LASA 1 – Applying Theory to a Case Study
Assignment 2: LASA 1 – Applying Theory to a Case Study
Select one of the two available video clips to the right.
The video will begin playing immediately.
Pause the video and notice under the Clips heading to the right, either you will see the “Case Study of Carol (30:38) or Case Study of Paul (26:40) depending on which video you have selected.
Move the video play head to the timestamp of the video. This will be the number in parentheses.
Watch the Case Study
Choose one of the following theories and use your chosen theory and chosen video clip to complete all of the questions in this assignment.
Watch the video clip of a supervisor and therapist discussing the case you have selected. The information from the video will supplement the information in the write-up.
Assess the client being described in the video and that client’s related issues using the questions provided.
Using only one case study and one counseling theory throughout your paper, provide a detailed response to each of the following questions. For example, if you chose Carol and Psychoanalytic Theory, you would answer all of the following questions about Carol using the psychoanalytic theory.
Based upon all that you know about your client, identify and describe what in your opinion is your client’s most significant problem? This may or may not be the stated “Reason for referral” that is written at the start of each profile. Give a detailed rationale for your assessment and provide supporting evidence from the profile and/or counseling session video clip.
Identify at least two secondary problems from the client’s profile or video that should be addressed at some point in the counseling process. Explain your rationale in some detail for choosing each of these with supporting evidence from the written profile and/or the video.
Using your chosen counseling theory, describe what your theory says about the possible cause or origin of the primary problem discussed in question 1 above. Here, you are trying to explain the assumptions your chosen theory makes about problems that might be seen in a counseling situation. For example if you assessed your client’s primary problem as low self-esteem, a psychoanalytic therapist would delve into the unconscious whereas an Adlerian would explore family history and a reality therapist would look at choices the person has previously made. Explain in detail by including concepts and terms from your chosen counseling theory to support your perspective.
Explain at least three counseling techniques or core principles from your chosen counseling theory that could be used to address the primary and secondary problems of your client. Explain how each of these techniques or principles would be applied in the counseling session and the expected outcome of each.
Given what you know about your client’s situation, identify one cultural issue that is significant in the client’s life outside of therapy or could become an issue between the client and therapist in the therapy session. After explaining the issue, explain two ways the therapist could sensitively address this cultural issue with the client in a way that that avoids stereotyping or bias. Remember to integrate your chosen theory into the discussion.
If you were to see this client on an ongoing basis, describe the types of change or outcomes you could realistically expect to see in your client, in light of the primary and secondary problems mentioned earlier using your identified approach in therapy. Be specific and show how the process of therapy with this counseling approach would lead to the outcomes you discuss.
Your paper should be double-spaced and in 12 point, Times New Roman font with normal one-inch margins, written in APA style, and free of typographical and grammatical errors. It should include a title page with a running head, an abstract and a reference page. The body of the paper should be 6 – 8 pages in length
ARNOLD LAZARUS Hi, I’m Arnold Lazarus, and I was asked to meet with these three people to do a case supervision live. Now, I have no idea what to expect. These cases are brand new to me, and they have a very short time to really fill us in with regard to the problems, but the idea would be, can I then be helpful? Is there anything that I can say that will make some sense to them, that willenable them to make progress with their cases? And we’ll then have group interaction. We’ll talk among ourselves and just see what comes out of the ferment. So, that’s basically what it will be all about, and I think we start with Jurgen, who’s gonna present acase, and I’m all ears.
00:40JURGEN BRAUNGARDT Okay, I present a woman who is 38 years old. I’ve see her for about three years now. Her name isCarol, and she came originally because she had ah, panic attacks,and she was in a really bad relationship. Uhm, so she is not married, but she was in a relationship. She has two kids , seven and four years old. Ah, they live in a house to, altogether, and their initial problems were ah, about this relationship, which was really terrible. The man was unreliable and ah, so it took us awhile to figure out what happened, and in the course of the treatment ah, she ended up separating from him. This happened this, this summer. So uhm, and they also had a lot of financial problems as a result of the relationship problems, so now she’s going back to uhm, find a job or find some ways to support herself. She has a lot of financial pressure. Uhm, she’s, she comes from a background where both of her parents were alcoholic. Ah, she behaves like theparent to her, to her own parents a lot, so she’s sort of obsessive compulsive in many ways, uhm, and plagued by anxiety and guilt. So, sometimes she flushes. Ah, she’s very articulate when she speaks. Uhm, she comes very regularly to therapy. She seems to move along pretty well in the, in the therapy process. And there has been many changes since she came to me. And now, recently we shifted more to one, still sort of stabilizing the situation in terms of making money and finding a, a professional identify for her. And then a lot more problems came up recently with her siblings. She has two sisters and one brother , and they also have alcoholism problems. So she gets into frequent fights with them uhm, which is a source of great ah, you know, anger and concern for her. So, she would like to help her, her siblings. So we’re working on this, on several issues at the same time. One is this, you know, family relations she has. Her father is still alive. Her relationship to herfather is also problematic. He ah, she becomes more and more hiscaretaker. The mother is dead, she drank herself, essentially it was a sort of, she drank herself to death, and ah, my client, Carol, witnessed it. So, that’s essentially the trauma for her.
