PSY 637 Final Paper

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Pepperdine University *

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637

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Psychology

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Dec 6, 2023

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1 Final Exam Carolina Walker Pepperdine University Psychology 637 Professor Parker September 20, 2023

2 Final Exam Intake Interview: Additional Areas of Information and Rapport. In the case of Katrina, I would seek additional, more detailed information on various aspects. One of the first points would be Katrina's social and emotional environment at school, that is, how her academic and behavioral problems affect her interactions with peers and teachers. It would also be pertinent to investigate further family dynamics, including her relationship with her younger brother, as the family environment may influence her emotional state and behavior. Likewise, I would need information about the coping strategies that Katrina has been using to deal with her emotional distress. No less important, it is necessary to evaluate whether Katrina presents risks of self-harm or dangerous behavior towards herself or others since aggression towards other students is mentioned. Still, it is unclear if there is a risk of self-harm. It would also be valuable to understand more about her current disinterest in activities that previously brought her pleasure to assess the level of anhedonia, a significant symptom of depression. To build a trusting relationship with Katrina, addressing her initial lack of trust in the therapeutic process and with authority figures is crucial. Establishing clear boundaries with Katrina and confidentiality in the therapeutic process would be essential to assure her that the space is safe and that she knows she will not be required to do what to do but will work collaboratively on her problems. Later, more information will be collected through the interview, but I will also seek to facilitate the change in Katrina's perception of the situation and her problems. To accomplish this, you could use open-ended, thought-provoking questions that allow

3 Katrina to express herself on her terms. At the same time, more structured questions would be needed to ensure that all clinical elements necessary for a comprehensive assessment are addressed. Formal rating scales could be reserved for later points in therapy once a trusting relationship has been established. The approach must be flexible and adapt to Katrina's verbal and non-verbal cues, always seeking to balance gathering clinical information with building a solid and reliable rapport. Case Formulation Katrina shows depressive symptoms, oppositional behavior, and conflicts at school and in her family environment. This was aggravated after discovering her father's extramarital affair, which led to a decline in his academic performance and a loss of interest in activities that previously brought her pleasure. Treatment goals 1. Emotional Regulation and Reduction of Depressive Symptoms: The first goal is to help Katrina improve her emotional regulation and reduce her depressive symptoms. This is critical given her clinical presentation of depression and oppositional behavior. 2. Development of Communication and Conflict Resolution Skills: Katrina faces conflicts with her mother and classmates. Therefore, it is essential to work on developing practical communication skills and conflict resolution techniques. 3. Improved Academic Achievement and Attendance: Since Katrina has shown a decline in her academic performance, a key goal is to enhance her engagement and performance in school.

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4 4. Revitalized Interest in Activities: Katrina has lost interest in activities that brought her pleasure. One goal would be to explore and rekindle her interest in activities contributing to her well-being and self-actualization. Clinical Hypotheses under the lens of the Humanistic approach ● Katrina could be living incongruently with her values and emotions, causing her emotional distress. ● Katrina feels that she is not heard and understood, especially by her mother and teachers, which impairs her ability to trust people. ● The client's family history suggests that the forms of love and acceptance she has experienced have been conditional, which could affect her self-esteem and self-respect. Therapeutic Plan ● Create a safe therapeutic environment where Katrina can explore and understand her emotions without feeling judged. ● Encourage using reflection techniques so that Katrina can understand her feelings and behaviors. ● Use family therapy to address communication and trust issues between Katrina and her mother. ● Implement strategies to cope with anger and improve interpersonal relationships. ● Explore options such as academic counseling to regain Katrina's interest in school and other cultural or sports activities that provide distraction. Methods/Measures to evaluate treatment results 1. Self-Report scales: Using Beck Depression Inventory (BDI) to evaluate depressive symptoms.

