Case Conceptualization

Case Conceptualization

Key concepts

Social interest, holism, lifestyle, directionality, equality, inferiority feelings, family birth order

Key Practices

Engagement, Assessment, Insight, and reorientation

Theoretical Understanding

Core concerns of the client

The client Jessica has a diagnosed bipolar disease case, but the impacts of the symptoms have shifted in the last few years. The major concern arises with her being in denial of her condition. Jessica is opposed to having a problem and even points at her mother as the one to blame her condition. This denial then causes her to blame others since she is convinced that she is alright.  It is also the cause of Jessica’s vulnerability in that she feels that everyone is against her because of her disorder.  Apparently, she has developed defense mechanisms based on her condition, on why all her siblings are adorable, except for her.  On the same note, Jessica will not acknowledge even when her behavior gets out of control, a factor that can explain her erratic behavior and hesitation to seek care. As a result of this denial, she is constantly fighting the disorder’s symptoms, as evidenced by her discomfort, fidgeting, and restlessness during the interview.

The client also has general incidences of mood changes upon which she becomes negative about everything.  In such moments, her behavior is generally unpredictable.  Furthermore, Jessica has anger issues, especially when her moods are low.  As narrated by the informants, when Jessica is upset about anything, she gets angry at the slightest provocation. During such times, she displays an outburst and goes beyond control, threatening to harm anyone around.  Due to the symptoms, she will fail to look beyond her disorder and suffers delusions that she has to protect herself because she feels that everyone is against her. When her behavior spirals out of control, Jessica suffers acute anger issues and severe depressive symptoms evidenced by her desire to remain alone.  Another core issue is her inner fear that she will end up alone in her life because no one will tolerate her behavior. Notably, her unfounded fears have negatively impacted her relationships. The concern is that once she goes out of control, she may cause harm to others around her.

Development of concerns

It is worth noting that Jessica is timid and with a desirable character until the symptoms of her disorder arise. Her disorder developed gradually, whereupon, she started demonstrating signs such as self-isolation and the desire to be left alone in her room or closet for long periods of time.  This behavior then intensified and became more pronounced in middle school.  The family did not report any attempts to diagnose the onset of these symptoms, which may account for the gradual development of her keeping her problems to herself.h Besides, Jessica develops a habit of keeping to herself, without sharing her problems since middle school.  It can be inferred that the client’s condition gradually worsened with time, especially there being no signs of attempted controls. Furthermore, her anger issues can be traced back to her father, who reportedly has never sought care from a professional; thus, the interplay between genetic factors and acting out modeled her behavior to the present state.

Resolving the concerns

In light of the identified client core concerns, a therapy tailored to address both the clients’ behavioral and cognitive aspects should be relevant in modeling her behavior and helping her fit in the social context.  Therefore, a productive therapy would be inclined to talk the client out of denial and thus embrace their condition. Meanwhile, in addressing the identified core concerns, an interactive therapy would be effective in reaching out to both the client and the parents; the client would acknowledge their condition and thus help the family understand the struggle they undergo.  Besides, this would play a part in controlling the clients’ anger symptoms, which accounts for the risk of hurting others. Notably, this therapy would best suit pharmacologic treatment to prevent the risk of the client’s remission and eliminate chances of recurrence.

Theoretical Practices

Therapy goals

Adlerian therapy is an objective, goal-oriented therapy that focuses on the individual’s feelings in their immediate social context (Osborn, 2001).  This theory would apply to the client, given that most of her core concerns affect her relationship and constitute her major fear of remaining forever alone.  The therapy’s first goal would be assisting the client and the family members to understand the nature of relationships among them. When in bad moods, the client reveals her disconnection with the rest of the siblings whom she feels are unique and adored in the family setting. In this sense, she reveals the poor connection existing between the family members, which may explain the depression and the client’s need for self-isolation. The therapist should assist the family nurture a strong connection amongst themselves to cultivate a feeling of belonging to a community within the client. Furthermore, the therapists will help the client develop an interest in the family, thus gradually readjusting the mistaken beliefs of not being loved.

Next, the therapist will guide the client in gaining insight into the origins of the inferiority feelings.  Adlerian therapists believe that inferiority feelings arise as a result of fault subjective evaluation (Osborn, 2001).  In this case, the client’s feelings of self-inadequacy and fear that the fear of ending up alone in her life can be addressed by guiding her to speak out about her problems and issues faced in the past.  The therapist will also encourage the client to acknowledge all factors she may dislike in her life and thus explain the inner anger and the hesitation to ask for help during bad days.

