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Running Head: THERAPEUTIC PROCESS 2

THERAPEUTIC PROCESS 3

Therapeutic Process

Lori Ann Wright

Grand Canyon University: PCN 610

August 21, 2019

Running head: ASSIGNMENT TITLE HERE

1

Running head: THERAPEUTIC PROCESS 1

Therapeutic Process

Part 1

Stella is a 40-year-old woman who is my client. Her eyes are expressionless as she gives an apology for being late for her appointment. On asking her where she was coming from she states that she had gone to see her nephew whom she had taken a few of her electronics she no longer thought she needed and he was better placed to use them. While she appears and admits to still being sad even after letting go of her electronics, she states that the sadness does not compare as to how she felt when she still had the items in her possession. Stella is recently divorced and had lost custody of her two children after being a stay at home mom for more than ten years.

It has been three months since her divorce and contrary to her wishes, we try avoiding talking about her divorce. We discuss her teenage children’s achievements over the years that she believes she contributed greatly. Mark is an achieving athlete while Ann plays the piano with talented mastery. This however, reminds her that she lost custody and her face is filled with the hopelessness we have been trying to help her see is not necessary. She states that she sees no need to continue living without her children whom she has been forced to stay states away from. Upon her divorce and loss of custody, she has had to move back to her parents’ as being unemployed she could not afford to live on her own. She explains she gave up accounting 12years ago to be a hands-on mom and upon inquiring whether she would like to go back to it she starts sobbing unstoppably.

Since our time was moving fast, there was little we could do amidst her sobs and I chose to let her cry as many tears as she could. After calming down she stated that all she knows how to do is take care of her children’s needs by preparing their meals, attending their games and play sessions, and tend to them when they were sick. At this point, she breaks down into tears stating that there was really no need to keep acting strong as she was feeling very weak and unable to take it all in. it is at this point that I notice the marks on her wrists.

Part 2

I believe that, Stella Matthew could potentially be a suicidal patient whom as much as they have not stated the need to end their life, exhibits symptoms and behaviors of one who has, or is about to start having suicidal thoughts. One of the reasons to believe so are her explicit mood changes and extreme sadness, while she is okay one minute she could be sobbing the next and avoiding eye contact or refusing to talk completely in the other minute (Panagioti et al, 2012). For instance, in this session, she kept sobbing and at some point she refused to continue talking citing that she was tired from having taken the electronics to her nephew and getting rained on.

In addition, she has a general sense of hopelessness that can easily be noted not just from looking at her but also from what she keeps saying. According to her, she dedicated all her life raising and catering to the needs of her children and now that she can no longer do that she does not know what to do and sees no meaning in fighting or even existing. The gravest symptoms in addition to all this is the fact that she has been cutting her wrists whenever the sense of hopelessness overwhelms her and that is one of the things she refuses to talk about.

Part 3

The minute I started being concerned about Stella’s possibility of being suicidal, I asked her the following questions so I could gauge her level of risk at hurting herself or ending her life. The first question was whether she had found herself wishing she didn’t have to wake up in the morning or wishing she were dead to which she replied in the affirmative. This I followed up with whether she ever had any thoughts of ending her life or had a plan in which she would do so, to which she nodded, looking away and avoiding my eyes.

She said that she cut herself in the shower when no one else could hear her sob in pain as she let the shower run while she did so. She believed that if she did that enough she would eventually bleed out in her sleep. She added that she thought this was taking more time than she had and even thought of adding sleeping pills to the exercise when she was alone in the house. Her thoughts appeared well planned out and ended up answering the third, fourth and fifth question together (Silverman & Berman, 2014). She has not only thought of ending her life but has attempted it on several occasions, only that she has been lucky enough to not succeed nor be found out. For whether she has started working out the plan to end her life she stated that she knew that her parents would be travelling to visit her sister soon and she planned to use the time she would be alone to take some pills and cut both her wrists so she could bleed out in their absence. This would reduce the risk of anyone finding her before she finally went to her end and would make things easier as she would not have to explain to anyone why she took that route. According to what Stella has reported she has started self-harming and is planning on doing more self-harm to herself. The first time she attempted suicide by cutting her wrists was two days ago.

From the questions asked, it is quite clear that Stella is at high risk for suicide, and if action is not taken she may even be tempted to re-attempt taking her life sooner than she states. Considering how hopeless she feels and how frequently she keeps falling into her bouts of hopelessness, action needs to be taken. On a scale of 1 to 10 she is a possible 9.5 and the first thing to do is ensure she is not left alone (Sullivan & Bongar, 2009). Getting her an extensive clinical suicide assessment, brief suicide safety assessment, after which she should be admitted in a mental health facility under strict monitoring. This would then require that her parents who she currently stays with are immediately informed and should also receive some counseling however brief, on how to handle her.

In addition to documenting all she says verbatim in the assessing and reassessing sessions, it is important that anything that could possibly give her a chance to self-harm should be kept away from her, talking to her parents could help with this. Also reconstructing her therapy sessions to help her see the positive things she has going on currently and giving her ideas for life, other than just helping her get over her divorce should be helpful.

References

Panagioti, M., Gooding, P. A., & Tarrier, N. (2012). Hopelessness, defeat, and entrapment in posttraumatic stress disorder: their association with suicidal behavior and severity of depression. The Journal of nervous and mental disease, 200(8), 676-683.

Silverman, M. M., & Berman, A. L. (2014). Suicide risk assessment and risk formulation part I: A focus on suicide ideation in assessing suicide risk. Suicide and Life‐Threatening Behavior, 44(4), 420-431.

Sullivan, G. R., & Bongar, B. (2009). Assessing suicide risk in the adult patient.