Case Studies

Creating Success For Our Clients

Couple (EFT Counseling)

 

About the Couple:

 

Andy and Rachel are a couple in their late 30s who sought counseling after a recent fight ended with Rachel telling Andy that they no longer had a satisfying marriage. Their lives are full of responsibilities, not the least of which include two young children at home. Rachel also works part-time, volunteers in a church ministry, and feels exhausted each day keeping the household running. Rachel shared that she feels a mix of loneliness and anger since Andy seems more interested in other things than in spending time with her or the kids. Andy is a busy professional, having been at his new company for less than a year. He acknowledged feeling pressure about work responsibilities, admitting he can be distracted at home with thoughts about work projects. While he acknowledged feeling good about his job performance, he shared he does not feel as confident about his efforts at home. Andy complained that Rachel often criticizes his ideas about parenting strategies or how they could spend time on the weekend together as a family.

 

Treatment Approach:

 

I met with Andy and Rachel to learn more about their relationship history. For the past 18 months, they reported feeling stuck in a typical pattern where Rachel ends up criticizing Andy when she feels exhausted or alone. In response, Andy would typically argue back for a while, but has lately decided it is not worth the effort, allowing himself to get busy with emails or watching sports. I used Emotionally Focused Therapy (EFT) for the couple, with the goal of improving Andy and Rachel’s connection. Further, the couple also wanted to discover a way to communicate where they would not end up feeling “against” each other. They attended counseling once a week for their first 5 sessions, which lasted 50 minutes. We met early in the morning, so that each person would not have to leave work during the middle of the day. I began by creating an alliance with each person, validating their experiences, and facilitating a process where each person could share with the other. I also helped each person to receive the other’s sharing, not reacting based on their past, distressing pattern. As their negative interaction began to change, Andy and Rachel still wanted to grow their positive connection. They continued counseling for this purpose, yet decided to step-down to attending every 2 weeks while extending their session length to 80 minutes. Continuing with EFT, I facilitated these sessions so that Andy and Rachel could have a new emotional experience together, not merely learning information from me.

 

Outcome:

 

During our time Andy and Rachel learned how to recognize their negative, interactive pattern in which they were getting stuck as the ultimate problem. They even gave it a name, and began catching themselves whenever it arose. Now, instead of getting stuck, they could pause and find better ways to connect. Andy and Rachel were speaking for themselves, focusing on their own feelings and asking for what each person desired in a given moment, instead of accusing the other of wrong-doing, or withdrawing altogether. After 5 additional sessions, they were confident that the negative behaviors each person occasionally displayed (i.e., Rachel’s criticizing, Andy’s withdrawing) were actually a protest against their disconnection. During our time each person shared vulnerabilities with one another and asked for forgiveness regarding certain matters. Andy reported feeling more respected and accepted by his wife, and Rachel expressed greater closeness to Andy, as well as a new confidence that he does in fact want her. The couple also took a brief assessment that showed each person now viewed the other as more accessible, responsive and engaged in their relationship than before. In total, I met with Andy and Rachel for 10 sessions. At the end of our time, they shared a plan of continuing to invest in their relationship by reading a self-help book for couples, knowing they could return if they ever had difficulty again getting un-stuck.

**Names and specific case details have been changed to protect the identity of our clients**

James (PTSD)

About the Person:
James is a 32-year-old male who sought treatment services after experiencing an on-campus assault resulting in bodily injury occurring 3 months prior to the initial session. He indicated that since the time of the assault, he had experienced physical pain, nightmares related to the assault, low mood/sadness, flashbacks, an increased startle response, hypervigilance, poor concentration, avoidance of places reminding him of the assault, and loss of interest in previously enjoyed hobbies. James shared that his symptoms were interfering with his family relationships, as well as his ability to complete coursework for his Master’s program.

Treatment Approach:
I met with James for an initial interview and assessment to understand presenting concerns and symptom history. For the next several sessions, using a Cognitive Processing Therapy model, we discussed education for trauma, anxiety, and low mood, as well as coping skills to help with feelings of anxiety and distress when experiencing low mood and memories of the assault. We also worked on addressing negative thoughts surrounding the assault, replacing them with more adaptive, helpful thoughts. Once acute symptoms of distress were alleviated, we completed a scripted exposure exercise, where James wrote his narrative of the assault and negative thoughts associated with the assault. Then, we worked together to rewrite the narrative to address unhelpful thoughts and beliefs, and to include statements of hope and resilience. James then read his script aloud both in and out of session, exposing himself to the memories of the assault.