03:20ARNOLD LAZARUS Typically when students come to me for supervision, they present specific issues with which they require some help or clarification. Instead, Jurgen presented a loose-case narrative from which I had to try to identify central problems that called for targeted interventions.
03:40ARNOLD LAZARUS Now what I didn’t get was whether or not she also has problems with alcohol.
03:45JURGEN BRAUNGARDT No, she never touches anything. No.
ARNOLD LAZARUS Okay. And you said that you have made some progress with her?
03:50JURGEN BRAUNGARDT Yes.
ARNOLD LAZARUS And so where have you been most helpful thus far?
03:55JURGEN BRAUNGARDT I think I helped her to ah, to get out of this relationship really smoothly. Ah, uhm, I helped her stabilize her anxiety to some degree. Although she still has some. And, and I helped her to understand some of her own guilt in relation to the things she does, which is mostly unconscious. So, I mean, she’sdoing things to other people and she thinks it’s right, but she’s actually ah, domineering oftentimes with them, and then disappointed if they don’t respond.
04:30ARNOLD LAZARUS And you’ve brought this to her attention?
JURGEN BRAUNGARDT Yes, frequently.
ARNOLD LAZARUS Uh-huh.
JURGEN BRAUNGARDT So we will(ph) work through these events that happen in her life.
04:35ARNOLD LAZARUS Okay.
JURGEN BRAUNGARDT So uhm, and in the course of the therapy, mostly is she comes once a week. Ah, she presents material. A lot of things happen from week to week, so we work through some of that, and then I always tie it back to some of my basic ah, themes I have, like her guilt, her aggression, and so on and so forth.
04:55ARNOLD LAZARUS Uh hmm. So you’ve got to put out fires, as they say, every week.
05:00JURGEN BRAUNGARDT Yes.
ARNOLD LAZARUS And then you head back to some of thebasics.
05:05JURGEN BRAUNGARDT Yes, yes, right.
ARNOLD LAZARUS At this juncture, I decided to try to focus the scope of our supervision.
ARNOLD LAZARUS So, is she somebody, then, that isn’t in goodcontrol of managing these things? Of course, the little bit you’ve told me makes me feel that the thing that I would want to accomplish in you must feel free to correct me if you think I’m offbase,- (crosstalk)
05:25JURGEN BRAUNGARDT Uh-huh.
ARNOLD LAZARUS – is to get her to prioritize, where it seems to me that these familial relationships outside of her nuclear family are not as important. I mean the sisters and whoever else- (crosstalk)
05:35JURGEN BRAUNGARDT Uh-huh.
ARNOLD LAZARUS – is battling with her, is of secondary importance compared to her job, as you say, as a primary goal, that I would make these goals very clear and be on the same page. Do you feel you’ve done that with her?
05:50JURGEN BRAUNGARDT I think you’re right. I think ah, to priorit, to, to prioritize the problem for her ah, sometimes it is difficult. Maybe I don’t do it enough. Sometimes it’s difficult to bring her back, to say to her, “You know, what about your job search?” And ah, she wants to be a, a writer, which is sort of be an independent businesswoman, an editor, and that’s not so easy to find enoughincome from that, and clients, so, but she does work. She has some success in that field. She has some clients now. But it’s probably not enough to help her at this point, support herself financially.
06:25ARNOLD LAZARUS You see, what, what I’m thinking is that you’ve presented a case where there are a wide range of interactive problems, and that if we do not prioritize, we can keep going all over the map and chasing tails all the time. So that I often tend to be very clear with the prioritization, and say to somebody, “Look, I know if this is all we do, you’re gonna be unhappy, ‘coz you’re gonna feel that I’m not looking at you as a complete person. So let’s divide our session up. Let’s spend no more than 20 minutes on other issues of the week, and then here are our three priorities that we’re going to zoom in on.” And keep hammering at those things and working out on how to achieve these things.
07:10JURGEN BRAUNGARDT Uh hmm.
ARNOLD LAZARUS And then we can move on to the next. I mean, that’s sort of a, of a theme. How does that sit with you?
07:15JURGEN BRAUNGARDT Well, it sounds a little bit too rigid ah, in terms of dividing the session into three ah, or something like that. Ah, but I think the general tendency, I think, is right, that I probably need to do some more focusing on the main task at this point. But the other thing is, I don’t really, I think she, she struggles with anxiety, so whenever she, I mean, she does certain things, just recently, she had ah, she submitted a proposal to some company, and ah, she came to me shortly afterwards, and she was in panic about it. She said it was so bad she couldn’t finish it. She said, “They will fire me immediately.” But the result was, they actually didn’t. They liked it, and it needed more improvement. And so, she struggles with anxiety in relation to those things. So, then we end up talking about this and ah, not so much about how to actually proceed with her ah, ah, job search.
