Lebanese American University

Byblos
Spring 2020
Theories of Counseling
Final Exam

Rebecca Antonios
ID:201605694

Case study

Farah is a 30-year-old Lebanese American woman who is recently divorced from her husband of
two years. She is a full-time student beginning her third year of medical school and lives with her
mother. Farah arrives for sessions neatly dressed, usually in hospital scrubs. She generally
appears younger than her stated age, demonstrates poor eye contact and shows very little
emotion.

Farah was referred for counseling following an incident in which she verbally confronted another
student during class and was asked to leave the classroom. The counselor at the medical school
who referred her suggested that she may have difficulty managing and appropriately expressing
anger; Farah does not agree that this is a problem. She says that she was justified in her anger
because the other student, a man, called her “crazy”.

Farah is adopted. She has no knowledge of her biological parents. Farah’s adoptive father is
American; her adoptive mother is Lebanese. She is an only child. Her father, who died two years
ago, had a history of alcohol abuse. Initially, Farah reported having “basically a good
childhood”. She described her mother as “the disciplinarian, hard-working and loving.” She
further stated that, although her father abused alcohol, this was not a stressor; she “adored him”
and he was “very good” to her. In later counseling sessions, Farah described her home life
growing up as uncomfortable; her mother and father argued frequently. She further disclosed
feelings of resentment and guilt related to her father’s alcohol abuse.
Farah reported having problems with interpersonal relationships for many years. Her ex-
husband, who lives in another city, recently told her that she should seek counseling because she
has difficulty letting go of relationships. She agreed with his assessment, characterizing herself
as “codependent”. Farah reports a lack of self-confidence, feelings of numbness during conflict,
insecurity with authority figures and a desire to avoid uncomfortable situations.

Farah recalled a time when she was dating a man and believed that he was cheating on her. She
discussed her suspicions with Leah her friend who convinced her that they should slash the tires
on his car and spray paint the windshield to “teach him a lesson”. Farah and Leah went through
their plan and vowed never to disclose what they had done. They engaged in other similar
activities and Farah felt “somewhat guilty” about some of the things they have done to other
people. Farah reports that she would like to end her relationship with Leah but that she is unable
because she feels it is necessary to remain loyal to her.
With men, Farah says she is unable to express her feelings when she senses disagreement and
describes herself as fearing abandonment.

Although she recognizes her difficulties with relationships, she says that she would like to work
on her “temper” and her feelings of abandonment.

I- Read the following case and try to imagine you are an REBT counselor. What are
issues in Farah’s case that you would be interested in? What is the process of therapy
that is used by REBT counselors? How would you apply it to this case? What would
be your ultimate goal?

As an REBT counselor, in Farah’s case many of her issues are worth exploring such as;
1- Her issue with self-confidence/self-esteem
2- Her issue with being abandoned ( As an adopted child)
3- Her issue with Athazagoraphobia
4- Her issue with anxiety i.e. ( insecurity with authority figures, avoiding uncomfortable
situations)
5- Her issue with her patriarchal figure (that could have potentially led her to repress her
feelings with men)
6- Her issue with anger management
7- Her issue with interpersonal relationships (Codependency)
8- Her feelings of vulnerability
9- Her Father’s issue with alcohol abuse
Rational Emotive Behavior Therapy (REBT); helps individuals identify self-defeating
thoughts and feelings and replacing those irrational feelings. Because REBT is a tolerance
training, it focuses on the different ways to achieve tolerance which are; unconditional other-
acceptance, unconditional self-acceptance, and unconditional life-acceptance.
It is designed to help individuals like Farah, overcome their mental health problems caused
by distortions, dysfunctional thought patterns that interferes with their daily life functioning.
The process of therapy is as follows; “ABCDE theory”, whereby individuals are blaming
external events on their negative emotions instead of their understanding of the event. This
model is used to educate other individuals that it is not the event that causes our emotional
reaction rather our beliefs, are the cause of our behavioral and emotional responses.
In the “ABC theory” ; The A stands for – Activating event ; which means any event that
takes place in the environment
The B stands for-Beliefs: Which implies that belief you have about the event that took place.
The C stands for-Consequence: which means the emotional response to your belief.

The D stands for- Disputing: which means debating those irrational beliefs
The E stands for- Efficient: which means that the client now has efficient rational beliefs

REBT therapy is goal-directed and problem-focused, whereby one of the most important
steps is identifying the underlying irrational thought patterns and beliefs. i.e. In Farah’s case
she believes that she would be better off by avoiding life’s difficulties and challenges, she
also believes that her happiness depends on external forces.
Once those underlying thoughts and feelings have been recognized, the next step to help
Farah is by challenging them, using direct and confrontational approaches in order to
discontinue the cycle of irrational beliefs and set new beliefs that are rational.

