Introduction Since the beginning, psychologisthave been using different theories to help their clients. In most cases, thetherapist decides which approach that they would use after they hear theirclients “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.
Ittakes every ounce of knowledge, from the client’s demographic and background information, to the good and thebad, and even their cultural background, to even figure out which theory ofpsychology to use.General History and Biopsychosocial HistoryFor most of her life, LaKeisha describedherself 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 herby herself. During this time, one thing that she learned from watching her momraise 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 leadher 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 wassomething that LaKeisha lived with for a long time.
Although, LaKeisha had alot of confidence on the outside, she did not always have that confidence onthe inside. She feared of following her mother’s footsteps; which made herdepressed and anxious at times, because she always wanted things to be perfect.LaKeisha had dreams of going into themilitary, to give her life purpose. She wanted to help serve this county andprotect 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 nota part of her life goals; she wanted to wait until she was financially ready tosupport a child, just in case something happens like it did with her mom. Immediatelyafter giving birth to her daughter, LaKeisha’s depression started to affect hermore and more each day. Although, depression is a common, disabling, andtreatable problem that can affect women, the infant, and their family; this levelof depression was detrimental to LaKeisha (Solomon et al.
, 2016). Over the years, LaKeisha has suffered fromdepression and anxiety; however, once she was diagnosed with end- stage renaldisease, the depression and anxiety increased as her illness got worse. She wasplaced on dialysis to help keep her body in balance, because at this point shehas lost about 85 to 90 percent of her kidney function. After years of ongoingdialysis treatment, LaKeisha has finally been place on the Kidney Transplantlist, which will give her the opportunity to one day get a new kidney.
Eventhough her life is about to change for the better, she is afraid of the thoughtthat she may not be able to have the surgery. With this fear, LaKeisha’sdepression and anxiety are intensifying, she fears that this is her last chancefor a pain free life. Since LaKeisha officially was never diagnosedwith depression or anxiety, she sought professional psychotherapy because ithas become extremely hard trying to concentrate on school and her daughter. Itwas during LaKeisha’s initial assessmentand first few counseling sessions, her therapist confirmed that she wassuffering from major depressive disorder and an anxiety disorder. Individualswho are faced with a major depressive disorder, have a depressed mood or lossof interest. Their mood will change, they no longer find joy in activities theyonce enjoyed, and they may feel worthless(American Psychiatric Association, 2013).
When LaKeisha’s therapist diagnosedher 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 herplan was altered, she still wanted to provide a great life for her child, butshe feared that her was never going to be same again. LaKeisha’s health playeda major part into her diagnosis, but the symptoms that she physically felt madeher feel different, worse even. Possible Barriers Therapist know that every client isdifferent; some may show similar signs, but every case has its own story. For LaKeisha’scase, she has been independent for so long, she does not know how to accepthelp. Her mother was around, but she also had to work three jobs just to makeends meet. This left LaKeisha at home taking care of herself. Upon observingand hearing LaKeisha, the therapist has to build trust with LaKeisha; since sheis used to doing everything for herself, it is hard to think someone else wouldcare to help her.
The therapist could use motivational interviewing, to useboth supportive and directive interventions motivate LaKeisha to keep fighting fordaughter as well as herself (Polcin et al., 2015). This type of interviewing can help establish a strong connection betweenLaKeisha and the therapist. The therapist will be able to help LaKeisha knowthat sometimes it will be okay to depend on others, especially when her daughters’happiness is involved.
Having the confidence and strength that she possessedwill allow her to overcome and deal with all of the negative things that weretaking place in her life.Cultural Issues When looking more into LaKeisha’sbackground, we as observers can see that she did not have many opportunities tosee a therapist, and to talk about her many issues she was going through.According to research, many African Americans do not go to counseling becausethey believe that it is expensive (Murry et. al, 2011). Also, for many AfricanAmericans it is hard for them to talk about their situations with others.
For LaKeisha,the therapist must remain culturally competent and nonjudgmental; she makessure that LaKeisha, feels safe and comfortable during the session. At one pointduring the session, she mentioned that she was surprised that she wasexpressing herself, she made it known that as a “black woman”, she had toportray herself as strong and independent. Although, she wanted to remainstrong, it was difficult because of the fear of her negative medical results(Hunter , 2015). LaKeisha’s strength kept her going and pushing, butthere were times when she did not know if she would make it.
