing but the fact cannot be avoided that it is affecting her life and her family. Scientists have tried to explain this in their own scientific terms like memory is actually a connection of the neutrons in the brain. The changes in this connection create memory loss. ( Myers, 2006).  Lucy Dawson suffers from dementia. It is a medical condition that is mostly found in old people but it gets worse as it is related to the intellectual process. Lucy initially had hallucinations and later it brought sudden changes in her behavior as she started to lose control of herself. This is also a life threatening disease and it should be handled by a good medical practitioner and also she needs to be counseled often. Lucy used to live alone after her husband’s death but after the diagnosis of this disease, her sons have started to live with her.  Her sons do not stay at home because of their traveling jobs and therefore, she is left with a nurse who attends to her occasionally. Amanda Wilson is suffering from severe depression. Her depression is due to her loss of sight and her inability to perform her daily chores.  Amanda had been a very active woman but due to her loss of sight in an accident two years ago, she has confined herself in her room which poses as a problem to her family. Ever since the accident, she has stopped socializing and regularly skips her food. This has been affecting her health also.  She had tried to cope with her problem without seeking any help. Though she needs assistance, she simply refuses to be helped by others. This has made her short tempered and she gets irritated very soon. In order to treat her depression, she needs to be monitored closely and has to be basically guided like a child. These women are now willing to undertake a group session but let us first understand the complications of all the above mentioned mental disorders in detail. Alzheimer’s disease cannot be cured totally and in the case of Samantha Wayne she is already 79 years old and her chances of recovering is very less as she was diagnosed with this disease recently. As it has been reported, “the older a person with Alzheimer's disease becomes, the more likely he or she is to decline rapidly.” (Alzheimer’s disease: Prognosis and Complications). Samantha has had many medical problems due to this disease like malnutrition, infections, poor health and she has fallen from the stairs several times as she could not co-ordinate her body. She simply forgets things which concern her actions and she is not even aware of her disease. Scientifically Alzheimer’s disease has been defined as “etiologically heterogeneous and can be produced by mutations of chromosomes 21, 14 and 1 as well as by as yet unrecognized causative factors.” (Gauthier, 2007. p 5).One of the useful group therapy for the Alzheimer’s disease is the music therapy. I would be dealing with these patients using this therapy because all these diseases are related with mental disorders. An example that presents a positive effect of the music therapy on such patients may be observed as follows: “When I was encouraged by a music therapist to sing to my husband who had been lost in the fog of Alzheimer’s disease for so many years, he looked at me and seemed to recognize me. On the last day of his life, “he opened his eyes and looked into mine when I sang his favorite hymn. I’ll always treasure that last moment we shared together. Music therapy gave me that memory, the gift I will never forget.”” (Gorman, 2005). Amnesia can be caused by accident or by ingestion of a toxic substance that directly affects the brain. Here are various types of amnesia and the patient which is treated by me is Polly Cromwell who suffers from retrograde amnesia. It means that she cannot remember any events that were related to her in her past. After getting this disease, she could not recall her past experiences. Polly has to struggle very hard to learn new things and forgets whatever she had learned in the past. She seems confused and does not know what to do. This has been troubling her family ever since she started to forget things. Polly needs continuous supervision.  To treat her in the group music session would be like enchanting a child with a familiar song that would control her emotions and work as a spell on her memory. Polly does not have the power to be attentive and so, music seems to be a better option than communicating with words. According to Daniel Stern’s research about mother and infant relationship, he has written, “when a mother stimulates her baby too little, the child will lose interest and not pay attention to what she is doing. If the mother is stimulating the baby too much, he will turn away or start crying. When the level of stimulation is more moderate, somewhere between the two extremes, his attention will be more easily captured and maintained.” (Ridder and Mette, 2004 pp 7-8) Polly’s amnesia could be treated if her attention span is maintained at an average level   by not forcing her or leaving her free in the music therapy session.  