By applying REBT to Farah’s case, I would show Farah unconditional positive regard so that
she feels comfortable in the session and then I would follow the ABCDE theory mentioned
above by helping Farah acknowledge her irrational beliefs i.e ( her insecurities with authority
figures, her fear of being abandoned, being dependent on others, and her interpersonal
difficulties) and guide her by establishing new beliefs that are rational. In addition, cognitive,
emotive and behavioral techniques are used in her case as demonstrated in the table below;
Cognitive techniques will deal with Farah’s cognitions
Emotional Techniques will help Farah imagine herself in different situations
Behavioral Techniques will encourage Farah to participate in some activities that will help
her overcome her anxiety.

Cognitive Techniques Emotional Techniques Behavioral Techniques

Disputing irrational believing-
emoting-behaving
Whereby, I will ask Farah
questions such as where is the
evidence of your belief?
Unconditional self- acceptance
Whereby, I will familiarize Farah
with the ways she could accept
herself unconditionally as a
person
Reinforcement
Whereby, I will encourage
Farah to reward herself with a
pleasurable activity after she
takes a risk on things she
commonly avoids.

Rational coping self-statements Unconditional other acceptance Penalization

Whereby ,Farah will repeat
rational coping self-statement
such as “I am not dependent on
other; I just need support
sometimes”
Whereby, I will give Farah other
acceptance so that she can feel
accepted, then I will help her see
how others can be accepted as
valuable humans too.
Whereby, in the case that Farah
refuses to change her thinking,
feeling, or behaving then some
real penalties might be taken to
dissuade her resistance.

Positive visualization Shame attacking exercises Skills training

Whereby, I will guide Farah in Whereby, for Farah to achieve Whereby, I will work with
reaching her achievement of self- unconditional self-acceptance, I Farah on her assertiveness by
confidence or self -efficacy will help her get rid of her guilt encouraging her to attend

Modeling
Whereby, I will help Farah see
that other people have similar
problems keeping in mind to not
awfulize them as Farah could
model herself after those people.
and self-damming beliefs. assertiveness training
workshops.
Rational Emotive Imagery
Whereby, I will show Farah how
to imagine some terrible things
happening. This will train Farah
to feel healthy disappointment
instead of unhealthy anxiety when
things don’t go as planned.

Psychoeducational methods Strong Rational coping

Whereby, I will encourage Farah
to read REBT self-help materials
Statements
Whereby, this will help Farah
undo her anxious reactions i.e. “ I
am not god; I can only do my
best”

Cognitive Distraction Humor

Whereby, I will encourage Farah
to use distractions such as
watching the TV or reading a
book. This will help ger block out
some of her anxieties.
Whereby, I will encourage Farah
to use her sense of humor as she is
an anxious client and anxious
clients take things very seriously.

Practical problem-solving
techniques
Whereby, I will encourage Farah
to use some practical methods of
tackling her problems such as
social skill training, assertiveness,
and decision making

As stated above, my ultimate goal is the help Farah think more rationally by recognizing her
irrational beliefs and disputing them to refocus on the positive and constructive beliefs. In
addition, I want Farah to be aware of the fact that we cannot control everything in life, but
we can control how we react to the situation!
Keeping in mind that change will not happen overnight.
II If you were a Gestalt therapist, what would your approach be to Farah’s case?

As a Gestalt Therapist, I would approach Farah’s case by bringing her attention to

live fully in the present moment by focusing on her self-awareness and self-acceptance. I
would focus on looking at Farah’s functioning a whole, that is her sense of self and the
way she responds to outside interactions. My main goal with Farah is to achieve complete
awareness, when individuals are aware, they will be able to self-regulate in their
environment and in Farah’s case that is exactly what she needs as she lacks self-
awareness. This could be due to two major key factors in this case
1- Farah’s preoccupation with her past, especially because her alcoholic father who
passed away
2- Farah’s lack of self-esteem and confidence
And thus, in order to help Farah, achieve awareness, I will be focusing on three main
elements listed in the table below

Contact with the environment Whereby, this can be achieved through

talking, moving, listening, looking
smelling, and tasting. This will allow Farah
to flourish in her own environment by
reacting to the environment itself causing
change.
The Here and now Whereby, Farah’s attention will be guided
towards living in the moment and being
conscious of the present moment rather
than concentrating on the worries of the
past and the future.
Responsibility Whereby, Farah will learn to assume
responsibility for her own life rather than
blaming her biological parents, her
adoptive parents or her ex-husband.

