In conceptualizing the psychological case of a person, many factors related to both the psychologist as well as the client are in need of consideration. Psychology encompasses the mental, behavioral, and emotional states, yet also the physical arena as well. Although psychologists are primarily rooted in the mental, behavioral, and emotional realms, it is vital to not ignore the physical aspects of a case and how physical states of being are related to the other states. The case of forty three year old Terry is no exception. In reviewing his past and current life situation in the aim to help Terry to find a more meaningful future, one notes his mental and emotional depression, distress, anger, frustration, and worthlessness, his behavioral unemployment and lack of drive, and his intense and crippling physical pain. All factors which have a negative or hindering effect on Terry’s life, on his holistic ability to find joy and meaning, must be carefully considered, so that a caring and hopefully effective plan can be made in helping him to better deal with his life situation and to find some solutions. In being a genuine help to Terry, a good psychologist will do as much as possible to help Terry to shed light on himself and on all of the positive options available to him.
With Terry’s first arrival at the office, the psychologist would aim first and foremost to make Terry feel welcome, to assure him that he has entered a safe and inviting atmosphere where he can open up and release some of the frustrations as well as work on finding solutions. The demeanor of the psychologist should be calm, genuine, and inviting, and the helper should have a balanced overview of ethical responsibility to the client in regard to maintaining professional boundaries and roles while partnering with the client in a helpful and personal way, facilitating as much as possible the client’s ability to speak and emote honestly and reflectively as well as encouraging the client’s ability to find meaningful life solutions and future directions. The attitude of the psychologist is of prime importance, because each person who walks through the office door will make an initial decision about whether or not the psychologist will truly be able to help. With the foundation of the helping relationship being laid, the psychologist can then more confidently suggest the option of completion of certain valid and reliable evaluations or assessments which may aid in a more thorough understanding of the client’s psychological state of being, however, it remains vital that the relationship is not jeopardized by forms and bullet questions which may intimidate the client or give off an air of impersonal behavior or acting too much like a removed and analytical expert. Assessment is vital, yet is able to be done effectively via paced and natural conversation.
The initial stage of working with a client generally includes inquiries regarding past and current mental, emotional, behavioral, and physical personal information. A client should not feel pressured or forced to divulge everything about oneself in a short amount of time, however, a good explanation about the importance of having a thorough general overview should be communicated to the client, so that the client understands the meaning behind gathering enough information to paint a colorful picture of the client’s actual past and current life situation. Assessments, evaluations, and even tests can be utilized to gather this personal information, although the more relatively slow moving or humanistic therapist may want to gather personal information simply throughout the building of the counseling relationship. In accumulating enough basic information about Terry to move forward in treatment, one would certainly aim to discover as much as possible about his mental, emotional, behavioral, and physical past and current conditions as possible, without pressuring him, and the wise and sensitive psychologist would understand that this initial phase may vary in time, process, and content from client to client.
The first steps in treatment generally include utilizing the best counseling/coaching techniques available to the psychologist, including and not limited to person centered and solution focused techniques. A clear theoretical background or framework is essential for the psychologist to be able to treat the client well, creating a safe and helpful environment and relationship with the client. Person centered theory and techniques were best illuminated by Carl Rogers, who affirmed the belief that clients respond well to a psychologist who is able to be open to client led or person centered ways of interacting, handing the reins treatment, of personal disclosure and personal work, over to the client, while helping as best as possible to facilitate the process of a client’s opening up, of self discovery, self reliance, and self directed feelings, emotions, and behaviors. In the person centered frame of thinking, the client is the one in the relationship with most of the power for personal change, and helping the client to recognize this, to trust oneself and rely on oneself, is the basic aim of person centered theory and counseling techniques. Psychologists also do well to rely on the theoretical philosophy of solution focused techniques. Shazer, Shazer, and Berg did a good job of clarifying the philosophy behind solution focused methods of interaction, affirming the positive nature of helping clients to search for goals and solutions rather than stagnating and suffering on problems. In addition to being person centered and allowing the client to take the reins, it is also important to encourage the finding of solutions, brighter paths for the client’s future. Essential for the psychologist is to remember that the client has come to the office for help, and help is essential positive, liberating, and healing. Instead of meditating too long on a problem or illness, it is often good to help move the client forward, especially in the later stages if therapy, towards personally fulfilling solutions. Beginning psychological treatment with Terry would involve accumulating knowledge about Terry, perhaps best done via gentle open ended questioning and reflection, allowing Terry to explore himself openly and to take the lead in discussing his life and problems, and later, treatment would move into a phase of encouraging Terry to actively seek out the best solutions for himself.
