Termination Summary of a Client - Case Study Example

Termination Summary: Termination Summary: Client: Nicole 2/10 Number of sessions: 50 Duration of Therapy:1/28/2010 to: 2/14/2011 Number of missed sessions: 3 Intake date: 1/28/2010 Termination: Planned Client Information: Nicole is a 28 years old woman who was diagnosed with Obsessive Compulsive Disorder (OCD). She is also a mother of three children who live at home with her. Nicole came to the realization that she had symptoms of OCD six years ago and that her habits were beginning to affect her work and family. However, at the moment she assumed that the habits and obsessions would disappear. At 28 years, Nicole is getting worried about the life she is living. According to her, this was not how she pictured her life at this age. Her compulsions developed suddenly six years ago; from then on they have increased significantly leading to her divorce two years ago. Her husband could no longer be with her due to her condition. Her family history does not indicate any significant signs of such a condition. Her condition has prompted her to take action and for some time, she has sought various treatments in the hope of finding a cure. Recently she has had suicidal and obsessive thoughts coupled with anxiety. All the treatments she has sought have not worked, and her condition seemed to be getting worse by the day. At this point, she admitted herself to our clinic in the hopes that she would respond to the treatment offered here. According to her, it all started six years ago when she had attended a church service with her husband. While talking with her husband, she made fun of a man who was seated nearby. It was so innocent that it should have been forgotten. However, she could not get over it. She kept playing it her mind over and over. All she could now think of was that the man had heard what she said; he would be angry, he might report her to the police, she might appear in the newspapers, and she would be locked for it. She felt as if she had sinned against the whole world. Her husband tried to reassure her, but she would not calm down. It was from this point onwards that she closely monitored what she was saying to other people. From here on it was panic, avoiding people, performing activities in over and over to prevent a repeat of the same. With time, she became keen on items and their use. For instance, while cleaning her toilet the instructions on the bleach bottle indicated that the bleach was not to mix with any other chemical. In her mind, she kept wondering if there were other chemicals in the toilet bowl and if she had mixed them up. This kept on to a point where she got worried that the chemicals would flow down the sewers and probably ignited, thereby, blowing up the area drainage system. She could no longer use toilet cleaners or bleaches anymore. She was scared of them, and whenever she saw bleaches she felt the need to clean her hands. From this point, her obsessions with tidiness grew significantly to a point where should could wash her hands around 100 times a day. This excessive cleaning caused bruises and bleeding on her knuckles. There were times when she felt like she had fleas and lice on her. She would spend hours and hours each day examining her bed and clothes for any such insects. She felt that she was the source of contamination for other people. According to her, people would die if they touched her or came into contact with her. While at a store, she would buy any item she had touched fearing that she had contaminated it for other people. Three months later colors and smells were also affecting her. She became extremely obsessed with patterns and arrangements. She was now turning to be an arranger and a counter (Radomsky and Marcel, 2004). She would not feel at ease if things were not arranged in her way. All this time she was pestering her husband seeking assurance for her actions and thoughts. Through her husband’s advice, she decided to seek help for her condition. She was given some medicine in tablet form to consume. These tablets were supposed to help her deal with her anxiety; obsessive thoughts give her a calming effect. After a while, she started to worry about the pills. She thought that she would lose them or that her children would take them. She felt like the pills were everywhere around her. She kept performing checks to ensure that she did not accidentally lose the pills on the bed, floor, handbag or clothes. She allowed only few people into the house fearing that they would leave with her pills on the soles of their feet. She would check the visitors or anyone leaving the house to make sure that they did not carry with them her pills. Leaving the house became a problem for her. She feared that she would leave the tap on or that there would be an electric fault that would cause a fire. Major Issues Affecting Nicole: 1. Lack of concentration or relaxation – she had re-occurrence of images and unwanted thoughts that would occupy her for a while. 2. Obsession with details – the little things like a stain on clothes or a tilted picture would bug her so much. Relief would only come to her if she fixed them. 3. Tidiness and neatness – she wanted to be clean at all times, washing her hands so many times hoping not to get sick or contaminate others. 4. Fear of germs, rodents and insects – her fear was more pronounced than that of other people. She would get panic attacks if she saw or suspected that either one was close to her. 5. Obsession with doing things her own way – she would not allow anyone in the household to clean the house. She felt like they could not do it properly. 