Final Demonstration and Assignment

Department of Psychology, Forman Christian College University

PSYC 440: Counseling Psychology

Name: Faraz Ahmed

Roll. No: 231-453072

Nazia A. Thakkar

June 27th, 2022

Case History and Presenting Problem

(i) Demographic Information:

Name initials: N.F.W

Pseudonym: Sonia

Age: 22

Gender: Female

Number of siblings: 2

No. of parents: 1

Birth Order: First child

Education: BS (Hons)

Occupation: Part-time freelancer at an advertising firm

Socio-Economic Status: Middle Class

Marital status: single

Religion: Islam

(ii) History

Growing up, Sonia was really close with her family. The oldest sister to two younger

sisters, Sonia lost her father 5 years from now and that itself has been a very tragic incident for

her to cope up with. As per the client, child she has always been very good academically, and

her relationship with her parents was pretty good. Being closer to her dad and the eldest

daughter, she was often prioritized in her family. Her father was a strong businessman, and

their family was blessed with all the luxuries one could ever wish for. Coming from a very

social family, they would be on trips and events almost all the time which made her a very

outgoing person from a very young age.

Throughout her school life, she was amongst one of the best students in her class as well

as a very active student through her extra curriculars. She was the president of the debating

society through her college and got into a renowned university on scholarship. However, a

tragedy struck her family when she was in college, her father passed away. As of now it has

been 5 years since her father passed away and it had a very negative impact on her mental

health as well as social life. Bing the closest to her father, she had to go through a very tough
time academically but she somehow managed to secure an scholarship in university based on

her debating skills.

According to the client, after her father passed away, she had to move to a new city with her

family and they faced a major loss in terms of finances. This was another setback for her as she

had to start working in order to support her family. The client mentioned facing problems

moving from a super comfortable house environment to a rough practical life as she started

working in an attempt to handle the finances.

Recently, client found out that her mother secretly remarried and realizing that some

other man had taken her father’s place was something she could not handle very well. The

client stated that she started reducing the time she spent with her mother otherwise as she could

not bear the presence of another man in her home. Trying to cope up with the intensity of the

situation, she started isolating herself and started feeling rather anxious when she was around

her mother and her step father. When isolation did not help, she started directing her attention

towards recreational drugs like hash and marijuana. Initially it was something she hid from her

mother but she soon found out which further deteriorated their relationship. As of now, the

client barely speaks to her mother, expressed concerns about highly disturbed sleep schedule

and a negative influence of using too much drugs on her life.

Presenting the problem

At the start of the therapy, client, Sonia expressed feelings of hopelessness in terms of

her future and was heavily dependent on drugs. Ever since her father passed away, she has felt

left out of her own family as she was the closest to him. This really impacted her social life

which became very limited and realizing her mother gave her father’s place to another man, she

developed a very pessimistic mindset. In order to deal with her feelings of hopelessness she

moved towards drug abuse. At this point she gets triggered when someone mentions her getting

married as she feels nobody is trustworthy enough to marry. Losing her father, she felt that she

could never find true love and appreciation therefore a great deal of hopelessness

overshadowed her life. This resulted in a deteriorating relationship with her mother, diverting

attention towards drugs to calm down her feelings of helplessness and going in for a job with
extreme working hours to keep herself distracted. Isolation, anxiety and drug abuse are some of

her main concerns. Client expressed racing heartbeat when around her mother, constant

headaches, palpitations, difficulty concentrating, getting easily irritable and extreme withdrawal

symptoms when she does not find her usual drugs. After getting completely burnt out, she

realized she needed help and that’s when she came in for therapy.

Understanding the Case in Theoretical Perspective

The situation of client Sonia is best treated using strategies from the behavioral

therapy paradigm. This school of thinking holds that an individual is a product of their

surroundings and experiences. This indicates that a human is a blank slate, and the way he or

she perceives the situation is through the lens of their subjective experience, which leads

them to their major concern: 'a human is neither good nor bad, but neutral.' In contrast to

other schools of thought such as psychoanalytical or humanistic approaches, behaviorists

argue that intrapsychic perspectives are more essential and that problems arise from them.

