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Introduction

            Since the beginning, psychologist
have been using different theories to help their clients. In most cases, the
therapist decides which approach that they would use after they hear their
clients “story”. It is important for them to know the background information,
in order for them to help the client make the best decisions for themselves. It
takes every ounce of knowledge, from the client’s demographic  and background information, to the good and the
bad, and even their cultural background, to even figure out which theory of
psychology to use.

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General History and Biopsychosocial History

For most of her life, LaKeisha described
herself as self as confident and self-sufficient. At the age of 10- years- old,
LaKeisha’s father separated from her mother, which forced her mom to raise her
by herself. During this time, one thing that she learned from watching her mom
raise her all by herself, was that sometimes you have to do things by yourself.
Over the years, she built up a strong sense of confidence, which sometimes lead
her to become prideful. She felt as though she knew what was best for her,
because her mom taught her not to rely on anyone else. This thought process was
something that LaKeisha lived with for a long time. Although, LaKeisha had a
lot of confidence on the outside, she did not always have that confidence on
the inside. She feared of following her mother’s footsteps; which made her
depressed and anxious at times, because she always wanted things to be perfect.

LaKeisha had dreams of going into the
military, to give her life purpose. She wanted to help serve this county and
protect it from harm and danger; however, when she turned 20 years old,
LaKeisha gave birth to her infant daughter. The birth of her daughter, was not
a part of her life goals; she wanted to wait until she was financially ready to
support a child, just in case something happens like it did with her mom. Immediately
after giving birth to her daughter, LaKeisha’s depression started to affect her
more and more each day. Although, depression is a common, disabling, and
treatable problem that can affect women, the infant, and their family; this level
of depression was detrimental to LaKeisha (Solomon et al., 2016).

Over the years, LaKeisha has suffered from
depression and anxiety; however, once she was diagnosed with end- stage renal
disease, the depression and anxiety increased as her illness got worse. She was
placed on dialysis to help keep her body in balance, because at this point she
has lost about 85 to 90 percent of her kidney function. After years of ongoing
dialysis treatment, LaKeisha has finally been place on the Kidney Transplant
list, which will give her the opportunity to one day get a new kidney. Even
though her life is about to change for the better, she is afraid of the thought
that she may not be able to have the surgery. With this fear, LaKeisha’s
depression and anxiety are intensifying, she fears that this is her last chance
for a pain free life.

Since LaKeisha officially was never diagnosed
with depression or anxiety, she sought professional psychotherapy because it
has become extremely hard trying to concentrate on school and her daughter. It
was during  LaKeisha’s initial assessment
and first few counseling sessions, her therapist confirmed that she was
suffering from major depressive disorder and an anxiety disorder. Individuals
who are faced with a major depressive disorder, have a depressed mood or loss
of interest. Their mood will change, they no longer find joy in activities they
once enjoyed,  and they may feel worthless
(American Psychiatric Association, 2013). When LaKeisha’s therapist diagnosed
her with an anxiety disorder; they noticed that she always worried about something,
be it being a mother, her health, and trying to remain perfect. Although her
plan was altered, she still wanted to provide a great life for her child, but
she feared that her was never going to be same again. LaKeisha’s health played
a major part into her diagnosis, but the symptoms that she physically felt made
her feel different, worse even.

Possible Barriers

            Therapist know that every client is
different; some may show similar signs, but every case has its own story. For LaKeisha’s
case, she has been independent for so long, she does not know how to accept
help. Her mother was around, but she also had to work three jobs just to make
ends meet. This left LaKeisha at home taking care of herself. Upon observing
and hearing LaKeisha, the therapist has to build trust with LaKeisha; since she
is used to doing everything for herself, it is hard to think someone else would
care to help her. The therapist could use motivational interviewing, to use
both supportive and directive interventions motivate LaKeisha to keep fighting for
daughter as well as herself (Polcin et al., 2015).  This type of interviewing  can help establish a strong connection between
LaKeisha and the therapist. The therapist will be able to help LaKeisha know
that sometimes it will be okay to depend on others, especially when her daughters’
happiness is involved. Having the confidence and strength that she possessed
will allow her to overcome and deal with all of the negative things that were
taking place in her life.

Cultural Issues

            When looking more into LaKeisha’s
background, we as observers can see that she did not have many opportunities to
see a therapist, and to talk about her many issues she was going through.
According to research, many African Americans do not go to counseling because
they believe that it is expensive (Murry et. al, 2011). Also, for many African
Americans it is hard for them to talk about their situations with others. For LaKeisha,
the therapist must remain culturally competent and nonjudgmental; she makes
sure that LaKeisha, feels safe and comfortable during the session. At one point
during the session, she mentioned that she was surprised that she was
expressing herself, she made it known that as a “black woman”, she had to
portray herself as strong and independent. Although, she wanted to remain
strong, it was difficult because of the fear of her negative medical results
(Hunter , 2015). LaKeisha’s strength kept her going and pushing, but
there were times when she did not know if she would make it. Her independence
hindered her from asking for help when she needed  it. During the session, she mentioned that
most of her life, she had to do things on her own and it was difficult for her
to receive that help. It wasn’t until her diagnosis, that she realized that
without the therapist help, her “world would continue to spiral downwards”.          