In addition, Farah has mentioned she has feelings of numbness and tension, as a Gestalt
therapist, I am able to focus on where her energy lies, how it is used, and how it could be
causing blockage. As blocked energy is a form of resistance, in Farah’s case her tension
is located in a part of her body which is her eyes, she avoids eye contact. Thus, releasing
this blockage may be impeding awareness. Farah may also be facing a growth disorder
which is an emotional problem that is caused by her lack of awareness preventing proper
interaction with the environment resulting in her dealing with issues in a defensive
manner as shown in the case above (Farah’s verbal interaction with a classmate during
class). Thus, approaching Farah in a way where she is seen as a self-regulating individual
who is able to motivate herself to solve different problems will be her guide towards
growing and developing as her own individual.
As a Gestalt Therapist, my approach with Farah relies on an active partnership with Farah
where she can learn about herself and adopt a realistic attitude towards her life by altering
her behaviors and seeing where that leads, furthermore, my aim is not to change Farah
rather assist her in developing her own self-awareness in the present moment allowing
her to resolve issues in her own life. Furthermore, confrontation will be key factor in our
sessions, it will allow me to challenge Farah in an empathetic way allowing her to face
issues that are important to her as well as using locating emotions in the body will guide
Farah in bringing awareness into her sensations and emotions.
These changes will occur as I integrate experiments and different learning experiences
with Farah. The experiments will be designed as form of a portrayal, homework, role-
playing and other activities that play an active role in promoting self-awareness. For
example, Since Farah has a problem with maintain eye contact, her homework would be
to talk to her instructor while maintaining total eye contact for the entire conversation, as
she spends time thinking about how she will look her instructor in the eyes for a long
period of time, it will promote self-awareness and enhance her self-confidence in
situations she deems uncomfortable.
III Would Reality Therapy work with clients like Farah? Why?

Yes, Reality therapy is effective with clients like Farah. Reality therapy is
established on a notion called choice therapy which means that clients like Farah strive
towards a goal, shape meaningful relationships, and progress their problem-solving skills.
The goal of Reality therapy is the improve the client’s overall life satisfaction, guide
them in finding meaning in life and enhance their well-being. This will guide Farah (or
other similar clients) to focus on the here and now rather than the past and will promote
her problem-solving skills to make better decisions to achiever her goals. Reality therapy
focuses on the idea that mental anguish is not the result of mental illness, rather an
outcome that individuals experience when their basic psychological need haven’t been
met and they are as follows; These have been revealed in the case of Farah as she had
experienced a tough life of being adopted, having an alcoholic father, interpersonal
difficulties, anger issues and feelings of abandonment.
More details in the table below;

Basic Psychological needs Application to Farah’s case

Love and belonging Farah has mentioned that her alcoholic dad
was good to her and that she adored him as
well as her hard-working disciplined mom,
but this has resulted in interpersonal
difficulties with her husband that led to
being codependent and eventually
divorced. Keeping in mind that she has
been adopted which might have led her to
fear abandonment and having a sense of
insecurity with authority figures leaving
her to, crave a sense of belonging.
Power and achievement Farah is a full-time student, pursuing a
medical degree this shows her dedication
towards achieving her goal and probably
providing her with a sense of power over
one thing in her life as she demonstrates
poor eye contact and avoids uncomfortable
situation.
Survival Farah lives with her mom who is dedicated
and hard-working and who always argued
with her alcoholic father which might have
caused Farah to develop a problem in
managing and expressing her anger
Freedom and independence Farah is somewhat independent, since after
being divorced she now lives with her
 mom, this shows that Farah has a fear of
being alone and cannot let go of others.
Fun Farah lacks severely in this department; she
has a problem with expressing her feelings
as well as her temper, she also has feelings
of resentment and guilt which do come in
the way of having fun especially when
Farah’s behavior remains the same.

As Human beings we are always actively working to meet those needs, and often time we
struggle between our feelings and physiology however we are able to choose our
thoughts and actions directly (sometimes ineffectively) and this causes a negative
repercussion on our health and well-being. Therefore, Reality Therapy guides clients like
Farah to dins ways of meeting their own personal needs while becoming aware of and
working towards changing negative thoughts and actions.

Furthermore, Reality Therapy will guide clients like Farah to strive towards a goal while
advancing her problem-solving skills and they rely on the three R’s.
The three R’s of Reality therapy
1- Realism
2- Responsibility
3- Right and wrong
Whereby Clients like Farah will face their problems and not deny them (I.e. anger issues)
they will also assume responsibility by recognizing that they are responsible for their own
behaviors ( not deny the issue or avoid it) which in Farah’s case would be her insecurity
with authority figures and as result clients will learn the idea of working with other
people towards achieving a goal and taking decisions where everyone no one is hurt and
still be beneficial.
Since Reality/choice therapy is composed of four distinct components;
1- Thinking
2- Acting
3- Feeling
4- Physiology

clients like Farah will become aware of their thoughts and feelings and working to
establish a strategy towards achieving their goals, change will be evident by focusing on
how their thoughts and behaviors have changed. As shown in the figure below

What do you want?