08:15ARNOLD LAZARUS Okay, now, on the issue of rigidity, it’s an important point that you raised there. When I speak about dividing it up, I don’t mean that this is it, and boy, the bell goes off now, stop mid-sentence, let’s go back to the next one. That’s not the idea.
08:30JURGEN BRAUNGARDT Yeah.
ARNOLD LAZARUS The idea is to try and have a, a format that you can adhere to, because otherwise you’re gonna keep, I think, spinning around, as I was saying. But there are times when you have to abandon all plans because something significant has come up, and that requires your full attention. So flexibility,- (crosstalk)
08:45JURGEN BRAUNGARDT Uh-huh.
ARNOLD LAZARUS – within a kind of a prescribed format, if you see what I’m saying, is how I like to operate. I’m, I’m always pushing for flexibility, so it was interesting to hear you say rigidity,but I can see why, because talking about divisions in that fashion, you’d say, “What is this guy doing? Is he setting up rigid ideas.” Twenty minutes are up. But, why are you still talking about that?,- (crosstalk)
09:10JURGEN BRAUNGARDT (Laughing)
ARNOLD LAZARUS – if I’m looking through the one-way mirror. “He should have moved on by now.” It doesn’t work that way.
JURGEN BRAUNGARDT Uh hmm.
ARNOLD LAZARUS But it often is good to say to the person, “Let’s have a focus. Because if we don’t have a focus, we’re not gonna really resolve these things too easily.”
09:20ARNOLD LAZARUS I found it rather amusing when Jurgen suggested that my recommendation sounded too rigid. In fact, one of my major points of emphasis throughout my entire career has been on flexibility. Much of the artistry or effect of psychotherapy is to maintain a flexible approach while focusing on the therapy in a goal-oriented, problem solving direction. However, I’m glad Jurgen spoke up about his perceptions of what I’d recommended. Good consultation requires an open dialogue between supervisor and supervisee and both need to feel free to disagree and raise questions. Jurgen gave me a chance to clarify what I meant.
10:10JURGEN BRAUNGARDT Well, I think the focus for me is in some ways to ah, her ah, self, her lack of self-esteem. She doesn’t trust herself. I think she’s a very good writer and she will be very successful ah, but she, she doesn’t really believe it, and it’s, it’s this anxiety in her which frequently just simply floods her. So uhm,and I keep repeating in from situation to situation, “Look, you didthat. It worked. You know, you can, if you can do this, you could do the next.” And ah, and I think she did makes, I mean, when she got out of this relationship a year ago, she had no job, no pros, no future, no hope that she could, she said, “I’m a housewife,” you know. Now she actually makes some money.
10:55ARNOLD LAZARUS Well, I found it interesting that she was panicking that this submission or proposal or whatever was soawful that she could get fired, and it wasn’t the case.
11:05JURGEN BRAUNGARDT Right. Exactly.
ARNOLD LAZARUS And of course, one could draw on that, but the point that I’m wondering about is the following: I find it very difficult to get people to change their minds, if you know what I mean to.
11:15JURGEN BRAUNGARDT Yeah.
ARNOLD LAZARUS To convince them, “Hey look, look at your history. You’re overreacting.” That’s very tough. Some like this in one ear and out the other. So what I do instead is I say, “Okay, let’s take the worst case scenario.
11:30JURGEN BRAUNGARDT Uh hmm.
ARNOLD LAZARUS Let’s just say you’re right, and you’re gonna get fired.
JURGEN BRAUNGARDT Uh hmm.
ARNOLD LAZARUS And let’s work through that scenario. How are you gonna cope?” So we get into a coping strategy, and so the therapy is not focused on reassuring her as much as it is in giving her, you might say, a way out if the fires do break out, so to speak.I mean, how does that sit with you?
11:50JURGEN BRAUNGARDT Well, that sounds, that sounds good. I think I’d, I never really went down that route with her because her anxiety is very deep, and it’s like about the death of her mother . I mean, these are really spiraling down into an abyss,- (crosstalk)
12:05ARNOLD LAZARUS Uh-huh. Uh-huh.
JURGEN BRAUNGARDT – these feelings that she has,- (crosstalk)
12:10ARNOLD LAZARUS Uh-huh.
JURGEN BRAUNGARDT – and really had, I mean, so I don’t want to evoke more of it to ah, somehow play with that fire.
12:15ARNOLD LAZARUS Although, let me ask you another question here, of something that I find useful. You’re not mentioning something that was highly traumatic, and this was the demise of her mother that produces still to this day great- (crosstalk)
12:25JURGEN BRAUNGARDT I could.
ARNOLD LAZARUS – abyss-like anxiety, right?
12:30JURGEN BRAUNGARDT Yeah, right.
ARNOLD LAZARUS Now, I often will say to people, “You areresponding to this job thing as though that’s one and the same as your biggest anxiety, whereas, is it? Like I, I’ve, I’ve often said to people in this day and age, “On a scale of zero to a hundred, if a hundred is you’ve lost your loved ones in the World Trade Center,- (crosstalk)
12:50JURGEN BRAUNGARDT Uh-huh.
