Introduction_to_Counseling

Lois Grace-Gecsey 0488352 Intro to Professional Counseling Thomas Edison State College December 2011 Counseling Specialty                 Counseling Specialty 2 The client’s name is Tiffany. Tiffany admitted herself to the hospital because she was feeling in her words, depressed and afraid she would harm herself. I visited with her there to see if she would like to attend some counseling sessions with me. Tiffany was diagnosed with depression while in the short-term psychiatric wing of a local hospital. I offered to meet with her when she was stable and ready to be discharged from the hospital. She agreed and met with me four days later when she was released. Tiffany is nineteen years old and has just finished her freshman year in college. She is wondering if she will be able to continue with her education because according to her she was barely keeping up with the schoolwork in her first year. Tiffany spoke about feeling depressed and having a lot of fears. Tiffany appeared to be well groomed, was pleasant and able to speak clearly and in a meaningful way about the difficulties she was experiencing. I asked Tiffany to tell me little bit about what is going on in her life now. Tiffany said that she really liked going to school and would be sad if she had to quit. She said she has a twin sister and two younger brothers. Her sister has one child and another on the way. She is on welfare and lives with Tiffany’s mother and her two younger brothers. Tiffany expressed again that she was hoping she could succeed in school because both her sister and her mother had gotten pregnant when they were young and they both ended up without the fathers being in their lives and on welfare.  Counseling Specialty 3 I asked Tiffany to describe what she was feeling when she was feeling depressed. Tiffany said that she felt very sad, “Pretty much all the time.” I asked Tiffany how her grades were in school. Tiffany said, “I barely passed.” I asked her about her social life at school. Tiffany said she had a few friends but most of the time she kept to herself. Tiffany was asked to talk a bit more about her school life and what her ambitions are. Tiffany said, “I am majoring in art and I love that, it is the other subjects I have to take that I find boring.” Tiffany is living at home while attending school. She said, “I am just going to a community college, and it’s hard because there are too many people in my house and I have a hard time finding a quiet place to study and do homework.” I said to Tiffany that it sounded like she has some challenges but it seemed like right now school was a positive influence in her life and asked if she would like to try to work on staying in school and finding some solutions to her most immediate difficulties. Tiffany said, “That would be great.” The development theory that seems to apply to Tiffany’s situation is multifaceted. She grew up in a household with a single parent of four children having three different fathers and no financial means to support a household of that size. Her mother then moved her family into the mother’s boyfriend’s household that according to Tiffany was not a nurturing or welcoming environment for children. “They treated us like crap.” I repeated back to her, “You and your siblings were treated badly by your mother’s boyfriend’s family'” Tiffany said, “Yeah, they Counseling Specialty 4 either ignored us or were always yelling at us for something.” I said to Tiffany that it must have been very unpleasant to be living in that sort of atmosphere, especially for young children and asked if she had ever spoken to her mother about this and Tiffany said, “She doesn’t care.” Seeing her twin sister begin to follow in the steps of her mother was unsettling for Tiffany. She expressed to me that, “I know I don’t want to end up like that but am not sure I can do well enough in school to get through it.” I explained to Tiffany that in my opinion the best approach right now would be to devise a treatment plan where she would set some goals in place and together we would figure out the best way for her to go forward. I told her we would begin to examine some of her thought processes to determine if they were impacting her negatively. I asked Tiffany if that sounded like something she would like to do and agree to work on. Tiffany said, “I think so. I don’t want to stay like this.” I asked Tiffany if she was still having feelings about harming herself and she said, “No, it was because I thought I was not going to pass this year. But I did and I feel better now.” I am planning an eclectic approach to counseling because Tiffany seems to harbor a lot of resentment towards her mother so I will want to explore some of those feelings and may need to speak about her past. I will mainly focus on the present day challenges that Tiffany is having difficulty with. I am hopeful for Tiffany because she has gotten this far on her own and that shows me she is capable and willing to move forward in her life. Counseling Specialty 5 I think the theory that relates the most to Tiffany’s situation is the humanistic and also cognitive behavioral. I like these because as stated above Tiffany has shown that she does not want the same kind of life that her mother and her sister have and she has made some definite steps in the right direction on her own. She is showing a natural tendency to reach self actualization. I feel she needs to learn what to do when she begins to have doubts or feelings of overwhelm. We will also work on releasing the anger she has with her mother by using some journaling and meditation. If possible there may come a time when she can let her mother know what it was like for her growing up as she did, although this may not be possible or her mother may not be open to hearing this. Tiffany will hopefully find that as she continues in school and builds on her self confidence that the positive things will be more salient in her life and occupy more of her thoughts. The behavioral piece will give Tiffany some tools she can use when she is beginning to feel despondent and also how to recognize some of the signs that precede her depression. She will also have some phone numbers on hand so she has people to reach out to when she is not doing well. Using cognitive restructuring Tiffany will begin to learn how her own internal dialogue is creating a self defeating pattern and she will need to start by becoming aware of that dialogue and listening to it and then coming up with some ways to replace those negative thoughts with more positive empowering ones. I am going to encourage Tiffany to follow a treatment plan that we would come up with together. I have some suggestions taking into account the things she has stated that are her most pressing issues at this time. The goals would include staying in school. The objectives that will Counseling Specialty 6 be listed under this goal would be to meet with a counselor to discuss her course selection and also any difficulties she had in the previous semester which might include setting up a structured study/homework time that she could use the school library for. There would also need to be something on there about socializing more with her peers at school. She will also take the medication she was prescribed and notice if it is having the desired effect on her and discuss this with the prescribing doctor. The last thing would be to start being aware of any tell-tale signs that she is beginning to experience a depressed mood. Under this would be objectives that would include noticing any self-defeating internal dialogue that comes up and some guidance of how to begin replacing them with more empowering and encouraging self talk. The anger that she has involving her mother (and sister') should be addressed at some point and I would ask Tiffany is she wants to include it at this time because I feel the most important thing right now is keeping school as a major focal point because it is something that Tiffany has stated to this writer is something she wants to do and feels is a way to give her a better direction in life than the one she had modeled for her by her mother. At some point it might be advantageous to bring her mother into the picture, but without knowing whether she would be open to hearing what Tiffany probably needs to say to her or whether she is defensive would need to be determined. Tiffany has said that she and her mother have fought a lot so this Tiffany would have to decide if this would be something she wants to pursue. The same thing actually applies to her sister. She is a twin and that must be like seeing a reflection of herself living the life Tiffany has emphatically stated she does not want for herself. Counseling Specialties 7 So these are tough issues that in my assessment need to be addressed at some point however, if it will depend greatly on Tiffany’s comfort level with these issues. Reference: Nugent, F.A., Jones, K.D., Introduction to the Profession of Counseling, Pearson, 5th edition, 2009. Pratt, C.W., Gill, K.J., Barrett, N.M., Roberts, M.M., Psychiatric Rehabilitation, Academic Press, 1999.