 What are you doing to get
what you want?

What is
happening
at these
stages

What other things could you

do to get what you want?

To conclude, Reality therapy will enhance individual’s self-awareness and will increase
their responsibility towards the choices they make in their lives which would be very
useful for Farah. Furthermore, Reality Therapy has been proven to be especially effective
to treat individuals with substance abuse, anxiety, and other behavioral and emotional
issues. Which will be of help for Farah (or other similar clients) as it will help her solve
most of her issues with Self-confidence, codependence, feeling of abandonment, and
temper issues.
IV What are the major characteristics of effective counselors? Are there any
contradictions between these characteristics and the various theories that you have
explored this semester? (This is a general question and not specific to Farah’s
case)

Various qualities and characteristics are key factors in whether we deem a

counselor as effective keeping in mind that each therapist is unique and has his/her
own way in therapy; first and foremost an effective therapist has his/her own
identity, they are aware of who they are as individuals, they know who they want
to be as individuals and most importantly they know what they want.
Consequently, an effective therapist respects and appreciates themselves by giving
help and obtaining help, they also have self-worth and are strong individuals that
feel adequate with others, they are also open to change, effective therapist possess
the willingness and courage to leave what they are familiar with if they are not
satisfied and venture in a new direction as they make decisions about who they
want to become as an individual and what they would change to become a better
version of themselves. They also do their job in an ethical and professional way.
They also remain true to themselves; they are authentic, sincere, and honest, they
are the same person inside therapy and outside. In addition, they take decisions
that are life-oriented, they are fully aware of the early decisions they have around
themselves, others and the world and they are willing to revisit them when needed.
This show that they are committed to living life fully rather than merely existing.
Effective therapists are real humans and so they have a sense of humor whereby
they put life events into perspective, they also make mistakes and are not afraid to
admit them. Effective therapists live in the present as they guide clients to live
fully in the present as well, they are not focused on the past nor the future. In
addition, they value cultural influences, they know that culture pays a very
important role in shaping us as individual and thus they respect other people’s
culture’s and preach diversity, they also respect individual’s cultural, ethnic,
gender and social differences. In parallel they respect, care, trust and value
individuals around them. With that, they have interpersonal skills that permit them
to create collaborative relationships with other individuals, they understand other
people’s perspective and knows how to manage and work with them. Most
importantly, the key point to be an effective therapist is passion, they derive
meaning from their work and they are passionate about it, they love and value their
job and are able to maintain healthy boundaries with their clients allowing them to
have a balanced life.
Yes, no theory is perfect, and no therapist has all those qualities. As we have
learned and explored throughout the semester, each theory is directed toward
tackling certain problems, you will find the theories and their contradictions in the
table below;
Psychoanalytical theory
Adlerian Therapy
Existential Therapy
Person-Centered Therapy
Gestalt Therapy
Cognitive behavioral therapy
In psychoanalysis, the contradiction is
obvious, they focus on the unconscious as
well the individual’s entire life strating
from his/her childhood up until adulthood.
Meaning that it is oriented towards the past
more than the present.
In Adlerian therapy, they focus on the
individual’s childhood, tackling the early
stages in life, the therapist also emphasizes
on the birth order in the family during
therapy rather than focusing on the
individual’s stuggles like an effective
therapist should.
In existential therapy, the therapist
empowers the individual to take
responsibility for the future and create the
future they desire. Meaning that an
effective therapist should guide his client to
focus on what they can do in the here and
now rather than the unknown which is the
future. It also highly depends on the
therapist’s own individual stance.
In person-centered therapy, there is a heavy
reliance on the therapist’s ability to
consistently be non-judgmental,
unconditionally accepting, and empathetic
with their clients and no effective
counselors is perfect and because we are
human, we are prone to judge others.
In Gestalt therapy, there is heavy reliance
on being confrontational, it sometimes
portrays the therapist as mean and has a
strong attitude.
In Cognitive Behavioral therapy, the focus
is mostly only on the present, they focus on
addressing current problems rather than the
underlying causes. CBT focuses on the
individual themselves (thoughts/feelings)
and don’t address various problems in the
families that often impact the individual’s
 wellbeing.
Reality/choice Therapy In Reality therapy, the therapist does not
tolerate excuses no matter the situation and
it could come of as apathetic.