case of louisa

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Texas A&M University, Kingsville *

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5305

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Psychology

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Dec 6, 2023

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docx

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Case Conceptualization Identifying information (0.5) Louisa is a 35-year-old unmarried woman who lives near her parents. Louisa has a small circle of friends and connections. She lives in a small house with many animals she calls her "substitute family," who provide her companionship. History of presenting illness (0.5) The client reported several concerning symptoms and problems affecting their mental health. They include self-harm, severe bulimia tendencies, and active suicidal actions. Louisa also mentioned self-criticism thoughts and felt she should not exist. The client also reports feeling lonely, which could add to their distress. Louisa's presenting problems have been ongoing for an undetermined period. They are distinguished by a constant sense of self-hatred and an inability to comprehend the meaning of their life. Any mistakes or inconveniences she encounters intensify these negative thoughts, resulting in a strong sense of hopelessness. She feels she would not be the person she is today if she had not been born a twin. This belief causes her to feel disconnected from her identity, as she does not feel like her name or birthday genuinely belong to her. These issues significantly influence the client's everyday functioning since she struggles to find meaning in her life and is filled with self-hatred. Louisa may have several goals for seeking therapy, even though they are not explicitly stated. These may include managing her suicidal behaviors, self-harm, and bulimia tendencies, which pose a significant risk to her overall health and well-being. Additionally, she may aim to reduce her feelings of self- hatred and hopelessness. Louisa may also wish to find support in discovering a sense of purpose or meaning in her life and improving her relationships with others and understanding of herself. Background information (0.5) Louisa is the second-born of twins, and she believes her parents were unprepared for their arrival and preferred boys. Louisa has said that her twin brother Michael, who was born first, is superior to her in every way, including being more imaginative, upbeat, and talkative. Louisa has expressed that if she were a boy, her name would have been Louis, which has caused her to have a hard time accepting her identity. Louisa has a history of mental health issues and has attended 143 weekly treatment sessions for three and a half years. She also spent three months in the hospital before starting therapy. Her official diagnoses include bulimia and borderline personality disorder (BPD). She also demonstrates "avoidant and dependent tendencies." She has very few friends and has never been married. Her educational history and problems with drugs, alcohol or the law are not mentioned. Personal Strengths/Weaknesses (0.5) Louisa's willingness to seek treatment, her commitment to attending weekly sessions for more than three years, and her capacity to express her thoughts and feelings during therapy sessions are among her greatest strengths. She also loves animals, which she refers to as her "substitute family" and which provide her comfort and company. Louisa's daily functioning is adversely impacted by a number of weaknesses, including constant self-hatred and a lack of

meaning or purpose. Her avoidant and dependent qualities, as well as symptoms of bulimia and borderline personality disorder, may make it difficult for her to develop and maintain connections with others. Louisa may struggle to deal with her mental health problems and daily stresses due to her lack of social support, as she has few friends or acquaintances. Therapeutic Goals (2) The goals I would set for Louisa in therapy would be to improve her mental health and reduce harmful behaviors while also dealing with her formal diagnosis of borderline personality disorder. In addition to helping Louisa deal with her feelings of self-hatred and helplessness, I would work with her to control her bulimia, self-harm, and suicidal impulses. Together, we would look into the underlying causes of her stress and create coping skills to help her regulate her emotions. I would also work with Louisa to determine her values, interests, and goals to help her discover meaning and purpose in life. To improve her social functioning and create healthier connections, she would need to work on her practical communication skills and avoidant and dependent tendencies. I would also work with Louisa to create coping techniques for the symptoms of BPD and bulimia. My goals for Louisa in therapy would be to identify and challenge negative thought patterns, build self-esteem and self-compassion, explore past experiences, and improve her overall mental health and functioning. Case conceptualization/Analysis (4) Gestalt therapy focuses on helping clients understand how their present experience relates to their past experiences. For the client to fully experience who they are, the therapist works with them to assist them in becoming conscious of their thoughts, emotions, and behaviors. Louisa's current problems result from her early relationships with her parents and twin brother. Louisa may have experienced feelings of failure and unworthiness due to her perception that her parents favored boys and were unprepared for her and her brother's birth. These experiences may have led to a lack of self-acceptance and a negative self-image. Louisa's twin experience, mainly being born second to her twin brother, may have contributed to her difficulties with identification and self-esteem. Her belief that she would have been happier if she were a boy and that her name and birthday do not truly belong to her suggests difficulty fitting her sense of self with her external reality. Louisa's early feelings of being unwanted and unimportant may have contributed to her avoidant and dependent tendencies and difficulties connecting with people. The Gestalt Therapy method provides therapeutic techniques that could help Louisa achieve her therapeutic goals. These methods include the Empty Chair Technique, mindfulness, and awareness training. The Empty Chair Technique allows Louisa to externalize her internal conflicts and communicate with her inner parts of herself. She could recognize and resolve her personality's conflicting traits, such as self-hatred and her desire for self-acceptance. Louisa benefits from awareness exercises because it increases her awareness of her thoughts, feelings, and actions in the present moment, help her stay grounded and present and lessen her likelihood of being overcome by strong emotions. Louisa could benefit from mindfulness practice since it would help her develop non-judgmental awareness and acceptance of her thoughts and feelings. She could use this strategy to lessen her tendency for self-criticism and increase her self- compassion. These techniques can help Louisa understand the underlying reasons for her current issues and develop the skills to manage her symptoms properly.

Critique (2) The gestalt theory focuses on the present moment and the client's unique experience in therapy. Even though it does not specifically address them, cultural influences can be included by recognizing and examining them. Regarding Louisa's struggles with identity and self-worth, her cultural background—including gender and family dynamics—may be significant. While the gestalt theory can assist in addressing her concerns, a culturally sensitive approach that considers how her culture has impacted her experiences and perceptions and any cultural beliefs that may be negatively affecting her mental health may be helpful. Although the gestalt theory may offer a helpful framework for therapy, it is crucial to consider how cultural aspects may affect the client's mental health and apply a culturally sensitive approach.

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