Determining the issues to address first in Terry’s case or any other case is best left in the hands of the client. No person can tell another person what issue is best for one to explore, what time or place is best to open up to a personal problem. Allowing the client to take the lead in divulging one’s own personal feelings and thoughts is a powerful element of person centered interaction, which can also be demonstrated by the psychologist in the use of “I” statements and keeping away from speaking for or about another person in the form of accusations, assumptions, and blame. Terry is best helped by the psychologist who can facilitate his opening up about himself, to release his pain and hardship on his own terms and in his own way. No one can be absolutely sure how or which issues will initially be addressed, because it depends on the emotional, physical, behavioral, and mental state of the individual. Terry may very well be more frustrated and focused on his problematic sex life on the initial visit rather than on dealing with the complications of being unemployed. The job of the person centered therapist is to meet Terry where he is, and begin finding out more about him, helping him to figure out more about himself, as the moments unfold. Wise psychologists are in tune with the fact that clients want to speak about what clients want to speak about, and rightly so, for they are the ones who, in the end, best know the way they need to go in order to get the help they need. The helper simply needs to be with them, to ask questions, to partner, to listen, to reflect, to guide, to challenge, to help illuminate the clients’ personal paths which they are already seeking. As the client begins to have a better understanding of the issues which are the most pertinent to him or her, then the sessions can move forward in the direction of finding personally fulfilling solutions for the client.
In addressing the overarching issue of grief and loss which are pertinent to many if not all client cases, it is first good to have an overview of what the client has actually lost, what is gone which cannot in any way be recovered or seems to be irrecoverable. Also, it is important to recognize that the concept of recovery will vary from person to person. For example, where one person may view a disability or death as a loss, another person may simply view the disability or death as a type of change or have faith in God that the person will be resurrected or reincarnated after death into perfection or new life, leaving hope for the next life or the afterlife. Feeling as if something is missing can certainly be disturbing and can create the sensation of disturbance of holistic harmony, and in some cases, emotional and even physical pain. In Terry’s case, the sense of loss, emotional grief, and physical pain is perhaps primarily associated with his spinal disability. As his body ceases to function properly, Terry faces challenges in employment difficulties, limited mobility and physical capabilities, reduced income, increasing medical expenses, and feelings of pain, hopelessness, sadness, and anger. Seeing that Terry’s issues primarily surround a physical disability, it is vital that the psychologist recognize that Terry does need to also be in the care of physicians or individuals trained in treating spinal and physical disabilities, however, the care that Terry receives through exploring his grief with a person trained in talk therapy or motivational interviewing is also extremely valid and can aid Terry in processing his situation in a more stable and mentally and emotionally balanced way. Grief from the loss of physical ability can be difficult to address, because a solution or a recovery may not be in sight, or at least, not near in sight. Some people find hope and solace in the idea of an afterlife, a new life after death where one is reborn into perfection, but some people do not. In Terry’s case, it may be good for him to voice his ideas and express his feelings surrounding either a possible recovery or a possible lack of recovery. If Terry sees recovery as a possibility, it may be good to help him to work on the steps toward healing and increased life quality, however, if Terry does not see recovery as possible, it may be good to facilitate his exploration of coping mechanisms or the ideas regarding faith in God in the present, future, and afterlife.
In helping Terry through the grieving process, an intelligent psychologist would aim to facilitate in every way the ability of Terry to open up and trust the therapist. The counselor should exude an authenticity, a genuine helpfulness, and be an actively interested yet relatively nondirective participant in the relationship with the client. If the client feels comfortable and safe with the coach, if a conversational and beneficial relationship has been established in the aim of best serving the client, then the counseling relationship will blossom and Terry will feel able to express himself regarding his loss. It is vital that the psychologist help Terry to be as authentic about his situation as possible, hopefully modeling authenticity. In processing grief and loss, the emotions and sequence of emotions involved will vary from person to person, however, the psychologist can expect that the client may exhibit emotions related to denial, anger, bargaining, depression, and acceptance, as postulated by theorist and scientist Kuebler-Ross. Terry has experienced significant loss in his life, primarily the loss of the health of his back, but in conjunction, also the loss of sexuality, finances, employment, and general wellbeing and satisfaction. A cathartic experience for every person is to have someone nearby, someone who cares, listens and questions, someone professionally capable of being a mental and emotional help in a time of need. Terry needs for his psychologist, therapist, counselor, or coach to be there for him, not directing him, but rather listening to the tale of his life story, aiding him in drawing himself out and expressing himself honestly and emotionally, and helping him to find solutions for his problems. A solution for Terry and some other clients may not entail a full recovery. It is vital to recognize the possibility that some clients will never be emotionally, mentally, behaviorally, or physically well, perhaps never again completely healthy, however it is vital that the psychologist do as much as possible in aiding Terry though the process of self discovery and finding appropriate and realistic coping mechanisms and helpful aids.
