Submitted in Partial Satisfaction of the requirements
For the Degree Master of Science: Rehabilitation Counseling
Western Oregon University
Description of Case Study
The client is a 26 year old Caucasian married female. She has four children in the home. She was born and raised in California. She has a chaotic family history and grew up with her father and her younger sister. She is the oldest child of the two sisters and was often the caretaker after her mother left to pursue her addiction. Client has minimal contact with her mother at this time. Client’s father has some legal issues and was incarcerated when she was reaching adulthood for previous misconduct with two of her high school friends. Client then married young and had her first child at 19 years of age. Client has diagnoses of Major Depression, Post Traumatic Stress Disorder, Amphetamine Dependence in remission, and Dependent Personality Disorder. She struggles with paralyzing features of depression at times and is unable to follow through with tasks related to her stated goal of becoming a nurse. She started the nursing program at Albany Community College and stopped attending classes in the early part of her first term. She became homeless with her four children and struggled with attending classes due to excessive worry over finding a place for her family to live. She had a single minded focus of finding a new home and just stopped going to classes. She also lost her insurance and medication around this time.
Description of Back-Up Case Study
Client is a 38 year old Caucasian divorced female. She was born in Texas, moved to Oregon for a short time, moved back to Texas, and then settled in Oregon with her husband and children. She has two children. Her older child lives with her and her younger child lives with her ex-husband. She was raised by her grandmother and step-grandfather. She believes this was due to her mother’s own mental illness. She has many half siblings but was raised with her one biological brother who is two years older than she is. She had a tough childhood with many moves and upheavals. Her grandmother/ adoptive mother died when she was in the first grade. She has diagnoses of Bipolar Disorder, Post Traumatic Stress Disorder, Attention Deficit Disorder, Mathematics Disorder, and Mixed Personality Disorder. She was a Certified Nursing Assistant but does not want to return to that type of work. She is currently working on obtaining her GED through Woodburn Center and has determined she would like to work with young children in a daycare setting. She has been attending her classed and struggling with math and her depression. At times when her depression symptoms are severe she has a difficult time with leaving her house. However, she has all of her GED tests done except for her math.
Statement of Purpose
I chose this client because I had worked with her in my advanced practicum and we have built up a rapport. I also think that in working with a client that has so many mental health issues will be a challenge for me. I enjoy a challenge and increasing my knowledge base, counseling skills, and abilities. I was also told that a client with mental health issues is the growing trend in this area and I felt I needed to know how to be effective at working with this type of a client in the vocational rehabilitation (VR) setting. I have always been interested in psychology and psychological issues and this is a chance for me to get some first hand experience with these issues that interest me.
My goal in working with her is to assist her in moving forward towards her stated vocational goal by providing substantial counseling and guidance. My personal goals are to increase my effectiveness as a vocational rehabilitation counselor by working with someone who has many barriers to employment, and to build up my familiarity with the different stages of the VR process. Another goal I have is to build up professional relationships with partners that will be beneficial to clients in reaching their goals.
Some of the strategies I am employing consist of listening to her through the narrative theory lens so that I can attempt to figure out what stories she tells about herself. As I understand her better believe I will be better able to guide her towards her goal and assist her in increasing her confidence to do it on her own. I am working towards assisting her in feeling more empowered. This may be difficult given her diagnosis of Dependent Personality Disorder. I am giving her manageable tasks that she can complete to help her see she can do what needs to be done on her own. I see my role as more of a coach or guide.
The specific objectives are basically empowerment and progress towards her stated goal. Another objective is getting her to utilize resources that are available to her by providing her with resource information (i.e. Disability Services). The end objective would be for her to be in a good career that meets he needs and the needs of her family.
The resources I plan to use to work with this client are collaboration with Disability Services, client staffing with my supervising counselor and others in the agency, literature that addresses career counseling with someone who has a personality disorder and mental health diagnoses, and whatever else I can pick up along the way as I am learning much about resources at this time.
Some of the tools I will be using are the theories that I have identified as compatible to my personal beliefs (i.e. Adlerian and Narrative Career Theory). Another tool I’ll be using is my active listening skills and empathetic nature as I think these are important to really understand the clients’ needs. The counseling tools that I bring with me from previous experience will be of value to me also. I am leaving myself open to pick up more tools that will increase my effectiveness as I progress with this client.