Expected Stages of
Therapy

During therapy, there are many stages
that a therapist has to get through, in order to have success in the session
with the client. According to Egan (2014), during the first stage, the
therapist helps the client tell his or her own story. To obtain this goal, the
therapist and the client must develop a relationship with one another. The
client is to openly speak on their past and show that they care during their
session  (Egan, 2014). Since this
experience is new for LaKeisha, the therapist will make sure to comfort her,
because the end result is to help LaKeisha feel like she is not alone anymore.

After telling her
story, LaKeisha must come up with problem-managing ideas, develop goals, realistic
strategies, and even commit to making some changes in her life. As the
therapist, it is their job to make sure that the client comes up with a plan,
they have to see if the client follows through with it  and take the actions on their plan (Egan,
2014).  In the case of LaKeisha, this
will not only help her become a divergent thinker but it will allow her to
actually prove that this is something that she wants to do. Although, she is
going through a difficult time with her medical issue, she could keep giving
her daughter the best life that she can get. Also, she can surround herself
with people (friends and family), they would allow her to feel like she is not
by herself. In the last stage, the therapist helps LaKeisha realize and
understand that although she went through and is still growing through a lot ,
she is willing to make changes. LaKeisha is willing to meet other people who
are experiencing similar situations; she just wants the help and becoming susceptible
to receive it is helping her. She has to open up to others so she be able to
get her medical help as well as get the support she need to continue to raise
her daughter.

Clinical Intervention

Cognitive Behavioral Therapy

Cognitive Behavioral Therapy (CBT) is an effective
therapy that is used when a client has suffered from depression or helps
explains how the client’s is continuing to feed into the depression. As the
therapist works with LaKeisha, most of the work is done by her. The therapist
is used as a guide, helping her to change any negative beliefs and assumption that she may have (Wedding
& Corsini, 2014, p. 247). For LaKeisha, this was something that at first
did not feel comfortable with; although, the therapist is not forcing her to
believe in what they feel like she should believe in. For a long time, LaKeisha
believed that others would not support her and be on her side; this negative
view blocked and placed barriers in her life. However, therapist is allowing
her to have a new outlook on life, a reason to want to find happiness and
change. The therapist builds a relationship with Lakeisha, this relationship
creates a sense of trust. This trust allows LaKeisha to want to improve and
keep changing; hopefully with the help of the therapist, she finds a way to
cope with her situation. Her thoughts start to change because she starts to
become motivated for the future

Assessment

As the therapist works with LaKeisha, there
are a few clinical impressions that are discovered during their sessions. When
looking back into her past, it is shown that even through her strength and
determination, there has always been a sense of fear. Since she found out about
her health, LaKeisha has always been afraid of what could or could not happen.
She struggles with the thought that she will not be able to see her daughter
grow up and graduate college. LaKeisha mentions that she has a couple of family
members who will be willing to take care of her daughter if anything were to happen
to her; however, she fears that her daughter will not know how to grieve with
the loss of her mother. It is clear that she is in pain, but she is staying
strong; she suggests that her motto is “fear is temporary, and strength is
forever”.

Although, LaKeisha shows signs of a Depressive
Disorder (not otherwise specified (N.O.S)), she is willing to find a plan that
will help her to overcome through this process. Since this session was the first
session, LaKeisha, and the therapist decided that during the next session, she
would develop a plan that will help give her happiness. This plan was one of
her ultimate goals; she wants to be happy, be a great parent for her daughter,
and to have to strength to conquer her diagnosis. This plan will consist of her
writing in a journal to express how she feels and trying to experience
something new once  a month. Since this
plan was new and this was LaKeisha’s first time in therapy, the therapist
decided to meet with her 2x’s out of the week. Also, LaKeisha has the opportunity
to change the plan in any way that will help benefit her and her happiness.

Conclusion

            In
conclusion, although LaKeisha has agreed to continue to meet with the therapist
to  improve and change, this process is
hard and difficult. For almost 20 years LaKeisha has had to depend on herself,
but since her diagnosis has gotten worse, she has realized that she can’t do
everything by herself. Her therapist had to understand LaKeisha, and understand
the reason why she felt and acted the way she did. They had to take their
cognitive techniques to identify and test LaKeisha’s beliefs; it’s because a
lot of the things that she was raised on, depicted how she lived her life now (
Wedding, 2014). The therapist feels that the more that LaKeisha meets with
them, then she would continue to open up and express herself. With everything
that the therapist knows about LaKeisha, they are able to decide on which
clinical intervention to use to continue to help LaKeisha, if one theory does
not work then they will have the opportunity to try another because both
LaKeisha and her daughter lives depend on the help of the therapist.

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