Outcome:
Within four sessions, James reported a significant decrease in trauma symptoms (e.g., flashbacks, hypervigilance, nightmares), as well as improved mood. After a total of twelve sessions, James was no longer experiencing distressing symptoms, reporting improved relationships with family and friends and regaining his ability to concentrate and complete coursework. He continued to attend check-ins for several months, and also continued to practice coping skills and challenging unhelpful thoughts outside of sessions.

**Names and specific case details have been changed to protect the identity of our clients**

Jane (Social Anxiety)

About the Person:
Jane is a 15-year-old female who presents with nervousness in social situations, stress related to volleyball, and conflict with her mom. Jane has many friends and prefers spending time with her close friends rather than being at home. Being in large groups of people is overwhelming to her. Jane says her parents are very strict and worry about her too much. Jane makes excellent grades but reports feeling a lot of pressure from her parents academically and in sports. Mom shared that she has noticed perfectionist tendencies on the volleyball court and in academics.

Treatment Approach:
I met with Jane’s parents for an initial assessment to learn about presenting concerns. I then met with Jane to get to know her better. We talked about anxiety and what treatment would be like. We discussed many coping skills to help her feel calmer during situations that typically trigger her anxiety and worry. We also practiced many of these skills together in session. We identified Jane’s negative, irrational thoughts and worked together to challenge them. We replaced negative thinking patterns with positive, rational thoughts using a Cognitive Behavioral Therapy approach. I also asked Jane’s parents to come in for a few sessions to talk about ways they could support their daughter and respond more appropriately when Jane gets anxious and after volleyball matches.

Outcome:
After around six individual sessions, Jane reported feeling significantly less anxious in social situations and during tests at school. Parents reported that she seemed more confident on the volleyball court and was enjoying the game more. Jane and her mom were having fewer arguments each week and both mom and dad were giving Jane time to reflect after volleyball games rather than analyzing her performance on the way home. I encouraged Jane to continue practicing and using coping skills on a regular basis. Due to her progress, she transitioned from weekly sessions to biweekly sessions for two months. During a check-in session a month later, Jane and her parents reported continued progress socially, academically, athletically, and within the family system.

**Names and specific case details have been changed to protect the identity of our clients**

Kelly (Depression)

About the Person:
Kelly is a 28-year-old female who presented with increased feelings of sadness, lack of motivation, and anxiety related to recently ending her relationship with her fiancé. Kelly’s parents divorced when she was 18 and her dad has remarried. She is an only child but has many close friends from college. Both her mom and some of her friends have expressed concern because Kelly prefers staying at home by herself than spending time with friends and participating in activities that she used to enjoy. Kelly has also been told that she is becoming increasingly irritable and easily frustrated. Kelly works part-time as a paralegal and reports that work is incredibly stressful and finances are tight.

Treatment Approach:
I met with Kelly for an initial assessment to learn about presenting concerns and to get to know her. We talked about her recent break-up, divorce, anxiety, and depression and how long these symptoms have been present in her life. We discussed what the treatment process would look like and her specific goals. One of Kelly’s goals was to talk about her parents’ divorce, a topic she had never explored and processed with anyone other than her fiancé. We discussed coping skills to use during periods of stress, anxiety, and sadness. Kelly practiced these in session and on her own at home as well. I educated Kelly on Cognitive Behavioral Therapy and helped her identify negative thoughts that were contributing to unwanted feelings and the evidence supporting or against such thoughts. We also worked together to change these thoughts to more encouraging, positive thoughts.

Outcome:
After 6 weekly individual sessions, Kelly reported feeling less anxious and more confident in all areas of her life. She began spending more time with her friends and going out to dinner on Friday nights became a regular occurrence again. She started volunteering at a local non-profit and met new friends there as well. Kelly continued using coping skills and challenging irrational thoughts. Kelly and I transitioned to meeting biweekly for four additional sessions and then checking-in once a month. She continues to make progress and has reported feeling very little anxiety even around her ex-fiancé, who shares mutual friends with her. Three months after the initial session, Kelly decided to change jobs and reported that her overall stress decreased significantly.

**Names and specific case details have been changed to protect the identity of our clients**

Mark (Male Behavior Problems)

About the Person:
Mark is an eight-year-old male whose family sought treatment services due to a number of disruptive and defiant behaviors occurring both at home and school. Mark displayed anger outbursts, refusal to follow rules at home or school, defiance of parent or teacher requests, aggression (physical and verbal), and yelling and screaming. At school, he frequently disrupts the classroom, resulting in being sent to the office and having his parents called. At home, he resists his parents’ attempts to discipline, and is often aggressive towards his younger brother and sister. Mark has frequent anger outbursts, where he hits, kicks, screams, and destroys the belongings of others.