Helping Terry cope with his situation is very much a part of the therapeutic process. Simply helping Terry to be expressive and active in finding solutions is a great coping mechanism for any person, and even when the counseling relationship with the psychologist is finished, Terry will have a brand new set of tools and self understanding. He will be better able to speak and emote about himself and better able to place focus on finding personal solutions for himself. In addition to the coping mechanism which is a part of, or is in fact, the therapeutic relationship, a way of being with another person which Terry could incorporate into other relationships in his life, such as the relationship with his wife, there are also more specific ways of coping. Perhaps Terry would find it important to figure out a way of working from home as a new avenue to employment, to explore the idea of yoga or stretching as a way of aiding physical recovery while also feeling the emotional and mental therapeutic effects, or to discuss nutritional and physical lifestyle issues with a nutritionist, herbalist, or physician. Coping mechanisms such as mediation and deep breathing are techniques which a psychologist can suggest and even practice with a client, and are even great ways of centering the atmosphere of the counseling environment, bringing a sense of calm and peace. Due to the fact that Terry’s physical problems appear to be relatively serious, coping, for Terry, may include medications, and it is vital that any and all medications for physical health or against negative physical symptoms must also work well chemically with any prescriptions for mental and emotional health or against negative mental and emotional symptoms. Always, it is important to remember that all coping strategies should be the authentic choice of the client, and not a forced directive of the psychologist or any other person. In helping Terry to gather as much information about himself and his options as possible, the psychologist works to enable Terry to stand on his own two feet and to make sound decisions regarding his lifestyle and wellness.
The case of Terry is different from that of some other clients in that his emotional and mental states of wellbeing are negatively affected by his physical disability. It is just as vital to remember that not all clients will have more physical disabilities as to remember that some of them will. In regard to Terry, it is fairly obvious that much of his mental and emotional anguish is related to physical anguish, however, with other clients, it could very well occur that little to no physical problems are present or that even hidden physical problems lie just under the surface. In all cases, it is important for the psychologist to remember that physical disabilities can be a part of a client’s problem and that psychologist are generally not the best trained people to deal will physical issues. Terry and other clients with disabilities are best served with a team of professionals who can each specialize in the areas of Terry’s life where they feel the most competent. Psychologists are best able to understand and help a client to process more mental, emotional, and behavioral issues.
Administering holistic care to a client means that one knows personally what one is able to offer and that one knows how to refer well to other qualified professionals, having a good and realistic overview of the types of services one provides and the types of services provided by other workers. Terry, like other clients, deserves the best and most high quality of care available. In offering and engaging in psychological treatment, the psychologist is able to function within a certain sphere of professional wisdom (unless also trained in other areas), able to work primarily within the areas of assessment, diagnosis, and mental, emotional, and behavioral treatment through coaching and counseling. In referring to other professionals, it is wise for the psychologist to consider personal limitations in the areas of physical health as well as perhaps spiritual wellness. In truly helping Terry to best of one’s ability, one also has to consider the other people who may be of help to him, including and not limited to psychiatrists, nurses, physicians, yogis, herbalists, masseuses, priests, and ministers.
Grieving clients can also be unique and varied in how they present about their losses and in the coping strategies chosen. Some clients will see recovery from loss as a possibility, some clients will learn how to cope with a permanent loss, learn to accept the loss and perhaps even the grief, some clients will accept loss and not grieve anymore, and some clients will continue in the loss and/or grief with the hope of redemption through death, or new life and joining of other, of spiritual wholeness, in the afterlife. There are many ways in which people choose to or are able to deal with loss and the feelings of grief associated with loss. Extra care must be extended to those people who seem to be deeply mired in grief and loss, who appear unable to deal with the magnitude of what they consider, and what may actually be, an intense tragedy. In the case of Terry as well as other people affected by serious loss and feeling deep emotions related to grief, the most careful and proactive treatment available should be provided, in providing the most attentive and expert counseling services as well as the most meaningful referrals to other capable related professionals.
As with every client who faces issues related to grief and loss, it is generally important for the psychologist to have an overview of what the client perceives to have been lost, to communicate genuine understanding of the pain and heartache related to having a vital aspect of life be stripped away, unexpectedly or not. The relief and understanding that comes from a client being able to share his or her story in the presence of an interested listener is invaluable, and allowing the client to lead the relationship in terms of content or what is shared is also an important piece of the healing relationship, where the suffering or confused party is empowered to speak, to gain insight, and to improve on his or her own terms, in his or her own way, and at his or her own time and pace. The finding of solutions should not be delivered on a list by the psychologist or through ticking off suggestions or advice, rather the helper must sit back a bit, relax, take time, and encourage the client to open up to goals and new positive directions slowly and purposefully. Rushing to an answer or taking over the responsibility of finding answers are ways that psychologists can truly do damage to the relationship. Not having an engaged individual present, a helping individual who truly wants to behave as a catalyst for client change rather than an enforcer or creator of client change, is often one of the reasons, perhaps one of many reasons, why clients feel confused or unwell in the first place. Taking control of the conversation, of treatment, progress, and steps forward is not the duty of the psychologist, rather the pleasurable responsibility of the client. In aiming to help guide in positive directions, the helper must have a good understanding of how stepping back and facilitating works much better at promoting client self efficacy and self esteem than giving advice, orders, or instructions. Truly helping Terry has much more to do with humanism, partnership, gentle guidance, encouragement, and authenticity than anything else, and molding a view of psychology into humanistic values is essential for any psychologist to be considered truly successful.
Corey, Gerald. (2005). Theory and Practice of Counseling and Psychotherapy. Wadsworth.
Friedman, R. & James. (1998). The Grief Recovery Handbook.