6. Obsession with routine – she had made up her routine and would be very upset if anyone interrupted her or interfered with it. 7. Obsession with numbers – she could not walk without counting the things around her. This included cars, electric posts etc. 8. Repetition of activities – she does not feel like what she does is enough or right. She keeps doing it over and over hoping that this time round it will be right. 9. Justification – she feels as if she has to properly explain what she wants or needs. She does this in so many words hoping that she will be properly understood. 10. Fear of punishment – she fears that punishment will befall her or her loved ones if she ignores her compulsions. Treatment: After the various treatments, medications and hypnosis sessions that she undergone it was clear that she was not well. After all these treatments, her general practitioner advised her to visit our clinic to undergo behavioral psychotherapy. The book “Living with Fear” by professor Mark was suggested to her for reading. After reading the book, she discovered that she was not alone. Her condition now seemed more like an illness (Purdon and David, 2005). The treatment was supposed to make her take chances and do all that she worked hard to avoid. She was now comfortable talking about her problems without feeling embarrassed. It was required of her to be as anxious as possible. This was done in order to let her understand that anxiety did not last for long (March and Karen, 1998). Various tasks were prepared that would increase her anxiety level. At first, she seemed scared but was determined to make it through. Her motivation seemed to be her children and providing a better and relaxed future. According to the list, the number of times she would wash her hands was reduced over time. For instance, she would only be allowed to wash her hands only five times a day. A strict schedule was imposed on her to ensure that she did not spend much time on one activity (Jongsma and Mark, 2003). The schedule included various activities like cleaning sinks and baths, making tea or coffee for other patients. These activities provoked her anxiety since she had always been afraid of contaminating food for others with her hands. At one point, she was afraid that she had mixed bleach from the baths with the tea. She was torn between throwing away the tea and ignoring her anxiety. After a few minutes of battling with herself she was able to convince herself that she did not need to throw away the tea. The programme seemed to take a toll on her despite her enthusiasm and its novelty. It was becoming hard for her as time went by. Her children were encouraged to visit her, with the younger child staying with her at the clinic. This was done to create a simulation of a home environment. She was able to clean and cook for her child. During one of the sessions after things had become easier for her, she suggested more difficult tasks to be added to the list. With the help and advice of the nurses she was able to do things without thinking much about it. She was now learning that the only way to deal with unexpected things was to accept anxiety and let it run its course after which she would be free again. This led to reduced fears in her life. She was now able to perform tasks that had before drove her into panic attacks. She could clean toilets using bleaches, cook regularly and wash her hands when required. Termination Status and Recommendations: After the 45 sessions that spanned over a period of one year, Nicole was able to improve considerably to a point that she could leave the clinic and take care of her children. Throughout the whole treatment, Nicole had demonstrated resilience and determination. This was one of the reasons that she was allowed to leave and join the community. This was a very important step as it would present to her the real world and see if she responds positively to it (March and Karen, 1998). During the first few weeks of release, she seemed a bit anxious than she was at the clinic. Since the sessions were not terminated, she was able to express her concerns. The fear of what other people thought of her was creeping back. She was worried about the reception she would get from her neighbors and friends. After a couple of sessions, however, the main objective of the whole treatment was reiterated and she began to accept the world. It was recommended that when she had any difficulties, she should contact the clinic to seek help. Her family members were also expected to be supportive. However, they were not to reassure her in any way. She was to face the world head on in order to overcome her anxieties. She was also encouraged to take up more activities and mingle with different people in order to overcome her fears. At the end of it all, Nicole had come to the conclusion that in order to overcome one’s fears one had to face them. This, however, hard it seemed was the only way since the nervousness and anxiety would subside after a while. The client, at the end of the session, demonstrated independence in her activities and confidence in her actions. By taking a day at a time and taking risks and chances, she is not expected to relapse. References: March, S. and Karen, M. (1998). OCD in Children and Adolescents: A Cognitive-behavioral Treatment Manual. New York: Guilford. Weg, H. (2011). OCD Treatment through Storytelling: A Strategy for Successful Therapy. New York: Oxford UP. Purdon, C. and David A. (2005). Overcoming Obsessive Thoughts: How to Gain Control of Your OCD. Oakland, CA: New Harbinger Publications. Radomsky, S. and Marcel H. (2004). "Introduction to the Special Issue-Experimental Approaches to Understanding OCD." Journal of Behavior Therapy and Experimental Psychiatry 35.2 : 85-86. Clark, A (2004). Cognitive-behavioral Therapy for OCD. New York: Guilford. Jongsma, E., and Mark, L. (2003). The Complete Adult Psychotherapy Treatment Planner. Hoboken, NJ: John Wiley & Sons. Read More