ARNOLD LAZARUS – you know, you had three loved ones who were working there on that dreadful day and that’s, that, that they are gone; that’s a hundred, tell me what is the figure for what you are complaining about now. Is it a hundred? Is it ninety? Is it eighty?” And very often the person will say, “Well, I guess that’s a, a thirty-one.” I say, “Okay, that, that’s pretty close. Well, let’s, let’s deal with it at thirty-one, not as a hundred.” And, and that becomes quite useful to the client to use as a barometer quite often. Would that, would that sit okay with you and her, do you think?
13:25ARNOLD LAZARUS I became aware that Jurgen’s thinking was more psychodynamic than I’m comfortable with, and at this point I decided to provide specific techniques that could be immediately introduced into the therapy. Actually, psychodynamic thinkers may argue that Jurgen was not really going deep enough into certain psychodynamic themes. Rather, he skirted around some of the tougher issues such as trauma and his client’s main fears and anxieties.
13:55JURGEN BRAUNGARDT I think that’s, that would work fine ah, for her to sort of learn to scale her own anxiety somehow. To bring more consciousness to it; to ah, understand it better. I think this would be helpful. Uhm, there is sort of a magnetic impact of the stories she has, she has this little. For example, little, as a little girl she was driving five years old or so, next to her mother who was drunk, you know, on a highway. And so, she was and this, her younger siblings in the back of the car. And so she describes these situations where she’s really focused on her mother’s driving, to stop it if there were an accident. And this same anxiety in some ways still fully operational in her.
14:40ARNOLD LAZARUS It is interesting, isn’t it? I mean, this poor lady has had a tough time, and the things that evoke anxiety were not just “neurotic,” in the sense of overreacting. These were very real events.
14:55JURGEN BRAUNGARDT Yes, and there are many, and there are many of those. Yeah.
ARNOLD LAZARUS Now, she’s faced real events. And, and thesethings do stick. I mean, it’s very tough to shake them off. I’ve often been asked by people, what do you think is gonna happen when someone’s seen a tremendous, traumatic event and lived through it? And my answer is, “It’s with them for life.” I don’t, I challenge any therapist, anybody, to remove it entirely. It cannot be done. But then it is living and coping as best we can, and I think of it in her case. But what she may be doing is not guarding against opening this floodgate where it doesn’t belong. It’s like, ” Boy, you’ve been through hell there, and you’re tying this thing now to that thing,” which you may or may not be aware of and I’m pointing that out and getting her, see, I like to give people kind of tricks of the trade,- (crosstalk)
15:40JURGEN BRAUNGARDT Yes.
ARNOLD LAZARUS – little things that they can use to safeguard against these things. It’s like saying insight is not enough. Even if the person finally gains insight into the fact that they are doing this overreaction pattern. Well so, but now what can we do about that? When you do the overreaction pattern, maybe you can, like, use the World Trade Center. You can use a number, or you can have a mantra, where you’ll be saying something like, “It’s not the same, it’s not the same, it’s not the same.”
16:10JURGEN BRAUNGARDT Yes.
ARNOLD LAZARUS What we’re, little tricks of the trade, you follow? And giving them these kind of weapons to use against what is often very devastating. So, where I to be working with you regularly, or come in as a co-therapist with you on her permission, I, I might be looking to hand out these particular elements while I would leave the more basic dynamics to you to, to cope with, which you do very well.
16:30JURGEN BRAUNGARDT Uhm, well, I think, ah, I did part of that, what you suggest ah, mostly in terms of, like, finding ways for her to contain her anxiety, like through yoga, through walks in the park, and so on and so forth.
16:45ARNOLD LAZARUS Right.
JURGEN BRAUNGARDT And that actually has worked pretty well for her, so nowadays, when it gets too much, she simply walks out and, and goes for a walk herself. So, and the, the yoga had, had helped her a lot. So, she is relatively resourceful in terms of finding some of the things to stabilize herself.
17:05ARNOLD LAZARUS Antidotes.
JURGEN BRAUNGARDT Yes.
ARNOLD LAZARUS Yeah.
JURGEN BRAUNGARDT Yes.
ARNOLD LAZARUS Good.
JURGEN BRAUNGARDT It did, it did.
ARNOLD LAZARUS Yes, I was about to ask what specific things have been done to try to attenuate the anxiety. And some people, of course, nothing works for everybody, as we all know. Some people respond so well to imagery, if they are image, good at imaging, and they picture scenes that are very calm, serene and other people hate that. You know, Yoga is great for some. Walking, exercise terrific. Any combinations thereof. Straightforward relaxation methods. These things are often very, very helpful asadjuncts. So, but I’m hearing that this has already been done.