5 2. Behavioral observation and direct feedback: Sessions with Katrina and her mother will allow for direct observation of behavior and interactions, offering opportunities to make therapeutic adjustments. 3. Periodic reviews and treatment plan adjustments: Regular reviews will be held with Katrina and her mother to evaluate progress and make any necessary adjustments to the treatment plan. 4. Analysis of goals and objectives: At each stage of treatment, a detailed analysis must be made of the extent to which the established goals and objectives have been achieved. This will include both quantitative and qualitative measures. 5. Feedback from teachers and school counselors: Considering that school is one of the contexts where Katrina faces challenges, feedback from teachers and school counselors will also be crucial in evaluating progress. 6. Self-assessment and reflection: As part of the humanistic approach, Katrina will be encouraged to engage in self-assessment and reflection, recognizing that she is the expert of her own experience. This plan addresses the underlying causes and overt symptoms of Katrina's malaise. Her main idea is to give her a space to discover and accept herself, feeling love and calm. Hypotheses and treatment objectives are designed to provide a coherent justification for each component of the therapeutic plan. Rating scales self-reports will be implemented to monitor depressive symptoms and progress in anger coping skills. Regular check-ins with Katrina and her mother will help adjust the plan to the client's needs, as Katrina is the expert on her experience and therapeutic process. Clinical Hypotheses under the lens of the Humanistic Approach

6 Katrina could be facing stagnation in her personal growth and self-actualization, a key concept in humanistic theory. Recent events in her family life may have led Katrina to disconnect from her emotions and needs. Katrina's family history suggests that the forms of love and acceptance she has experienced have been conditional, which could affect her self-esteem and self-respect. Legal and Ethical issues It is crucial that both Katrina and her mother, Julia, understand the nature of the therapy the potential risks and benefits, and give her consent to continue. The therapist must be careful about the fact that Katrina is a minor, and therefore, her mother has to provide legal consent. Furthermore, the fact that Katrina's mother was present during the initial session and spoke on her behalf raises questions about maintaining Katrina's confidentiality while obtaining the necessary consent from the mother. Since Katrina's mother is intensely involved in the therapy process, it is imperative to set clear boundaries about what information will be shared with her and what will remain confidential between Katrina and the therapist. However, as Katrina has expressed distrust of the therapeutic process, it is essential to approach this carefully to ensure that her rights as a patient are respected. In addition to ethical codes, the therapist must clearly understand state and federal law regarding the treatment of minors and the release of information. Another relevant aspect is the clinical competence of the therapist to treat the multiple problems that Katrina presents. She displays depressive symptoms, academic problems, and oppositional behavior. A practical therapeutic approach will require diverse clinical skills and the intervention of more than one specialist. It should also be noted that Katrina was referred by her academic advisor, so the therapist needs to avoid any duality in the professional relationship. If

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7 the therapist has any other role or relationship with Katrina outside of the therapeutic setting, that could compromise the effectiveness of the treatment and the client's well-being. The father's separate geographic location in Puerto Rico could suggest employing video calls or online therapy to engage him in Katrina treatment. However, this raises other ethical issues, such as consent and confidentiality. Counseling Skills I chose Active Listening and encouragement as the most appropriate techniques to work with Katrina. Active listening Active listening forms the basis of any therapeutic relationship and involves understanding, validating, and responding to the client's verbal and non-verbal content. Given Katrina's suspicion of opening up and her lack of trust in adults, active listening could help break down those initial barriers. As Katrina feels heard and validated, she is more likely to participate more openly in the therapeutic process. The client presents with depressive symptoms and oppositional behaviors that interfere with her academic and social functioning. Active listening can help uncover the underlying feelings and thoughts contributing to these problems. This skill would allow the therapist to identify Katrina's unspoken concerns, which could be related to her paternal abandonment. A significant barrier on Katrina's part would be the pre-existing lack of trust in authority figures and professionals, which she has mentioned. This skepticism could cause Katrina to perceive active listening as an act of manipulation. Another barrier could be the presence of her mother, Julia, who tends to speak up for Katrina. This behavior can hinder active listening by disrupting direct communication between Katrina and the therapist.

8 The humanistic approach focuses on personal development, self-realization, and the individual's sense of belonging (Young, 2019, p. 189). This approach suggests that each person has an inherent capacity for growth and self-understanding. Katrina, experiencing a complex family situation, could benefit from a therapeutic approach that allows her to be herself without judgment, facilitating an environment conducive to self-exploration. From the humanistic perspective, empathy and unconditional acceptance are fundamental pillars in the therapeutic relationship. Since Katrina showed signs of distrust and a lack of reliable emotional support systems, active listening can facilitate genuine, non-judgmental communication. Active listening allows the therapist to fully enter Katrina's emotional world, reflect on her feelings and thoughts, and foster an environment where she can begin to accept and process her emotions. The humanistic approach also values authenticity in the therapeutic relationship (Young, 2019, p. 35), and this aligns with Katrina's need to interact with someone who does not tell her what to do but listens and understands her. Through active listening, the therapist can demonstrate coherence by reflecting on what she hears and feels in response to Katrina, which can help her begin to trust the therapeutic process. Empathy and Encouragement Empathy allows the therapist to put themselves in the client's shoes, facilitating a safe space for emotional exploration. Katrina distrusts authority figures and has a lack of interest in therapy. In this context, active listening, careful observation of non-verbal cues, and open-ended questions will be required to allow Katrina to explore her feelings. This delicate balance can help Katrina open up and confront her emotional and behavioral problems. Encouragement acts as a facilitator of action and change. Katrina also needs encouragement to rediscover her sense of