The third goal would be coaching the client on handling life tasks (education, relationships, and work) without putting the others at risk of harm.  This would be a long term goal but whose achievement would be the ultimate breakthrough into fostering the client’s well-being.  It could be guided by a question on how the client’s life would be different if they were well, to assess the client’s avoidance of certain tasks. In this way, the therapist would help the client approach their social life and tasks while improving their disorder’s embracement.

Therapist Roles and Stance

The Adlerian therapist would take various stances during the course of the therapy. The counselor’s main role, in this case, would be to encourage the client and the family to embrace the disorder and learn to live with its shortcomings.  As an educator, the therapist would enlighten both the family and the client on the challenges and various dynamics of the bipolar disorder (Sweeney, 2009). They will also serve an advisory role by teaching the families and the patients on how to react to different circumstances on the course of the treatment, for instance, advising the client to speak out when she feels like not thinking straight and the family members to note when her speech starts getting louder and faster.  Moreover, the therapist takes a coaching stance, in that they guide the clients on how to take onto their daily roles gradually without affecting others’ wellbeing.  They will also coach the client on how to navigate through their feelings of inferiority when compromised by bad moods and anger management techniques.  Finally, the therapist takes the coordinator’s stance, meaning that they will help the family and the client solve their problems and communicate appropriately to prevent misunderstandings due to communication breakdown.  Therapists, in this case, would teach and role-play on brainstorming on a problem without making the client feel inferior or locked out.

Culturally Responsive Approaches in Therapy

When dealing with the client, the therapist needs to implement culturally responsive measures to fully involve the client and the family on the wellness journey.  One such method is by including openness to address any experiences of racism or discrimination in any stage of their lives. Racism continues to be a salient feature of African Americans whose daily experiences with macroaggressions greatly impact their psychological functioning (Jones, Huey & Rubenson, 2018).  Encouraging the client and the parents to discuss racism openly will open doors to address possible causes of the client’s acting out behavior.

Also, striving to achieve a positive racial identity is valuable when working with African Americans (Jones, Huey & Rubenson, 2018). Furthermore, endorsing the development of a positive self-identity would help the client develop high self-esteem, which has, in the past, been found to light up her moods, improving her psychological well-being and academic achievement upon joining College. Lastly, integrating a greater level of spirituality and religion would be a significant step in forging a working relationship with the family, especially the grandmother, who blends well with the client.  This would also help the family look past the belief that the client’s behavior is carried away further and focus on moderating this behavior.

Reflective Practitioner

What draws me to the Adlerian Theory

The rationale for choosing this theory is that it is goal-oriented and places the patients and their relationships at the core of practice.  This theory views a mentally ill individual as a discouraged person and focuses on their daily strive to succeed and connect with others (Sweeney, 2009).  In this case, this theory would be effective in evaluating the daily efforts of the clients in connecting with the family members and the others, although she feels like everyone hates her. The theory also digs into the inferiority feelings, which often overwhelms a client and causes mood swings. This theory is also impressive in that the therapist is purposed to coordinate and coach a client into handling their daily tasks, relationships, and work.  This makes the theory best suited in this case.

What Challenges Me about the theory

However, this theory is problematic in its reliance on a person’s memories, which they may be willing to explore.  For example, in Jessica’s case, she might not be willing to explore her childhood past and times when her father did not make it up to her as she would have desired.  Besides, the technique proposed by this theory may rule out individuals with low verbal intelligence and may take time to achieve an intended result.

What I can Take forward

It would be useful in research on the use of the Adlerian technique on bipolar patients can establish practical activities that could allow a patient to reduce the reliance on medication to counter the impact of bipolar disorder. future research also need to answer the short term strategies of improving patient experiences, especially those with acute symptoms of anger, depressions, and mood swings such as the client in question

Treatment Plan

Client’s Name: Jessica

Presenting Concerns

1. Acute incidence of anger and risk of harming others
2. Denial of her condition
3. Fear of remaining alone for the rest of her life

Plain Language Goals for this client

References

Jones, E., Huey, S. J., & Rubenson, M. (2018). Cultural competence in therapy with African Americans. Cultural Competence in Applied Psychology (pp. 557-573). Springer, Cham.

Osborn, C. J. (2001). A visual encapsulation of Adlerian theory: A tool for teaching and learning. The Journal of Humanistic Counseling, Education and Development, 40(2), 243-249.

Sweeney, T. J. (2009). Adlerian counseling and psychotherapy: A practitioner’s approach. Taylor & Francis.

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