17:40JURGEN BRAUNGARDT And she has, and there’s another thing which I find interesting is puzzling to me, actually. She has a verykeen ah, sense of awareness sometimes. She can walk through nature and she sees the, the colors, the green, the sunshine, and she can describe it with such a vivid uhm, precision. It puzzles me. I mean, It’s like as if she experienced in a very immediate way, in a very strong way, and mostly it’s in relation to nature.
18:10ARNOLD LAZARUS I see. So, so, she’s got strong imagery.
18:15ARNOLD LAZARUS At this point, I thought it was important to provide a sense of my orientation so that there would be a better understanding of where my suggestions are coming from.
18:25ARNOLD LAZARUS I haven’t got time to give you the essence of my orientation,- (crosstalk)
18:30JURGEN BRAUNGARDT Uh-huh.
ARNOLD LAZARUS – but my orientation looks for that kind of a, of a fulcrum and lever, so as to speak, and if somebody is good at imagery, I use that. I’ll zoom into imagery. And what do I mean by that is it’s like saying, “Wow, okay. Let’s see if we can find pictures in her mind that she can use to offset the negative ones.” Because when something bad is happening, my belief is that there are going to be thoughts about it, feelings about it, and pictures about it, at the very least. Sensation is often tied into it. And I, I would track these things very often with people in order to say what’s going on, and then look what we can give them that would offset that. So, in her case it would really be, “Well, when you are having this miserable reaction, or you’re feeling so anxious, or you’re, you’re fighting with your sisters or something, give me an idea of the pictures. You may not be aware of them yet, but look for the pictures that accompany them. And if you can bring them into me,we can just see what we can do to give you different pictures so that you will have a different emotional reaction. And, and what are the thoughts you are having at the same time, and does it tie into your sensations? Do you notice any tensions, any pains, any trembling? What goes on negatively in sensations?” So, you’re tracking, is what we call it imagery, cognition, sensation, with a view to looking for something to offset that. And then if you find something, meaning, you know, she gives you the pictures, and they are very bleak and untoward, and you can say, “Let’s fill that with a picture of the sunshine, of the green grass,” whatever it is that she’s describing of this beautiful hue or whatever image(ph), and then use that, “Try to use that at those times and see if it calms you down.” Again, just another- (crosstalk)
20:20JURGEN BRAUNGARDT Uh-huh.
ARNOLD LAZARUS – tool for her to apply.
20:25JURGEN BRAUNGARDT Hmm, it sounds good.
ARNOLD LAZARUS During my supervision groups, I like to open it up to all the participants for their input. Regardless of how experienced the therapist is, he or she can always learn from the deceptions and ideas of others.
20:40ARNOLD LAZARUS Okay, this might be a good time for us to open it up to these good ladies and see what thoughts they may have that they can add to what we’ve discussed, if you’re okay with that?
20:50JURGEN BRAUNGARDT Uh hmm, yes.
ARNOLD LAZARUS All right, may we call upon either one of you to proceed, to say what you wish to say.
20:55MARLOU CRUZ Well, on my head, I think uhm, having her challenge her thoughts with regard to uhm, whenever she has fears about- (crosstalk)
21:05JURGEN BRAUNGARDT Uh hmm.
MARLOU CRUZ – going to her job and, and the thoughts that came, that come up, I think challenging it with something concrete then gives her the reality of what’s really going on.
21:15JURGEN BRAUNGARDT Uh hmm.
MARLOU CRUZ Is it her fears as opposed to uhm, what proves that to be true, her fears?
21:20JURGEN BRAUNGARDT Uh hmm.
ARNOLD LAZARUS Uh hmm, Uh hmm.
JURGEN BRAUNGARDT Hmm.
ARNOLD LAZARUS What do you feel?
21:25JURGEN BRAUNGARDT I think a lot of that already works in her(ph). So, I mean, she has a lot of dialogue with herself.
21:30MARLOU CRUZ Uh hmm.
JURGEN BRAUNGARDT And ah, she is, because she’s a professional writer, I mean, she uses words. She doesn’t use somuch these images. But ah, also that she has an artistic side, but uhm, she does talk to herself frequently in, in various situations, and she consults her friends , actually, a lot.
21:50MARLOU CRUZ So, she has a healthy support.
JURGEN BRAUNGARDT Yeah, yes.
21:55MARLOU CRUZ Okay, that’s good.
JURGEN BRAUNGARDT So, that’s interesting advise, it’s the word that you saw(ph). I think she does it more externally, in terms of consulting friends about her problems. So, she has, like, four or five friends , and she talks with them. And they really know her, I saw it when she doesn’t hold back.
22:05ARNOLD LAZARUS I, I just got a feeling when you mentioned she’s a writer.
22:10JURGEN BRAUNGARDT Uh-huh.
ARNOLD LAZARUS And so, in the left brain, right brain idea,- (crosstalk)
22:15JURGEN BRAUNGARDT Uh-huh.
ARNOLD LAZARUS – she’s very left brain.
JURGEN BRAUNGARDT Yes.
ARNOLD LAZARUS But she’s also very right brain from what you were talking about with the imagery, but she hasn’t used that. It almost sounds like it’s a modality sitting there for her to learn to use to offset other things. And she draws too much on words rather than pictures, and can do both of them and find that there is a potentiating effect. That was just a thought that I had.