Michelle Burke’s loss of short-term memory is like the case of Polly Cromwell. Michelle was a professor of English in the University of Colorado and after her voluntary retirement settled near New Orleans. She was a very learned and intellectual person. But as she started to get older, she initially forgot small things and then slowly she could not concentrate and remember any new information. This changed her dramatically and she found herself to be the dumbest person. She lives with her eldest son who is unmarried and owns a grocery outlet. He cannot attend to his mother who needs assistance and supervision. Her disease had also been diagnosed recently and as she is speaking to others, she stops in the middle as she forgets what she was saying. This is the worst stage though there are some chances of recovery. Michelle has to learn new and basic things in order to live a normal life. Here, the music therapy would help her in focusing her concentration and learning things quickly and not forgetting that information. As in the words of Daphne Bavelier, associate professor of brain and cognitive sciences at the University of Rochester, “When we hear things, we naturally process them in a series, When we hear music, for instance, it comes to us second by second, so the part of our brains that processes auditory information has evolved to absorb information in sequence. This means hearing a spoken list, such as numbers in an ATM code, corresponds more closely with what the auditory brain does naturally." (Sherwood, 2004).  Dementia pertains to memory loss but it also affects the personality and behavior of the patient. Lucy Dawson has poor memory due to this disease and she also forgets things easily sometimes for a shorter while and sometimes for a longer time. Lucy’s behavior has changed as she does not realize that her life is affected by this disease. She can never be normal again though some remarkable changes can be seen after the therapy sessions. Her furious nature and her irritation can be bothersome to her family as this could proceed to self- injuries. She has to be kept under supervision and has to have an assistant all the time. Lucy actually does not want to accept the reality and this is also one of the symptoms of dementia. Lucy is confused and disoriented and her aggression proves that this disease has severely affected her thought process and sense of perception. Her health has also deteriorated as she suffers from malnutrition and this can be checked with careful study of her recent weight measurements. (Pomeroy, Mitchell, Roerig, 2002. p 70).  An example of a man who was suffering from Dementia supported the therapy of music and said, “I don’t know how anyone can live without music.” (Gorman, 2005). This also further proclaims that a patient suffering from dementia can be treated and cured with the music therapy.  The case of Amanda Wilson also highlights the fact that depression can be harmful if not treated wisely. Amanda’s loss of sight is the main reason for her depression. She has been blaming herself for the accident which caused this unfortunate loss of her eyesight. As she was a very active social woman, this sudden incident changed her completely. Her depression overtook her completely and she was not the same person again. Depression also deals with the mental process and it can be cured if she is counseled regularly. It is regarded as a serious illness that affects the whole family. Amanda stays with her family and they take care of her immensely but the question lies in understanding the emotional turmoil which is felt by Amanda alone. Sometimes depression can be a danger to life and this may even lead to suicide. Amanda has isolated herself and seldom eats. This also affects her health tremendously. Due to her concern, her family had approached me to counsel Amanda. Amanda needs guidance and has to be treated by other specialists like the nutritionist and psychologists. The music therapy also works in this case and could act as a remedy because it provides some positive aspects of living one’s life. An old lady who is of 93 years old had attended music therapy sessions and said, “Now, there is no need to be morose. I can have my music here with me and listen to it whenever I want to feel young.” (Gorman, 2005) After studying various literatures and looking at the stages my patients are going through, the group therapy which I will be focusing upon is the music therapy. This music session would be held regularly for a period of six months and then it would be increased according to the patients’ needs. As I have already mentioned, it provides a profound effect on the patients who are suffering from such mental disorders. Their anxiety, fears, dilemmas, confusion, inattentiveness, etc can be handled with great care if the patients co-operate with the therapist. The music therapy is all about moving into a more comfortable zone where the patients can interact freely and not get intimidated while being treated. But why should I use music in a serious therapy? Music has a special remedial effect on the patients who suffers from mental disorders. It produces a soothing effect which catches the attention of the patients even if they are in their own world. The music therapy’s goals are to make a place for these patients to free their burdens and learn to socialize again, to analyze and understand the patients’ desires and to involve them in their activities as if they are controlling their own world. I can