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COUN5239 Theories of Psychotherapy

Choose one of the three cases below for your Unit 9 theory application paper.

Case Study OPTION 1: The Case of Enji

Presenting Information:

Enji is a 46-year-old Japanese man. He was born in Japan and moved to the United States by himself when he was in his early 20s to go to college and work. He presents to counseling with multiple complaints of depressive symptoms, anxiety about being in social situations, relationship problems, and financial challenges. He reports feeling irritable and down most of the time but continues to go to work even though he does not have the energy. He also states that he experiences nervousness when he is around people at work and socially, so much so that he has begun to isolate himself. He feels afraid to talk to people because he thinks, "They will look at me like I am stupid and just walk away. So I just don't talk to people. I am better off that way anyway because nobody understands my situation." He states that it is difficult for him to come to counseling because his Japanese beliefs do not support counseling. Strong encouragement from one of his American friends convinced him to come.

Social History:

Enji states that he was engaged to be married but his fiancée left him for another man about six months ago. They were together for about three years. Enji says, "I came home from work one day and she had all of her stuff packed. She told me she did not love me anymore, and then she left. I just did not know what to say or do, and ever since then I have been stuck." His fiancée was Japanese, too, but was more Americanized than Enji feels he is. Even though he has lived in the United States for many years, he states that he tries to remain close to his cultural roots. Enji has never been married and does not have any children. He has a few friends but says that he does not spend much time with them anymore. He feels like they see him as weak because he can not move on from the breakup. He was also involved in karate as a four-time black belt but has dropped out of the dojo.

Mental Health and Addictions History:

Enji states that he has never been to counseling and has never abused any substances.

Family History:

Enji's family still live in Japan, and he feels that they have a close relationship. His parents are elderly and are very traditional in their Japanese ways, so he does not talk to him about his problems or about seeking counseling. He is an only child. Enji reports that while in high school he was bullied a lot by other students and frequently physically harmed. He tried to talk to his father, but his father said that he had to be a man and stand up for himself. Enji continued to be bullied but never spoke of it again. He said he had forgotten about the incidents for many years but has now begun to think about it more. He reports that he has even had nightmares about his coworkers and friends bullying him.

Occupational and Educational History:

Enji has a bachelor's degree in business and computer technology and is the information technology specialist at a local company. He is currently having financial problems due to his fiancée moving out and taking a substantial amount of money from their joint savings account. 

Case Study OPTION 2: The Case of Susan

Presenting Information:

Susan is a 29-year-old white female. She is divorced with two children, a four-year-old daughter and a 10-year-old son. She is currently in a relationship with John; they have been together for about a year. John was recently laid off from his job with a small local manufacturing company. Susan presents to counseling with multiple concerns. She reports feeling tired and lethargic most of the time and does not sleep well. She feels decreased motivation in general and a discontent in her life, feeling like a dark cloud follows her around. She does not enjoy her life as she once did. She states, "I feel like every day is just a struggle, and I do not know where to turn." She also reports having a lot of relationship problems and challenges with her son. In her relationship with John, she feels that he ignores her and puts everything else first. She says that he just stays with her because he has no where else to go, and that he does not even want to talk to her about how she is feeling in her life or about her financial concerns. She says that she loves him, but she is worried about his lack of ambition, and she is not sure she wants to stay in the relationship. She states that she cannot trust John even though she has no reason not to trust him. She also reports that her son is getting in trouble in school and that she is at a loss for what to do. He has been sent home a few times in the past three months for fighting physically and verbally, and she feels like she is a bad mother because she does not know what to do to help him.

Social History:

Susan has lived all her life in a small rural town outside a larger city. Susan was first married at age 19, when she and her boyfriend discovered she was pregnant. She was married to Mark for six years and got divorced just after having their daughter, her second child. She states that her ex-husband was controlling and says, "He kept me on a tight leash and never gave me any slack." She reports that he had bouts of using drugs and had an affair early in their marriage. She says she tried to get over the affair but could not, stating, "I could never get the image of catching them together in our bed out of my head." She states that the decision to divorce was mutual but that he made it very difficult as he helped minimally with the kids. He is now seeing the kids twice a month and pays a small amount of child support through the state, but she says that she worries about what is going on at his house when he has the kids. She reports that her son comes back angry and defiant after staying at his dad's house for the weekend.

Mental Health and Addictions History:

Susan states that she used marijuana in her early 20s but has not used it in five years. She only drinks alcohol occasionally, having a few beers once or twice a month. She reports that she felt she was depressed while in her marriage but never sought counseling or treatment because her husband would not have let her.

Family History:

Susan is an only child. She states that her mother and father were divorced when she was 14, and she feels like she never got over that. She says, "I can just remember how they fought and yelled like I wasn't even there. I hated that time in my life and I hated my parents." She reports that she ran away from home several times during her early teen years and that there was never enough money for her to do the things she wanted to do in school or for extracurricular activities. She states that her relationship with her mom is supportive now, but she has little contact with her dad. Susan later found out that her dad was having affairs while he was married to her mom, and Susan states that she just cannot forgive him for putting them through that. Although Susan's mother is now sober and supportive, she lives about an hour away and works full time. Susan states, "I don't want to burden my mom with my problems or my kids."

Occupational and Educational History:

Susan went away to college but dropped out when she got pregnant and married. She got a CNA license and started back to school a year ago to work toward a nursing degree. She works full time and lives paycheck to paycheck. She is worried about her job, saying, "I just can't get the FF motivation to do a good job and sometimes I can't even get out of bed to go in." She is also ambivalent FD about being a nurse. She states that she should since she has been a CNA, but that she has no motivation to go to school anymore and her grades have been dropping. 

Case Study OPTION 3: The Case of Juanita 

Presenting Information (includes relevant family history for this case):

Juanita is a 45-year old woman and is seeking counseling due to feelings of despondency, guilt, and despair. Juanita was previously married to Max and is in contact with her former husband of 10 years, who, like Juanita, helps to support their daughter, Leisha, and their young grandson. Recently, Juanita’s aging mother fell and broke her hip and came to live with Juanita after being released from rehabilitation therapy. Leisha, who recently lost her job, is talking about bringing her son and a coming to live with Juanita. Juanita feels overwhelmed with the demands on her time and energy. She states that she loves her mother, her daughter, and her grandchild, but feels “pulled in too many directions.” She states that after her divorce, and after Leisha left home, she had gone back to school to complete an associate’s degree. After adjusting to living alone, she found that she had enjoyed challenging herself to reach for new goals.

Social History:

Juanita grew up in a rural environment; her parents worked in jobs that supported a rural economy. Juanita states that she "did not fit in" and moved to the nearby city as soon as she graduated from high school. She became pregnant with Leisha shortly after meeting Max, and states that she “kept to herself” because of her negative social experiences while growing up and the demands of working and raising her daughter. Recently, however, she has met someone and has enjoyed going out and exploring a new relationship.

Mental Health and Addictions History:

Juanita reports no prior counseling and she does not drink or do drugs.

Occupational and Educational History:

Juanita found work as a home health aide when she left home and moved to the city, and she discovered that she excelled in that role. Recently, she entered a program at her local community college to become a certified Medical Assistant, a goal that excited her and gave her hope for a better life in her middle-adult years. Her current feelings of distress are rising because she anticipates having to give up on her dream.

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