Develop a treatment plan for the client you selected in Week 4. Note: You will use the same perspective or approach that you applied last week.

Case Conceptualization: Working With Adult Clients

REBT Case Conceptualization: A case of Rebecca

PART 1

Identify what you believe to be the client’s primary presenting problem(s).

Are there secondary concerns?

The primary problem facing Rebecca is her inability to get over the loss of her husband of less than a year. While it is evident that Rebecca and Joseph were in a marriage for less than a year, it is notable that the bond between them was incredibly strong. Joseph was 17 years her junior yet they had a mutual love for one another. The extent of the love between the two is best captured in Rebecca’s statement, “We had the perfect marriage. I loved him so. He was wonderful . . . He would wake me up every morning with coffee. He wrote me love letters. How many men do you know who write their wives love letters?” An analysis of this statement suggests that both Joseph and Rebecca were madly in love and naturally, one would find it difficult to get over such a loss. It is also notable that Rebecca is at pains when she remembers the physical pain and tribulations which Joseph went through as he battled the memories of his time at the war. After trying several medical approaches, Rebecca says that Joseph ultimately sought the help of a doctor at the Veterans Administration. Unfortunately, Rebecca says that it is the VA doctor that killed him. She feels that the pills which the VA doctor prescribed for Joseph had adverse effects on him and ultimately led to his death. Rebecca contemplates filing a suit against the VA doctors. The circumstances surrounding the death of Joseph might have contributed to Rebecca’s pain and anguish.

There are secondary concerns which might have caused Rebecca’s situation. It is notable that Rebecca relied significantly on her husband for finances. When he died, however, he lost a huge chunk of this source of finance and she is struggling to meet various financial obligations. To make things worse, when Joseph dies, he had a life policy cover of $ 100,000. Joseph had lied to her that he would make her the beneficiary but that did not happen and the money went to Joseph’s parents. There is a sense in which Rebecca feels betrayed by Joseph to this extent and that is affecting her state of mind. Joseph’s family is unwilling to share the money with her and neither are they willing to interact with her. Another secondary concern which may be affecting Rebecca is the fact that she stays away from her family and close relatives. It is stated in the case that none of Rebecca’s siblings live near her. The lack of family comfort and support is likely to be hindering Rebecca’s recovery process (Dobson & Dozois, 2010).

Part 2

What was the Activating Event?

The activating event in this case was the death of Joseph. Rebecca and Joseph were madly in love with each other. After the death of Joseph, Rebecca remained lonely and troubled. It is this loss that is the genesis of all the challenges which Rebecca is experiencing.

What do you think some of the client’s Beliefs are about this event?

One belief of Rebecca about the death of her husband is that someone else or some people are responsible for it. From Rebecca’s statement, she says that the doctor at the Veterans Administration caused the death of her husband. Thus, had it not been for the actions of the doctors of this organization, perhaps Joseph would have survived. The thought that Joseph died as a result of the negligence or other actions of medical officers is a source of massive pain for Rebecca. Rebecca also believed that Joseph betrayed her when he promised to make her the beneficiary of his life insurance but he failed to do so, and instead listing his parents as the beneficiaries. It is highly likely that this act may appear to Rebecca as an act of betrayal.

Are there any that may be rational? (Not demanding, only preference)

There is a sense in which Rebecca’s belief that the VA doctors are responsible for his death is rational. Before his death, Joseph’s health did not indicate that he was about to die. The major concern was the mental and physical strain that the war period had on Joseph. Thus, when Joseph visits the VA doctors and he is provided with medicines on which he depended at the time of his death, it is easy to assume that the new medicines played a role in the deterioration of his health and death. While there is no indication of a post-mortem which was conducted to ascertain the cause of Joseph’ death, one is left with an impression that the medicines which the VA doctors provided to Joseph might have been responsible for his death.

What might be the client’s beliefs that are irrational? (Demanding, “Musterbation”)

While appreciating the fact that there were rational beliefs of Rebecca, it is also notable that there were some irrational beliefs of Rebecca. Rebecca believes that the doctors at the Veteran Administration killed Joseph. In this sense, she believes that there was a deliberate attempt by the doctors which killed the patient. The reality is that every medical practitioner makes efforts to make sure that the patient is in the best state of health. Thus, it is irrational to believe that there was a deliberate effort by the doctors to harm the patient. The doctors may be accused of negligence of professional incompetence but it would be unfortunate to believe that the doctors intended to kill the patient.

What are the Emotional consequences of the irrational beliefs?

One of the emotional consequences of the irrational beliefs is that it has kept Rebecca thinking about the circumstances under which her husband died and she is even contemplating pressing charges. Perhaps it is this feeling that the husband was killed that has kept Rebecca troubled and she is unwilling to move on from the unfortunate loss of her husband. She is not at peace that her husband died out of natural causes and that, to an extent has affected Rebecca’s recovery. In many instances, people who do not believe that their family members of loved ones died in natural circumstances remain unsettled until they get ‘justice’ served justice to the deceased. If Rebecca did not have such feelings perhaps she would have recovered.

Think about how you may Dispute these. (part of treatment)

One of the ways of disputing the irrational beliefs of Rebecca is to describe to her the roles of medical officers in the provision of care services to patients. Perhaps it would be beneficial to inform Rebecca that all doctors are under oath and all the things which they do are to the best interests of the patients.

Part 3 Treatment Planning

What Disputational techniques might you use?

The primary disputational technique which may be used in this case is to present facts to the patient. Rebecca has beliefs that are founded on falsehood and emotions and the most suitable way of doing this is to make sure that Rebecca gets the facts that would allow her to make appropriate decisions. For example, it would be necessary to explain to Rebecca the real causes of Joseph’s death as that would make her to be at peace with self.

What might you say?

I might tell Rebecca that the VA doctors did their best to address the condition of the patient but the medications did not succeed in addressing the condition of the patient. It is important to make Rebecca understand this element of medical practice

Could you use Rational Emotive Imagery?

The rational emotive imagery is an important activity in therapies. It is the use of self-help exercises in between therapy sessions (Dryden, 2014). The session involves helping the patient to identify the activities or issues that trigger undesirable responses. The rational emotive imagery is likely to be beneficial in the process and it needs to be used in the provision of the therapy.

Could you use humor?

Humor could be used in the session to lighten up the mood of the client. When dealing with Rebecca, it would be necessary to make sure that she improves her mood and humor could be essential in this sense (Beck, 2011).

What homework assignments could you give?

I will give Rebecca homework to keep track of the things that distract her and prevent her from continuously thinking about her situation. The distractions will be important in determining the various issues, events or circumstances which may be used to help Rebecca recover from her situation.

References

Beck, J. S. (2011). Cognitive therapy for challenging problems: What to do when the basics don't work. Guilford Press.

Dobson, K. S., & Dozois, D. J. (2010). Historical and philosophical bases of the cognitive-behavioral therapies. Guilford Press.

Dryden, W. (2014). Current Issues in Rational-Emotive Therapy (Psychology Revivals). Routledge.