visualize the first session I intend to hold with these patients and at the end of the session I may write down my experience as follows. In the counseling session, I made some observations about the patients and found that the patients initially were confused in the music therapy class but soon they started to look forward for these sessions as it provided them their own space and made them feel independent. Amanda, who could not see, heard the music and felt it deeply as if it was rejuvenating her body, mind and soul. Samantha who has Alzheimer’s disease had to struggle to respond to the music and would forget about it but when the same music would be repeatedly played then she would closely observe the sound as if it is familiar to her. Lucy, Michelle and Polly also had a tough time to adapt themselves in the music sessions as they would forget about their presence in the music sessions. But as the music sessions proceeded further, they also enjoyed being in the music class. Music has the power to influence a human mind which has lost control over it and this has been proved by using music as an alternative for talk sessions.   Music therapy provides ample of opportunities for the patients to regain their lost confidence and also develop self-respect. The aims of music therapy can be accounted as follows: the patient’s memory can improve which would give her some consolation, there will be a positive transition in their emotional feelings, a feeling of self – control would boost their confidence, it can increase their attention to music because of self-awareness, feelings such as fear, depression, anxiety, stress can be reduced, it increases the intimate bond among the family members when they listen to music together and it also aims in providing social interaction with the patients and their respective families. (Gorman, 2005). According to Dr. Oliver Sacks said, “The power of music is very remarkable... One sees Parkinsonian patients unable to walk, but able to dance perfectly well or patients almost unable to talk, who are able to sing perfectly well... I think that music therapy and music therapists are crucial and indispensable in institutions for elderly people and among neurologically disabled patients.” (Gorman, 2005)  This kind of therapy sessions are considered to be effective while dealing with the septuagenarian patients as the music soothes their disturbed mind and focuses their attention to familiar things which are related with their past experiences. It also assures them security and provides them to be the master of their own life. Mostly these therapies make use of instrumental as well as vocal music which promotes in gaining the attention of the patients quickly and it also encourages in retaining this music in their minds. This prevents them from forgetting and getting depressed. As in the cases of Samantha Wayne, Polly Cromwell, Michelle Burke, Lucy Dawson and Amanda Wilson, music therapy pertains to unlock their feelings and settle them in a new environment without any restrictions. In order to deal with them, I will have to analyze their behavior one by one. The music that should be played in the music therapy should be slow and somber which would help in reforming the patients’ distressed feelings. Music that is familiar to them could be played.  This would help them to be more nostalgic and remember happy events of their life. The patients could relax while listening to the music and concentrate on their breathing. Music like “Respighi’s Nightingale” is one of the popular songs used by therapist. (Grocke, Wigram, 2007, p.43)   Along with this music therapy, Samantha Wayne who is suffering from Alzheimer’s disease also needs family therapy. This could be effective as her case is quite difficult due to her age and her weak health. Her family has to spend more time with her and search an agency which would assist them financially and also look after the patient. The family is affected by the patient’s disease and so, the family should make legal planning to unburden their worries and tensions regarding Samantha. (Group for the advancement of psychiatry, committee on aging, 1988, pp.60-61) In this family therapy, the patients could have the company of neighbors and friends and this should help in outlining the process of supporting the patient and her family. It depends on the severity of the patient’s disease and her family to admit her in a nursing home.  Samantha’s case suggests that it would be an apt choice for her family to admit her into the nursing home. As a therapist, the family has to be encouraged in making decisions, getting medical facilities for the patient and searching ways to cope with the disease of the patient. The other patients could also take part in the family therapy and this would certainly change their perception and adapt themselves with the new rules for maintaining a better relationship. Polly, Michelle, Lucy all have similar disease and this could proceed to become like Samantha’s case if not handled with proper medical care. Though they are all aged, they seem to respond to the music sessions more than Samantha. Lucy’s behavior is a bit disturbing as she has violent fits of anger and she gets irritated even in the therapy sessions and takes a long