Summary
The current case study incorporates the patient, Mrs. Smith, a woman in her early sixties who has recently lost her husband and finds herself alone for the first time in her life. She depended on her husband significantly, and after his death, Mrs. Smith has not only experienced significant grief but has also been anxious about living by herself and taking care of herself with no one else there for her (Smith, 2019). This is a problem that many widows and widowers face because life as they knew it had changed drastically, and the fear of the unknown makes it harder to cope and understand how they will manage their lives in the future (Kenen, 2021). The case of Mrs. Smith entails the consideration of the approaches a healthcare professional will take, her presenting issues and precipitating, predisposing, perpetuating, and protective factors, the inclusion of a treatment plan, interventions, and different forms of reflection.
The Approach
In counseling, patients can be approached from several perspectives, such as the person-centered approach, the psychodynamic approach, and cognitive behavioral therapy (CBT). In the case of Mrs. Smith, the most likely approach is the person-centered perspective, which is focused on the belief that all people are born with the ability for psychological growth in the case when environmental factors allow them to do so (Renger, 2021). When applying the approach, the counselor is mainly concerned with expressing empathy and unconditional positive regard to the client (Moayedoddin & Markowitz, 2018). This entails the use of micro-skills such as active listening, the reflection of meaning and feeling, as well as genuine communication between the client and the counselor (Beck & Kulzer, 2018). Within the approach, the therapist will play a supportive role in helping Mrs. Smith to recognize the strengths that she has and find answers that align with her beliefs and values.
Case Formulation
Mrs. Smith presents to the counselor reporting intense grief over the loss of her husband and severe grief about managing her life in the future. The death of her husband, which is a precipitating factor, is a blow to her not only because she lost a person she loved dearly but also because, for the first time in her life, she found herself responsible for herself (Racine et al., 2016). This is incredibly challenging because Mrs. Smith married at eighteen years old and never had to worry about providing for herself because her husband took responsibility for most parts of her life, which suited her.
This can be considered Mrs. Smith’s perpetuating factor as it maintains her problem. Growing up, she never had to worry about money because her parents had a stable income (Mason, Tofthagen, & Buck, 2020). Thus, besides dealing with grief, the patient faces the challenge of restructuring her life completely (Whalley & Kaur, 2020). The protective factors entail the strengths that Mrs. has to reduce the problem’s severity and promote healthy functioning (Racine et al., 2016). The strength she had when nursing her husband through cancer can be considered a protective factor.
Treatment Plan
The treatment plan for Mrs. Smith will entail the meeting of three specific goals, such as validating her past, adjusting to the present life, and redefining the future, which will align with the beginning, middle, and ending phases of the counseling process (Sutton, 2022). Therefore, at the beginning phase of the counseling process, it is important to validate Mrs. Smith’s experiences by creating a non-judgmental environment in which she can share the positive memories and the history of her husband, whom she lost. At this stage, if there are any grievance areas or unfinished business, Mrs. Smith will be encouraged to discuss them openly with her counselor to facilitate the resolution of any issues that she may have.
At the middle stage of the counseling process, the work with Mrs. Smith will be focused on helping her adjust to the present, especially when it comes to establishing a new daily routine of tasks and activities, including self-care measures that can help her adjust. Important measures to communicate to Mrs. Smith include recommendations to engage in healthy behaviors such as regular mild exercises, healthy food, and enough sleep (Wickham et al., 2020). Besides, she should talk with friends and family more often if she finds it comforting (NIH, 2017). At this point, it is unnecessary to make a significant change in daily habits, such as moving; the emphasis should be placed on showing Mrs. Smith that life goes on and that having a routine is a good strategy for coping.
At the final stage of the counseling process, it is necessary to help Mrs. Smith redefine her future without her husband as the key treatment goal. It is essential to discuss any dreams and aspirations that the client has and help her consider new opportunities despite the loss (Rehman, 2021). These can include considerations of her professional career as she now has to provide for herself without her husband around (NCOA, 2021). Also, at this stage, in case of any severe grief reactions, Mrs. Smith can be referred to a psychiatrist for further evaluation (Mayo Clinic Staff, 2021). Overall, the main objective of therapy is to help Mrs. Smith understand that loss cannot be reversed; however, life goes on.
Intervention
In the counseling practice, there have been several interventions carried out to help patients address the issues associated with grief. These include cognitive-behavioral therapy (CBT), acceptance and commitment therapy (ACT), traumatic grief therapy, complicated grief therapy (CGT), group therapy, art therapy, and play therapy (Lindberg, 2021). All of the mentioned interventions are aimed at processing the experience and the feeling of emotions to integrate what has happened, facilitating healing (Price & Hooven, 2018).
Among the mentioned interventions, it is likely that Mrs. Smith will benefit from ACT, which can help her learn how to accept negative feelings and situations and then develop healthy patterns (Scott, 2020). It entails the ability to enhance psychological flexibility to ensure the acceptance of emotions instead of trying to ignore them. It will use mindfulness to help process grief and accept the loss (Kelly, 2021). Mrs. Smith will be encouraged to focus on the present, observe herself experiencing different circumstances and situations, identify core values, and overcome difficulties using previous techniques.
Reflection and Supervision
To support the reflective counseling work with Mrs. Smith, it is imperative to implement reflective supervision, which entails meeting on a regular basis, such as twice a week, to discuss problem areas (Wiedow, 2017). The client will be encouraged to choose the problem areas so that she can encourage her thoughts and feelings about the problem areas (Health Federation of Philadelphia, no date). In this sense, the relationship between the counselor and the client in reflective supervision models will entail the development of a therapeutic and helping relationship that is based on collaboration, trust, choice, and control.
References
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