22:35JURGEN BRAUNGARDT Well, I think that’s totally correct, because she wants to be a co, like a copy editor or an editor for other people’s writings. I keep saying to her, “You know, you could write something yourself.” (Laughs) ” Write a story of your familyand make a novel out of it, or something.” But it never really, she simply doesn’t respond to, I think she thinks she’s not ah, creative in that sense. So, but yeah, I think ah, that would be an inter, if I can find a way to bring it closer to her, this would be good.
23:05ARNOLD LAZARUS Mary?
MARY HERGET Uhm, I was interested in relationship for her,- (crosstalk)
23:10JURGEN BRAUNGARDT Uh-huh.
MARY HERGET – you know, where things are at now since she broke up, and,- (crosstalk)
23:15JURGEN BRAUNGARDT Uh-huh.
MARY HERGET – you really say, she has a great resource in herfriends ,- (crosstalk)
JURGEN BRAUNGARDT Uh-huh.
MARY HERGET – and she uses that quite a bit.
23:20JURGEN BRAUNGARDT Uh-huh.
MARY HERGET Is there more?
JURGEN BRAUNGARDT Well, yeah, since she got out of that relationship, also it’s still somewhat fragile, he’s the father of herchildren and she’s looking for men, and she’s started to date some men ah, but she’s also very anxious to get into a new relationship.Ah, she’s a beautiful woman, so men are interested in her.
23:40MARY HERGET Uh hmm.
JURGEN BRAUNGARDT Uhm, but I don’t think she has, at this point, the trust.
23:45MARY HERGET Uh hmm.
ARNOLD LAZARUS Is she an assertive person in any way, or does she need to learn that?
23:55JURGEN BRAUNGARDT I think she’s in some ways assertive. I mean, she can, if, but it’s more like uhm, she operates out of need, and then she can be assertive. She can go and get what she needs.
24:05ARNOLD LAZARUS Right.
JURGEN BRAUNGARDT But she’s not assertive in terms of her uhm, let’s say, ability to separate from the family , really, in terms of, you know, self-esteem. I mean, I think she’s not so assertive.
24:20ARNOLD LAZARUS ‘Coz I’m thinking particularly with regard to any new male/female relationship, my sense is that, if one is not assertive immediately in that, problems go wrong. It’s like the first time somebody steps out of line, you let the person know that’s unacceptable.
24:35JURGEN BRAUNGARDT Yeah.
ARNOLD LAZARUS There’s no waiting, let’s see if it happens again. You don’t wait. You, you’re right in there; that, that sort of thing. I would coach her. I don’t know if you mind coaching your clients.
24:45JURGEN BRAUNGARDT Yeah. You see in this..
ARNOLD LAZARUS Note that many of my suggestions and ideas are offered to Jurgen for his consideration and reflection, not as commands or directives. The therapist, not the supervisor or consultant, is the one who generally knows the client best and he or she must figure out ways to incorporate feedback in a manner that seems most relevant to their work together. This approach also keeps supervision from becoming critical, which often results in the recipient shutting down or losing self-confidence.
25:20JURGEN BRAUNGARDT That’s a good idea, I think, because ah, would she, she went out with a, with a man whom she actuallyliked. So, they spent, like, I think, two or three dates or so, and at one point she ended up being in his house and on the phone talking to her ex-husband , and then and he, and then he realized the extent of the chaos in her life, or something, and he didn’t want that. And he said, “Well, maybe it’s not a good idea between us.”And she was crushed afterwards. I said, “Well, you learned something from that situation. I mean, you know, to keep better boundaries, and keep it more separate for you.” But I think she has a tendency to ah, take on the blame, and so she makes herself the guilty, bad one always, who’s responsible for the mess and tries to clean it up. I think that’s her modus operandi.
26:15ARNOLD LAZARUS Sometimes the use of paradox is usefulwhere it’s dangerous. But ah, you’ve gotta know your client about the idea being, “Well, look, we know that it’s all your fault, everything is your fault. We really think that you are at fault for what’s going on politically in the world.” And so, you, you make it to the point where she knows that you, you’re kidding, but it’s the reassuring quality to paradox, is the thought. But, you know, I, I saw a woman a few months back in a similar situation; very eager to reestablish a relationship with a guy after things went sour with somebody else, And ah, so I always said to her, “You, I don’t trust your judgment,” I said, without being disrespectful, “Your judgment in guys, I don’t know what you go by. I want you to run by me your dates, and I wanna hear what, what goes on.” And she comes to the session, and she says, “Yeah, I’ve met this guy, and we went out for dinner, and he sounds like a nice guy over the phone, and I met him, and he was. I really, he seemed like a very pleasant guy,very bright,” and so on. “But there was one thing that bothered me.” “And what was that?” “He was so nasty and rude to the waiter.”
27:25JURGEN BRAUNGARDT Hmm.