Treatment Approach:
I met with Mark’s parents for an initial assessment/intake to understand presenting concerns. I met with Mark’s parents for several weeks to provide education about disruptive behaviors, as well as basic behavioral management strategies to help control Mark’s behaviors. I also helped create a reward and consequence system for home and school, as well as helped Mark’s school restructure expectations to manage his behavior. I then met with Mark, discussing education for anger and frustration. We also practiced specific techniques to help with feelings of anger, as well as practiced expressing emotions and feelings in a healthy way.

Outcome:
Within six sessions, Mark’s parents reported a decrease in disruptive behaviors at home and school. He no longer was sent to the office daily, and looked forward to earning rewards for good behaviors. Further, Mark’s parents indicated that he was successfully able to identify his emotions and use skills to calm himself when he felt upset. They also shared that Mark was teaching friends and siblings ways of calming themselves when they became angry, and would remind family members to use techniques and to share how they feel on a regular basis.

**Names and specific case details have been changed to protect the identity of our clients**

Michael (Substance Abuse)

About the Person / Family:
Michael is a 16-year-old male whose family sought counseling after discovering text messages about him using marijuana and drinking with his friends. Upon questioning him, his parents stated he melted-down, to the point where Michael began to shouting how no one in this family understands him, and made remarks about wishing he no longer lived there. Though his parents had noticed Michael being somewhat more irritable and withdrawn lately, they reported thinking his experience was normal for teenage behavior.

Treatment Approach:
I met with Michael’s parents first to gain a good understanding of their family dynamics, including Michael’s own emotional and behavioral history. I then met with Michael to hear his perspective. In addition to occasional use of marijuana and alcohol, Michael also reported experiencing several depressive symptoms such as increased irritability, decreased energy, difficulty sleeping, loss of interest in pleasurable activities. I met with Michael to develop and enhance his own motivation for positive change in his life. Using Motivational Interviewing, as well as strategies from Cognitive-Behavioral therapy, we developed skills he could use during moments of frustration, such as a brief exercise regimen, playing the drums, utilizing relaxation techniques, or going outside to shoot basketball. Further, we also scheduled positive, pleasurable activities such as participating on the cross-country team, resuming music lessons and participating in his church’s youth activities. Throughout my sessions with Michael I offered education about marijuana and alcohol use. Though I primarily met individually with Michael, his parents also came separately for consultation appointments to learn effective ways of supporting Michael to maintain motivation towards his goals, while also providing healthy boundaries around marijuana and alcohol use.

Outcome:
After six sessions together, Michael reported his mood had become more positive, and also acknowledged feeling more energized. While still having occasional sleep difficulties, Michael acknowledged his relaxation techniques now help him fall asleep. He still seemed mixed in his attitude about marijuana, making claims that it is not a big deal since he believed it would be legal in a few years anyways. However, he ultimately reported that he had come to value the freedom and privileges his parents provide him as more important to him than occasional substance use. Michael’s parents also reported that he has been more pleasant to be around at home, and their arguments had significantly decreased in frequency. Michael also acknowledged that several friendships had deepened since joining the cross-country team, and he states he is more comfortable around people and enjoying life again like he once had. Michael then stepped-down to coming every other week, and in total came for 10 sessions. His parents attended a total of 3 consultation meetings overall, and they reported feeling more confident in establishing and maintaining healthy boundaries with Michael. They also identified ways to improve their connection with Michael, by scheduling occasional family activities on the weekends such as hiking or camping trips.

**Names and specific case details have been changed to protect the identity of our clients**

Sarah (Choking Fear)

About the Person:
Sarah is a ten-year-old female whose family sought treatment services due to the development of significant food selectivity and a fear of choking related to a choking incident that occurred two weeks prior to the initial session. The family indicated that Sarah had choked on a hot dog while at a picnic and required the Heimlich maneuver. Since that time, she had refused to eat most solid foods, choosing only yogurt, soup, and smoothies and she had lost approximately five to eight pounds. She experienced many physical symptoms of anxiety surrounding mealtime including stomach aches, headaches, fast heartbeat, and difficulty breathing.

Treatment Approach:
I met with Sarah’s parents for in initial assessment or intake to understand presenting concerns. I then met with Sarah. We discussed education for anxiety and fear as well as the mechanics of swallowing, our body’s protectiveness, and the Heimlich maneuver. We also made a list of easy, medium, and hard foods to eat, and discussed several specific coping skills to help with feelings of anxiousness during mealtime. We practiced chewing and swallowing using designed “games” for exposure activities in session at first and then at home.

Outcome:
Within five sessions, Sarah was eating normally, gaining weight, and able to resume everyday activities. She no longer feared mealtime, and her parents reported that she seemed happier and better adjusted at home, at school, and with friends. She continued to attend check-ins for a couple of months and continued to practice at home, especially for more difficult foods.

**Names and specific case details have been changed to protect the identity of our clients**

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