Behavior therapy is best used for conditioned behaviors that pose harm to oneself.

The case of Sonia is one such case which can be looked deeper through the eyes of a

behavioristic approach. Her actions such as drug abuse or self isolation are purely

conditioned from her recent experiences of her father’s death, financial crisis and last but not

the least, her mother’s 2nd marriage. Sonya forming maladaptive behaviors is entirely a result

of her experience and negative reinforcement where a child might do what’s right but not get

what she wants so she would rather go for something that would not be favourable for her

but at least she wont get punished. In this case, drugs and self isolation are the actions she

believed save her from the constant tragic events. The client wishes to diminish this self

sabotaging behavior which weighs her down and has exceeded to an extent that he is falling

behind in mundane tasks as well. From literature behavior therapy is best suited
 in this such cases as it is an unwanted/maladaptive behavior which needs to be diminished

(Bergin, 1970).

Role as a counselor and techniques

In this modern world, where everything has become so fast-paced, everyone is busy with

their lives so much and trying to cope up with their own problems that they don’t have time to

listen to what others might be going through. Additionally, during the pandemic, these problems

in people’s lives have increased to a greater extent and almost everyone is going through the first

pandemic in their lives which suggests that we have no prior experience related to it hence

making it difficult to cope up with it. My role as a counselor is to be a dedicated listener who

listens to the client whole-heartedly, help them identify the problem as it is the first step towards

change, nevertheless also help finding them direction which leads to the path of betterment.

However, change never occurs overnight, it is a process a person goes through, while my client

goes through this process my aim is to be there as an active moral support for one in order to

make her identify their problems, realize her potential of growth and eventually making one self-

reliant enough who can deal with their own problems effectively. Moreover, the behavioral

therapy’s focus is upon helping client change the behavior which is causing problem and making

them realize how would the change result in positive outcomes, so another focus be to eradicate

the identified undesirable and mal-adaptive behavior and change it with an adaptive and

desirable behavior which can give the client a sense of positivity and encouragement to

overcome the habit of drug-use (Gotter, 2018). Despite the fact, the path chosen towards the end

goal could vary according to client, the main focus of this counselling session would be to put an

end to maladaptive behavior and replace it with adaptive behavior.

 Intervention:

1) Relaxation training

The relaxation therapy refers to the techniques designed to enable voluntary relaxation. The

most common form of relaxation training used by behavioral therapists is progressive relaxation.

It is used to treat variety of disorders including headaches, psychosomatic pain, other anxiety

related problems etc. the main focus of this technique is to ease up tensed muscles by able to

discriminate between tensed and relaxed muscles, with relaxing the muscles anxiety can be felt

to be reduce as anxiety increase tensed muscles.

Rationale

Anxiety tends to increase the amount of anxiety experienced by individuals, the prime

purpose of using this technique is to relax tensed muscles for a while which increases the blood

circulation in body leading to lowering resting heart rate enabling the individual to focus on

present situation and increasing self-awareness. Additionally, these relaxations and breathing

techniques reducing the impact of stress-related situation and encourages physiological and more

importantly psychological equilibrium.

Implementation

The procedure of applying this technique to particularly this client would include to

successively tense and relax various muscles in the body while directing the focus of client on

the relaxing sensations. Each step of this step would of 10-15 seconds with an equal interval and
would be practiced several times. It would be done in a quiet environment and my role as a

counsellor over here would be to use soothing tone while directing the individuals (Stasiewicz et

al., 1996).

2) Behavioral assessment:

Behavioral therapies most often start with the behavioral assessment when they start working

with their client. This technique’s purpose is to gather information about the problem client has

presented to be going through and the behaviors which come along. The information that needs

to be collected must be specific and concrete about particular situations and how do the client

react to it in order to know the root cause of the problematic behavior.

