The purpose of this paper is to evaluate Scenario #3 case study that describes the client as a 40 year old male by the name of Roger. Roger entered treatment for several different issues including suicidal ideation, loneliness, depression homosexual thoughts, and self-image issues. Roger also has health issues due to his battle with obesity which has contributed to developing diabetes and high blood pressure. The client needs a clear treatment plan to establish goals of treatment. In order to provide a comprehensive treatment plan, the counselor must explore the client’s background, client’s overarching goals for treatment, theoretical approach, building a therapeutic process and examining their own biases for treating the client. This paper will explore the importance and the process for each of these areas in order to develop an appropriate treatment plan for this client.
Gathering personal information is vital in a counseling environment. In order to have a clear picture of the issues the client has and the course of action to take, the therapist needs an understanding of the client and family of origin. The gathering of personal information begins to lay the foundation for therapist to determine if there are any issues that may prevent the development of a therapeutic relationship or if there are personal biases or limitations for the therapist to consider in treatment. Failure to understand the impact of family dynamics and past relationships could cause the therapist to overlook contributing factors of core issues with the client. Core issues tend to lead clients into poor decision making process or into developing poor coping skills to deal with unpleasant feelings. In a study by Saffierie, the anti-fat attitudes of children 6 years of age were monitored. They characterized silhouettes of an overweight child as “lazy,” “dirty,” “stupid,” and “ugly.” (Fabricatore, & Wadden, 2003). It is these types of encounters as children that can begin the process of creating a core issue. Roger’s background is important to understand to see if there are any areas in his past that have wounded him. These old wounds could be the basis for some of the current issues Roger is bringing into treatment. Personal Biases and Limitations
According to the American Counseling Association (ACA) “Counselors refrain from referring prospective and current clients based solely on the counselor’s personally held values, attitudes, beliefs, and behaviors,” (American Counseling Association, 2014, A.11.b.). Therapists must continually evaluate their personal biases and limitations to ensure that no harm comes to the client. The imbalance of power in the therapeutic relationship allows the therapist to have influence of the client. If a therapist has a bias against homosexuals, then dealing with Roger’s homosexual thoughts may turn into a hurtful experience if the therapist condemns Roger from a place of sin or moral judgements. The bible instructs Christians to love the sinner but hate the sin. Dealing with client issues from a sin perspective can be detrimental to the client. Hypothetically, if Roger is feeling shameful for having homosexual thoughts and the therapist begins to condemn Roger for his sinful nature, Roger could abandon therapy entirely. Worse yet, Roger could walk away from a relationship with God. Roger may begin to feel judged or mocked for his lifestyle choice, thus blaming God and the therapist. This is the type of harm that is described in all of the ethical guidelines. Goals
The therapeutic alliance is the most important thing to create with the client, however, goal come close behind. Goals are important for many reasons. First, it encompasses the issues that the client wants to work on. Next, it gives both the client and therapist a road map of how they are going to resolve the goals together. Finally, it gives a timeframe to both the client and therapist when they should be seeing some resolution to the issues. Goals are flexible as well. Treatment plans are reviewed every thirty days to make sure everyone is still on track and if there has been a bump in the road, the treatment plan can be changed as necessary and appropriate to continue to help the client. Therapy is directed by the client so Roger needs to be engaged in the process of setting goals for his treatment. Roger would be asked to identify the issues as he sees them and why he is seeking help. There are several areas that Roger may want to focus on in therapy. First there are his health issues of obesity, diabetes and high blood pressure.
Dealing with the health concerns can provide “an enhanced sense of psychological well-being, including reduced feelings of stress, anxiety, and depression, and improved sleep patterns are associated with enhanced levels of physical activity and improved fitness,” (McInnis, Franklin, & Rippe, 2003). Addressing Rogers’s mental health would be another goal. Roger’s recent suicide ideations would need to be evaluated by a psychiatrist to ensure that he is not a danger to himself. “Recent evidence indicates that behaviors within the categories of emotion-focused and avoidant coping are predictive of depression and suicidal ideation,” (Horwitz, Hill, & King, 2010). Referring Roger to a psychiatrist to have a psychological evaluation would be appropriate. A goal to work on self-esteem would be appropriate to raise his self-worth and provide a new outlook on his life. This could also help with the way he views his relationship situation. Lastly, a goal of effective communication may help Roger to improve opportunities of creating meaningful relationships. Theoretical Approach
Cognitive behavioral therapy (CBT) is a form of treatment that focuses on examining the relationships between thoughts, feelings and behaviors. CBT differs from other traditional methods of psychotherapy in that the therapist and the client actively work together to help the client evaluate flaws in the client’s thinking process. Individuals who are treated with CBT can expect their treatment to be problem-focused, and goal-directed in addressing the challenging automatic thinking processes. Because CBT is an active intervention, the client can also expect to do homework or practice outside of sessions. Roger may have difficulty processing his Automatic Negative Thoughts (ANTs) associated with his homosexual thoughts, obesity and loneliness.
The bible instructs us to take every thought captive and helping Roger to do this will allow him to evaluate if the thought is a truth or if it is a negative thought. Roger then can begin the process of changing his thought patterns which will result in new and prayerfully healthy behaviors. Roger would be assigned homework to help him evaluate his ANTs and work on building his self-esteem. Journaling would be another technique to help Roger begin to identify feelings and thoughts that may need to be addressed. Roger would be encouraged to develop a social plan to develop healthy relationships. This would be situations like a bible study or maybe a therapy group. Therapeutic Progress and Success
Clients can evaluate whether or not they have been successful with their treatment. This could be indicated by the client gaining insights about their thoughts and behaviors. If the client can identify their success in making changes, learning new behaviors, learning to gain insight into themselves, identifying fewer symptoms, and having more coping skills, then they can identify that their goals have been achieved. Reviewing the treatment plan is the primary way to help the client track their accomplishments in treatment. Conclusion
Roger is a very complex client who must be treated holistically. Roger’s mind, body, and spirit need to be addressed to ensure that the whole man is addressed. A complete and thorough bio psycho social would identify many of the background questions that would allow the therapist to develop a complete picture of the client. Realistic, measurable goals in his treatment plan will allow the client to see progress. Finally, using Cognitive Behavioral Therapy will empower the client to make changes in his thought process and change unwanted behaviors through the reinforcement of homework assignments, journaling and practice.
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