9 self-efficacy and her intrinsic abilities that have been affected by emotional problems and family circumstances. Recognizing her small achievements and skills can work as a motivational boost. Both techniques are critical to establishing a trusting relationship, which is especially crucial given Katrina's initial skepticism toward the therapy. Additionally, these techniques offer the flexibility to be adapted and combined with other approaches as treatment progresses. One of the main barriers could be her initial distrust attitude, making it difficult to form an authentic therapeutic relationship. Empathy here serves as a tool to dismantle these emotional defenses by clearly understanding her feelings. Another barrier could be projecting parental figures onto the therapist, especially considering that her father has been emotionally distant. Empathy and encouragement could be seen as attempts at manipulation if not approached carefully. In the humanistic approach, particularly in client-centered theory, empathy is perceived as a fundamental element to facilitate personal change and growth. Carl Rogers proposes that an effective therapeutic climate is created through congruence, unconditional acceptance, and genuine empathy on the therapist's part (Young, 2019, p. 42). These factors, especially empathy, foster a safe space where the client feels understood and validated, allowing for introspection and change. Confrontation In Katrina's case, I do not consider using the confrontation skill because it aims to help the client become aware of certain inconsistencies between her thoughts, words, and emotions. This technique is usually applied when a solid therapeutic alliance has been established, and the client shows mixed messages or apparent contradictions.

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10 In Katrina's case, several factors make using the confrontation skill inappropriate, such as the absence of a therapeutic alliance. Katrina has clarified that she doesn't trust anyone, including the therapist. Confrontation could heighten her resistance and skepticism toward the counseling process. Since the client is dealing with parental betrayal and family conflict, her emotional state is already fragile. Confronting Katrina could lead to a decrease in her emotional well-being. Furthermore, Katrina's mother, Julia, answers most of the questions, indicating that Katrina is not yet ready to face her contradictions. Socio-cultural factors ● Katrina is of mixed ethnicity, which could add a layer of complexity to her self-understanding and how she interacts with her surroundings. The "mixed ethnicity" concept encompasses diverse experiences and cultural identities that can result in internal conflicts or a rich resource of social adaptability. The client's father lives in Puerto Rico but is absent from her life. This information suggests the need to consider issues of ethnic and cultural identity in treatment. There may be differences in cultural values and family expectations that affect her perception of the world and her emotional well-being. ● Katrina faces family concerns, such as her absent father and mother, who sometimes speak for Katrina, limiting her free expression. Gender norms and family roles in different cultures can influence how Katrina perceives these dynamics and how she feels about her family dynamics. It would also be beneficial to consider how her mother's attitudes and beliefs may influence Katrina and how they can be constructively integrated into the therapeutic process.

11 ● Since Katrina is a 13-year-old young woman, issues of gender and development are also relevant. Her emotional and cognitive development must be considered to ensure that any intervention is appropriate for her age and mental maturity. ● Katrina's family had to move to a smaller apartment due to her father's absence, which could contribute to her stress. Home conditions can significantly impact mental well-being, and each culture can perceive reduced socioeconomic status differently. ● The school environment, where Katrina has displayed oppositional behavior and poor academic performance, is another space where norms exist. School culture may have its forms of classification and possible stigmatization that affect Katrina. ● It is essential to ask if there are language barriers, as this could affect the quality of the therapeutic process. Katrina's native language and her family's language preferences must be known to avoid communication problems in therapy. ● Based on these considerations, the choice of counseling techniques and therapeutic skills must be adapted to address these multiple levels of influence. This therapeutic process requires an advanced level of cultural competence on the therapist's part, continuous assessment of the therapist's biases, and commitment to her professional ethics. ● Last, the therapist must also be attentive to her biases and prejudices, especially when dealing with clients from different cultural and ethnic backgrounds.

12 References Young, M. E. (2019). Learning the art of helping: Building Blocks and Techniques .

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PSY 637 Final Paper

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