ARNOLD LAZARUS I said, “Drop him.
27:30JURGEN BRAUNGARDT Hmm.
ARNOLD LAZARUS I don’t need to hear anything more.” To me, the way a person treats underlings tells you everything you need to know about them that’s basic and significant. “Dump him. Do not see him again it’s my advice to you.” And she said she took it, and ah, and thought about it and didn’t regret it. And, and then ah, I think she’s recently met somebody that so far has passed my tests and,- (crosstalk)
27:50JURGEN BRAUNGARDT Uh-huh.
ARNOLD LAZARUS – and her tests, you see, you know, so, I hold myself out as the, as the judge, you see, in various times in this fashion and, and go from there. Of course, clients have the right to tell me to take a walk, but ah, there it goes.
28:05JURGEN BRAUNGARDT Yeah. I didn’t go so far yet with her but ah, she normally presents these things, like, after they’ve happened. So, ah, she has certain secrets from me. You know, I think, she keeps those things. She tells me afterward. Sometimes she’s afraid to tell me, also. She had a big fight with her sister , is one of her sisters , and she said she almost didn’t want to come because she was afraid of what I would say about this. And then it turned out I said, “You were totally right, and your sister behaved really badly.” And she was relieved after that. But uhm, so, she does keep secrets.
28:40ARNOLD LAZARUS And there’s a trust issue, obviously, that runs through it that makes it tough.
28:45JURGEN BRAUNGARDT Yes.
ARNOLD LAZARUS Yeah.
28:50MARLOU CRUZ How does she identify with her feelings?
JURGEN BRAUNGARDT Ah, normally, they are too close to her, and so, that she gets, the feelings it well up and disrupt(ph) through the, it’s in the body, oftentimes, and they come up, right up, and then she’s very, and she’s sort of ah, explosive, like there’s a lot of fire in her. So, frequently she does certain things and she regrets it afterwards.
29:10ARNOLD LAZARUS I hope that this discussion has been of some value, in the sense that, what I was trying to achieve here from this very complex and kind of heartbreaking case was to find specific kinds of tactics and procedures that could make a difference. Sort of feeling that, too often, we can get caught up with a client in their morose feelings and go with it, as opposed to setting some limits, setting some structure, doing some coaching, giving some tips, and, and being very active in that sense. So, that was basically the message behind it, in the hopes that it’ll be of some value.
29:50JURGEN BRAUNGARDT I think it, it is definitely ah, of some value to me, and I think I need to do some more of it. Uhm, to have a case presentation like this allowed me to get some distance to, to what I do with that.
30:05ARNOLD LAZARUS Right, right. Well, thank you for presenting it.
30:10JURGEN BRAUNGARDT Yes, thank you. thank you.
ARNOLD LAZARUS I felt that Jurgen was offered some new tools and the strengths of his work were supported and he was shown where he might have be more direct with his client in dealing with her fears. It is a complex case where there are no easy solutions. So my goal was to explore areas where the therapy and therapist seemed to be stuck, hoping to move it in a more fruitful direction.
30:35ARNOLD LAZARUS Okay, let’s now hear from Marlou. Perhaps you can give us a quick summary and we’ll go from there.
30:40MARLOU CRUZ Okay. I have a client, I’ve been seeing her for about three years, and uhm, she is in a relationship. She’s been married for ten years. She has no children of her own. Uhm, she has adopted one son recently, last year, and currently has anotherchild that she’s been fostering. My struggle with her is uhm, it seems like she’s struggling to have a relationship and at the same time she’s sabotaging the relationship with uhm, her 14-year-old. Uhm, she comes from a family that’s intact. Ah, her brother died when she was much younger ah, about age 25. She’s about ten years older. She married a man uhm, who also had the same grief/loss issues, where he had lost a brother uhm, about ten years younger. And uhm, so, they have a lot of uhm, emotional support about being, being committed to one another, always taking care of one another. Her family history has it that uhm, her father has heart problems. Uhm, her brother died because of a heart problem. And uhm, I think part of the reason why they don’t havechildren is possibly the fear of passing on uhm, this genetic heart problem to a child that uhm, they, very much desire to have, but the fear is just so great. Uhm, anyhow, she has a relationship with this ah, 14-year-old foster child , and she’s really struggling. She would like to be close to him, and what I see is that they’re very similar in personalities. Uhm, what’s been happening is she has a lot of ah, “shoulds.” “He needs to do this, he needs to do, to dothat, for us to be close.” But what I see is that uhm, they tend tohave a lot of uhm, conflicts stemming from basic normal relationship, where he doesn’t desire to do his homework, she feels that he needs to do this. She’s a teacher, her mother is a teacher. And uhm, her relationship with her husband is one where uhm, she requires his support. If she doesn’t feel his support, then I notice ah, she becomes more passive-aggressive. Uhm, one of things that we’ve been working on is having her vocalize just her feelings at the very moment, because everything seems to be in her head. Uhm, “I think that this needs to happen for this to occur. If uhm, my husband were here more often to help me with uhm, with, with the children uhm, the 14-year-old, then I can then feel like I’m part of this family.” She feels ostracized from the family , uhm, and it’s causing her to feel depressed. Uhm, she feels bad all the time. Ah, maybe she’s not doing enough. She at other times ah, seeks to be very close to uhm, her son , to be a part of thefamily , but in some ways her personality is just very different, uhm,she closes off some, for whole week sometimes. She will go into the bedroom and not wanna talk to any of them because she’s upset, but they don’t know what to do because they feel like they’re walking on eggshells around her. Uhm, so.
