Case Conceptualization

Anna Conceptualization

Case Conceptualization Katya Lavelle HDCN 6300 October 2, 2008

1

Anna Conceptualization

2

Brief Overview of Client at Intake The client I am working with is Anna Harrison. Her parents have brought her to counseling because of her hostile behavior towards the family. Some background includes that Anna is a 12 year old white female who currently resides in New York City. A history of her family includes that her parents are divorced and that her father has recently become engaged to a younger woman, Isabelle, who Anna does not approve of. The recent engagement makes Anna feel enraged and as if Isabelle is trying to “replace” her mother. Anna also claims that she is still angry with her father for “leaving her and her mother behind” because of the divorce. The divorce was nasty and it feeds into her feelings of anger and insecurity. Currently she has rebelled against forming a relationship with Isabelle, which has caused a rift between Anna and her father, as well as between her father and mother. A recent added pressure for Anna is that her family recently discovered that her mother has breast cancer and is dying. Anna feels betrayed because her mother secretly went through an unsuccessful round of Chemo without telling her, but says “it will be fine” when I ask how this makes her feel. The person she is closest to in her family is her mother and she looks to her mother for motivation as well as acknowledgement making the fact that her mother is dying very difficult for her to understand and for her to grieve over. Anna has no prior history of substance abuse, as well as no prior treatment for mental health issues. Goals for Therapy Immediate Goals These goals start with assuring her that there is some confidentiality in our sessions. She is still a minor so if she does tell me something that I feel her parents should know it is up to my discretion to tell them. It is also vital that I establish rapport with my client, and let her know

Anna Conceptualization

3

that she can trust me in our sessions. I must also determine what the facts are, and assess her feelings about the facts, meaning that I need to collect all information about her parents divorce, her mother’s breast cancer, her living arrangements, as well as the situation with Isabelle in order to fully understand her emotions about each of these situations. Next I must evaluate her living arrangements since her father and his new fiancé are currently living with the children. This could be significantly impacting Anna’s psychological health. It is also essential to clarify some boundaries between the two families, and to see what their standpoint on boundaries currently is. However I think the most important immediate goal is to get Anna grief counseling so she can better deal with her mother’s breast cancer and how the loss will impact her life. Long-Term Goals My first long-term goal is to declare a truce between the two feuding families. Both families have been fighting for years and Anna has always been stuck in the middle so we need to determine how the family can communicate and declare a truce. It is also crucial that we foster a relationship with Anna and her soon-to-be stepmother Isabelle. Fostering this relationship between them can perhaps help her cope with the relationship better. This is also vital because Isabelle eventually will be her full time mother when her mother passes away. Therapy needs to give Anna the acceptance and security to grieve as well as give her to tools for long-term coping which could include finding ways that she can remember her mother after she is gone, grief counseling, and perhaps some homework to attend a local group which deals with children of cancer stricken parents. Because of this it is also important to strengthen Anna’s relationship with her father so that she can cope with her abandonment and loss issues dealing with him leaving her when her parents divorced, and learn to accept him as a essential part of her

Anna Conceptualization

4

life. Lastly, we will work on validating Anna’s emotions and putting a name to the emotions that she feels on a day to day basis. Theoretical Orientation The theoretical orientation that I am going to use in Anna’s therapy is comprised of Gestalt therapy and family therapy. My goal for using Gestalt therapy with Anna is to help her gain awareness of what she experiences on a day to day basis and how she feeds into these experiences. I feel that Anna is dealing with much unfinished business which is resulting in her unexpressed feelings of hatred, resentment, pain, anxiety, grief, guilt, and abandonment. The unfinished business includes her issues from the divorce, as well as her mother’s breast cancer, and it is creating unnecessary emotional debris that is cluttering her present-centered awareness. I do anticipate that Anna will have resistance to contact since she has trouble making effective contact with the other significant figures in her life. So far she has exhibited projection through blaming Isabelle for why she feels so sad and refuses to accept responsibility that it is herself that makes her feel depressed. I feel that through the here-and-now, setting that motivates change and allows for experiments that Anna will thrive through the Gestalt theory. The goal working with her family is to help foster an environment where I can point out family interaction patterns that perhaps Anna and her family have never noticed when they are interacting with one another. This point of view can help them to identify what it is that is making them not work as a unit and to work towards congruence within the family. My plan is to meet with Anna for once a week, one hour, sessions that continue for six weeks. She will have homework that includes attending some outside group for children of cancer parents, or children of divorce, however the sessions we will engage in will be individual sessions. I then want to incorporate the family into our

Anna Conceptualization

5

sessions and have four family sessions so what we can work on not only Anna and her issues, but the family as a unit. Techniques The beauty of the Gestalt theory is that there are a plethora of techniques that I can choose from which are strengthened by our therapeutic relationship. These techniques, which include experiments and exercises, can help elicit some type of emotion, produce some type of action, or achieve a specific goal that we set in therapy and should be conducted only when Anna feels that she is ready to engage in them. To start, I could set up a dialogue between Anna and one of her significant others such as her mother, Isabelle, or her father. Another effective technique is role-playing, where Anna and assumes the identity of her mother and father and acts out a scenario. There is the Empty Chair technique where Anna carries on a dialogue between two conflicting aspects within her to better understand why she responds the way she does and how she could change these responses to decrease the likelihood of a fight. “Staying with the feeling” is another technique, which encompasses staying with an uncomfortable emotion so she can learn to endure the pain that is necessary for unblocking and can help her to grow. In regards to the family work that I mentioned above, there are specific family orientated techniques which can produce change. These include family sculpting where Anna places her family where she views them from her perspective, the family genogram which outlines their family so that I can gather valid information on each member of the family, reframing which deals with how the family members speak to one another and deals with helping them to learn how to change their statements from negatives to positives.

Anna Conceptualization

6

Ethical Considerations There is one main ethical dilemma that I must consider with this case which is that Anna is a minor. The time where confidentiality could be breached with Anna would include if I found out she was a harm to herself or others, if the parents request her information , or if for some reason the court requests her information (for example if her parents fight over custody and the court needs to deal with the children). Yet, this is such a touchy subject that I must be very careful when approaching her confidentiality. One other ethical concern for me is her participation in group therapy where confidentiality could be breached by another member. Termination The ultimate goal for Anna is to reach the point where she can self-regulate as an organism and can successfully interact with others around her. When looking for success in therapy I want to look to see if Anna has increased awareness of herself and if she has a better understanding about her emotions. I also want to look for her to assume ownership of her experiences instead of her making others responsible for the way that she is thinking, feeling or doing. Lastly, I want to observe to see if Anna has an awareness and acceptance of responsibility and understands not only her actions but also the consequences that come along with them, and look to see that she has moved toward internal self-support so that she is not only able to ask for and get help from others, but to more importantly be able to give to others. With the family sessions I want to help her family to understand Anna as well as understand themselves and how they each family member fits together to make one unit. Once I can see that they are not only communicating more effectively but are having more empathy for one another I will suggest that the family come and see me once every six months for the next year, and after that it will be on an as needed basis.