time to relax. Amanda’s case pertains to depression and this can also be dealt with family therapy. Family therapy can be futile if the patient is not comfortable with others like in the case of Amanda. She was frustrated to hear her family speak about her and she did not want to hear anything. Out of anger, she blamed them for her condition and left them speechless. This gave a negative effect on the family and to convince them about supporting her was a very tough job. Amanda initially wanted to be left alone in the therapy sessions. As the sessions proceeded, Amanda showed some interest in expressing her feelings through songs and this helped other patients as well. Once, they circled around her and listened to her. This was not organized and as the patients who suffered from memory loss would again be on their own.  The other important aspect of conducting therapy on these patients was to win the trust of the patients as well as their families, respectively. This would provide the basic foundation for dealing with the patients together with their families. It has been reported that family therapy should bring about a change in the relationships rather than the patient or an individual. (Corey, 2008, p.439) According to Goldenberg and Goldenberg and Nicholas, techniques are equipments used for achieving the goals of therapy. (Corey, 2008, p.439). As a therapist, I will be ascertaining several points that would help me achieve therapeutic goals, like the patients should be respected irrespective of their race, class or religion; the patients should feel the compassion of the therapist, true concern and empathy for the patients should be the basic principle of the therapist. Family therapy is challenging as it opens up various kinds of feelings and emotions that might prove to be beneficial to the patients and sometimes it might be futile.  Conclusion:  After reviewing all the above mentioned cases in six months, I would like to draw the attention of the readers towards the importance of therapy for septuagenarian women who are suffering from mental disorders. The therapy session which would begin in December 2009 sees patients who had little or no hope of recovering. Their families would be relieved to bring them to the therapy sessions as if a burden has been lifted off their shoulders for some time. In the beginning of the sessions, the families would be concerned about the patients but their emotions might seem superficial. But as the sessions proceed, the families are certain to change their perspective. These diseases should not be taken lightly as we have already seen the cases of Samantha, Polly, Michelle and Lucy. Amanda’s case is a bit different as we already know that she is suffering from depression. Though all the patients will be treated with equal care, Amanda may need assistance all the time. It is only in the music therapy sessions where she can feel relaxed and feel free. In the third month of therapy sessions, Amanda would begin to talk about her family and this effort may be appreciated by her family. It might be that in the course of time, their families might want them to get admitted to nursing homes for proper medical treatments, but the music therapy should continue in order to help them cope with the medical processes.                                                References 1. Basics of Alzheimer’s disease. (n.d.) Available at: http://www.alz.org/national/documents/brochure_basicsofalz_low.pdf  (Assessed on 11/11/2009). 2. Corey, G. (2008).  Theory and Practice of Counseling and Psychotherapy. Cengage Learning. 3. DeGuise, E. (n.d.) Amnesia. Available at: http://cirrie.buffalo.edu/encyclopedia/pdf/en/amnesia.pdf (Assessed on 11/12/2009). 4. Gauthier, S.(2007).  Clinical diagnosis and Management of Alzheimer’s disease. CRC Press. 5. Gorman, C. (14 November 2005). MT Alzheimers 2006.indd. Available at: http://www.musictherapy.org/factsheets/MT%20Alzheimer’s%202006.pdf  (Assessed on 11/11/2009). 6. Grocke, D.E. & Wigram, T. (2007).  Receptive Methods in Music Therapy: Techniques and Clinical Applications for Music Therapy Clinicians, Educators and Students. Jessica Kingsley Publishers. 7. Group of the advancement of psychiatry. Committee on Aging. (1988). The Psychiatric treatment of Alzheimer’s disease. Psychology Press. 8. Healthy Place.com Staff Writer. (11 December 2008). Alzheimer’s disease: Prognosis and Complications.  Available at: http://www.healthyplace.com/alzheimers/main/alzheimers-disease-prognosis-and-complications/menu-id-56/  (Assessed on 11/11/2009). 9. Myers, C.E. (2006). Memory Loss and the Brain. Available at: http://www.memorylossonline.com/glossary/memory.html  (Assessed on 11/11/2009). 10. Pomeroy, C. Mitchell, J.E. & Roerig, J. (2002). Medical complications of psychiatric illness. American Psychiatric Pub. 11. Ridder, O & Mette, H. (August 2004). When Dialogue Fails. Music therapy with elderly with neurological degenerative diseases. Available at: http://www.musictherapyworld.de/modules/.../MTT5_4_Ridder.pdf  (Assessed on 11/11/2009). 12. Sherwood, J. (September 1, 2004). Your short term memory’s effectiveness significantly influenced by sight and sound. Available at: http://www.medicalnewstoday.com/articles/12721.php  (Assessed on 11/11/2009). Read More