The steps that I expect to take with this client are to provide substantial counseling and guidance to ascertain whether this is truly a motivated client, or if her disabilities are the reasons for her lack of progress. If it is motivation that is lacking I will attempt to use what I have learned about Motivation Interviewing in my undergraduate work. If it is disability related I will work towards getting her set up with resources that are helpful to her. Setting her up with disability services to get services that will assist her in meeting her stated goal is the next step. I will make sure I use informed choice the whole way because this is her life and her goals. The counseling and guidance is going to be occurring throughout this process. This client will not be finished with her education by the time my internship ends, but I believe she will be back in school and have found her comfort zone by the time my internship ends. She will be able to feel empowered to finish her schooling with less counseling and guidance before my internship ends and she will have other resources in place by then.
Briefly discuss this in relation to the other diagnoses.
Cultural and Background Information.
Caucasian, married female.
Discussion of rehabilitation-related issues.
Ariga, M., Uehara, T., Takeuchi, K., Ishige, Y., Nakano, R., & Mikuni, M. (2008). Trauma exposure and posttraumatic stress disorder in delinquent female adolescents. Journal of Child Psychology and Psychiatry, 49, 79-87.
Blom, M. B. J., Spinhoven, P., Hoffman, T., Jonker, K., Hoencamp, E., Haffmans, P. M. J., & van Dyck, R. (2007). Severity and duration of depression, not personality factors, predict short term outcome in treatment of major depression. Journal of Affective Disorders, 104, 119-126.
Davis, J. L., Byrd, P., Rhudy, J. L., & Wright, D. C. (2007). Characteristics of chronic nightmares in a trauma-exposed treatment-seeking sample. Dreaming. 17, 187-198.
Fischler, G. L., & Booth, N. (1999). Vocational Impact of Psychiatric Disorders: A Guide for Rehabilitation Professionals. Gaithersburg. MD: Aspen Publishers.
Harringnton, T. & Newman, E. (2007). The psychometric utility of two self-reports measures of PTSD among women substance abusers. Addictive Behaviors, 32, 2788-27898.
Lenze, S. N., Xiong, C., & Sheline, Y. I. (2008). Childhood adversity predicts earlier onset of major depression but not reduced hippocampal volume. Psychiatric Research: Neuroimaging Section, 162, 39-49.
Meinz, R.I. (2001). Employment Counseling with Personality Disorders. Edmonds, WA, Roger I. Meinz.
Schlapfer, T. E., Cohen, M., Frick, C., Kosel, M., Brodesser, D., Axmacher, N., Joe, A. Y., Kreft, M., Lenartz, D., & Sturm, V. (2008). Deep brain stimulation to reward circuitry alleviates anhedonia in refractory major depression. Neuropsychopharmacology, 33, 368-377.
Summary Statement of Adlerian and Narrative Theories
I will be using Adlerian Theory with this client. I believe it is important to build up the rapport with the client so that I can better understand her private logic, her lifestyle, and her subjective point of view. I believe that in helping someone become gainfully employed it is important to make sure that they are the one leading the process and I just assist them in meeting their goals. Informed choice fits well with Adlerian Theory in this way. I will also attempt to figure out if she has any underlying mistaken notions by listening to her talk about her private logic and the way she sees herself and the world around her. I can help her explore these beliefs/notions and explore new ways of seeing herself in the world. Assisting her with furthering her education will also fit well with helping her develop a sense of community which is an important part of Adlerian counseling.
In using Narrative theory finding out the story she tells about the world of work could be useful in determining what barriers she may place in her own way. Her story will give me a lot of information that we can examine to see if her story is problem saturated and then we can work together to create a solution focused story that will serve her well in her new career field. There is a lot of information that can be gained in just listening to the story she tells and to see where the work needs to be done in helping her change the story.
What I hope to Learn
I hope to learn about how well my chosen theories work for me when applied to a real person with real issues. Just because the theories fit well with my ideas of the nature of people does not mean that they are applicable in all settings and situations. I want to see the applicability in using Adlerian and Narrative in the vocational setting in getting someone moving forward to an employment goal. I also hope to strengthen my skills in working with someone who has multiple issues that affect her ability to cope with the world of work.
I want to learn more about available resources and networking to help the client meet her stated goal. I also hope to learn about how the whole vocational rehabilitation process works by doing all that I can to assist her in moving forward rather than staying stuck. Most of all I want to learn what it is like to be a vocational rehabilitation counselor who must work with many issues that are barriers to the client in order to help her meet her employment goal.