Her independencehindered her from asking for help when she needed it. During the session, she mentioned thatmost of her life, she had to do things on her own and it was difficult for herto receive that help. It wasn’t until her diagnosis, that she realized thatwithout the therapist help, her “world would continue to spiral downwards”. Expected Stages ofTherapy During therapy, there are many stagesthat a therapist has to get through, in order to have success in the sessionwith the client.
According to Egan (2014), during the first stage, thetherapist helps the client tell his or her own story. To obtain this goal, thetherapist and the client must develop a relationship with one another. Theclient is to openly speak on their past and show that they care during theirsession (Egan, 2014). Since thisexperience 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 herstory, LaKeisha must come up with problem-managing ideas, develop goals, realisticstrategies, and even commit to making some changes in her life. As thetherapist, 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, thiswill not only help her become a divergent thinker but it will allow her toactually prove that this is something that she wants to do. Although, she isgoing through a difficult time with her medical issue, she could keep givingher daughter the best life that she can get. Also, she can surround herselfwith people (friends and family), they would allow her to feel like she is notby herself. In the last stage, the therapist helps LaKeisha realize andunderstand 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 whoare experiencing similar situations; she just wants the help and becoming susceptibleto receive it is helping her. She has to open up to others so she be able toget her medical help as well as get the support she need to continue to raiseher daughter.
Clinical InterventionCognitive Behavioral TherapyCognitive Behavioral Therapy (CBT) is an effectivetherapy that is used when a client has suffered from depression or helpsexplains how the client’s is continuing to feed into the depression. As thetherapist works with LaKeisha, most of the work is done by her. The therapistis 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 firstdid not feel comfortable with; although, the therapist is not forcing her tobelieve in what they feel like she should believe in. For a long time, LaKeishabelieved that others would not support her and be on her side; this negativeview blocked and placed barriers in her life. However, therapist is allowingher to have a new outlook on life, a reason to want to find happiness andchange. The therapist builds a relationship with Lakeisha, this relationshipcreates a sense of trust. This trust allows LaKeisha to want to improve andkeep changing; hopefully with the help of the therapist, she finds a way tocope with her situation. Her thoughts start to change because she starts tobecome motivated for the futureAssessmentAs the therapist works with LaKeisha, thereare a few clinical impressions that are discovered during their sessions. Whenlooking back into her past, it is shown that even through her strength anddetermination, there has always been a sense of fear. Since she found out abouther 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 daughtergrow up and graduate college. LaKeisha mentions that she has a couple of familymembers who will be willing to take care of her daughter if anything were to happento her; however, she fears that her daughter will not know how to grieve withthe loss of her mother. It is clear that she is in pain, but she is stayingstrong; she suggests that her motto is “fear is temporary, and strength isforever”. Although, LaKeisha shows signs of a DepressiveDisorder (not otherwise specified (N.O.S)), she is willing to find a plan thatwill help her to overcome through this process. Since this session was the firstsession, LaKeisha, and the therapist decided that during the next session, shewould develop a plan that will help give her happiness. This plan was one ofher 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 herwriting in a journal to express how she feels and trying to experiencesomething new once a month. Since thisplan was new and this was LaKeisha’s first time in therapy, the therapistdecided to meet with her 2x’s out of the week. Also, LaKeisha has the opportunityto change the plan in any way that will help benefit her and her happiness.Conclusion Inconclusion, although LaKeisha has agreed to continue to meet with the therapistto improve and change, this process ishard 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 doeverything by herself. Her therapist had to understand LaKeisha, and understandthe reason why she felt and acted the way she did.
They had to take theircognitive techniques to identify and test LaKeisha’s beliefs; it’s because alot 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 withthem, then she would continue to open up and express herself. With everythingthat the therapist knows about LaKeisha, they are able to decide on whichclinical intervention to use to continue to help LaKeisha, if one theory doesnot work then they will have the opportunity to try another because bothLaKeisha and her daughter lives depend on the help of the therapist.