34:05ARNOLD LAZARUS Now tell me about the child who was adopted.
34:10MARLOU CRUZ Uh-huh.
ARNOLD LAZARUS Just remind me, this is how old the childnow?
34:15MARLOU CRUZ He is now 19 years old.
ARNOLD LAZARUS Nineteen.
MARLOU CRUZ Uh-huh.
ARNOLD LAZARUS And she gets on with this kid okay?
34:20MARLOU CRUZ She does. They’re very similar in personality.
ARNOLD LAZARUS So, but you said the 14-year-old is creating problems?
34:25MARLOU CRUZ Yes.
ARNOLD LAZARUS And that’s the foster child .
MARLOU CRUZ Uh-hmm.
ARNOLD LAZARUS And the, that the 19-year-old, because of these similarities, works well. Is that what you’re saying?
34:30MARLOU CRUZ Yes.
ARNOLD LAZARUS So he does attend to these little details that she thinks are so important.
34:35MARLOU CRUZ He did, he had lived in the home for about three years, and they struggled with the same issues, ah, over homework issues. Uhm, It’s only after the time when he was getting ready to leave ah, to go into the service that they started to bond.
34:50ARNOLD LAZARUS I see.
MARLOU CRUZ Uhm, so, now we’re seeing a replication of some similar issues from the first child ah, who was also a foster childuhm, and this one now. Only this child that they have is much younger, you know.
35:05ARNOLD LAZARUS And what does husband do for a living?
MARLOU CRUZ Ah, he works, Accounting.
35:10ARNOLD LAZARUS Okay. Because one of the first thoughts that I had here was whether or not it would be helpful to bring in the, in the couple and maybe even the family , of course, there seems to be a family issue is what I’m hearing. Well, what’s your take on that?
35:30MARLOU CRUZ Well, I have met with them as a family but what I’m noticing is that there’s so much going on in her life that uhm, the family is willing to work on several issues together, but what I’m hearing from her is more of uhm, her struggles and things that she needs ah, to feel filled in her life. Uhm, When she was younger, ah, I think she was a parentified child , and uhm, she was the eldest. A very good child . Never did anything wrong. Uhm, but it also allowed her to be overlooked all the time, and her siblings were theones that were given the attention; the sibling that died and her other brother . Uhm, and I think she’s comfortable to a point with that, but now that it’s her own family , and she’s feeling the same feelings of being ostracized again, or being forgotten, she has the feel-bad syndrome, and at the same time uhm, the anger that I’m the wife , I need to be a priority, I need to be heard in this familyand uhm, even when they try to give her that, it’s still not enough. And then she just goes again into her room, oftentimes, and just doesn’t wanna talk to anybody.
36:45ARNOLD LAZARUS Uh hmm.
MARLOU CRUZ So ah, I ah, I’m seeing that there’s so much more going on within her, and when I try to have her journal uhm, to talk about these issues ah, she just goes more into her thoughts. And for her feelings to come out of her, it’s almost that she numbs it. And uhm, even when we try to role-play, “How do you feel?” She’ll say, “What I think about the situation is..” So, it’s almost like she’s been completely disconnected, and then a week later she’ll start to feel remorseful and realize that her family was helping her. Uhm, it’s just at the moment, she wasn’t getting her needs met.
37:25ARNOLD LAZARUS Once again, we’ve been given a narrative that omitted specific issues that needed to be addressed. After some whittling down, we got to what seems to be the meat of the situation.
37:35ARNOLD LAZARUS Now it’s funny, if you were to ask me to give a title for this particular case thus far, I’d call it, “The Teacher.” Meaning, it seems to me, that she is a teacher,- (crosstalk)
37:45MARLOU CRUZ Uh hmm.
ARNOLD LAZARUS – much too much of the time. She’s a teacher in school, and she’s a teacher at home with the kids , and she’s ateacher of the husband , and we’ve gotta get her to stop being a teacher but to be a wife and a mother and ah, whatever, as a goal. I mean, does that ring through?
38:00ARNOLD LAZARUS The consultant, in this case, me, has to preview his interpretations of the case with the therapist. Does it ring through? Does this make sense to you? The importance of a dialogue versus just giving expert advice cannot be emphasized enough. This approach also models what the therapist’sinterpretive style should be, for example, open-ended and tentative, awaiting the client’s response and input.
38:30MARLOU CRUZ That, that has been a struggle. I have asked her uhm, maybe to let go of the homework part with her foster child .