Rationale

The rationale of this technique is to collect information regarding the behavior of the

client in particular situations in order to dig deep down and understand what leads the client to

act in a certain way. Furthermore, one of this technique’s goal is to identify the target behavior

and more importantly the controlling variables which lead the client to act in a particular manner

so that problem is understood which leads to developing a strategy to effectively intervene and

tackle the problem from its root cause.

Implementation

This technique would be implemented by doing behavioral interviewing in which client is

asked questions related to their behavior, the questions can include why, where, when how etc. in

this certain scenario of drug-use the client can be asked questions like when do think of doing the
drug? Or perhaps if I were watching you in the situation, what would I see? Asking questions

like these, bring out specific information which helps develop an accurate picture of client’s

behavior in the situations they go through which helps counselor get a better idea of the problem

behavior and its associated variables.

3) Systematic Desensitization

It is a technique designed to reduce anxiety which has its basis upon the concept of classical

conditioning (Raypole, 2019). It involves pairing of the neutral stimuli with the stimuli which

brings out fear. The client is exposed to a situation which brings out fear, step by step, gradually

one is exposed to the situations with stronger stimuli until the stimuli which used to bring out

fear can be experienced in a relaxed state (Mcleod, 2021).

Rationale

This technique is to be used because the client mentioned that she started using drugs to

avoid situations which bring anxiety and fear inside her (Bergin, 1970). This technique aims to

reduce the anxiety by facing the situation, gradually moving in to it and being exposed to it.

Furthermore, experiencing situations or stimuli gradually would reduce the amount of fear or

anxiety experienced by the client which would decouple the maladaptive behavior hence leading

to adapting a better way to deal with the situation rather than avoiding it which would be the first

step to building the way of better well-being and would help develop the confidence to face

upcoming situations in life too.

Implementation
 For implementation of this technique, there are three steps; training in deep muscle

relaxation, constructing a hierarchy of emotionally provoking situations and systematically

pairing the items on the list with relaxed state. Hierarchy construction includes pointing out

situations that bring out anxiety or fear regarding the situation client has already faced or hopes

to deal with in near future, this hierarchy usually includes 10 to 20 items on the list which are

arranged according to lowest to the highest provoking situations. Once the hierarchy is

constructed, client would be exposed to the situation step by step as the situation stops producing

fear and then client would move on the next step and the process would go on until client faces

highest provoking situation in a relaxed state which is known as the pairing process.

Conclusion

When Sonia first came for therapy, she expressed extreme behaviors that were not good

for her. Such behaviors led to increased symptoms of anxiety such as sweating, irritability,

palpitations, constant headaches, restlessness, hopelessness, and a pessimistic view of everything

which directed towards drugs to feel better. However, after going through therapeutic techniques

with her, Sonia expressed some degree of relief and was ready to work on herself. The willpower

to do better increased and it showed in her actions as she started spending more time with her

mother and reduced the amount of drugs she did massively as compared to older times.
References

Bergin, A. E. (1970). Behavior therapy. Behavior Therapy, 1(4), 550–554.

https://doi.org/10.1016/s0005-7894(70)80082-x

Gotter, A. (2018, September 29). Behavioral Therapy. Healthline.

https://www.healthline.com/health/behavioral-therapy

Mcleod, S. (2021). Systematic Desensitization as a Counter-conditioning Process | Simply

Psychology. Simply Psychology. https://www.simplypsychology.org/Systematic-

Desensitisation.html

Raypole, C. (2019, February 25). How Systematic Desensitization Can Help You Overcome

Fear. Healthline. https://www.healthline.com/health/systematic-desensitization#:

%7E:text=Systematic%20desensitization%20is%20an%20evidence,you%20slowly

%20overcome%20a%20phobia.

Stasiewicz, P. R., Carey, K. B., Bradizza, C. M., & Maisto, S. A. (1996). Behavioral assessment

of substance abuse with co-occurring psychiatric disorder. Cognitive and Behavioral

Practice, 3(1), 91–105. https://doi.org/10.1016/s1077-7229(96)80032-0