Emily is a 39- year-old female who is of African American decent has attended her first session with her 31-year-old sister. Emily is very attached with her family and relies on her sisters and mothers support. Culturally she is from a Haitian decent and the 4th generation to living in the United states. She claims that she is not really fully connected with the cultural as much as her grandmother is. She identifies as a middle class citizen and who’s occupation is a teacher. She also identifies as a straight female and she is a fully functional person.
Emily’s primary symptom was that she was not eating a majority of these foods that were prepared at home. She was struggling a great deal to leave the house and seemed affected by preoccupation with thoughts were around getting a stomach virus. She was fearful that eating anything that was prepared at home would result vomiting and sickness. She also frequently looks at her utensil to check for cleanliness and handwashing washed 7-9 times a day. Over the course of sixty days Emily had lost 27 pounds as a result of eating restrictions. When she was coming into the office before she had will pull her sleeves to cover her hands to open the door from the lobby to the main office. During the appointment during the session she has shown very little eye contact. Emily’s sister and mother attends some if the counseling sessions with her for support. Emily often look to her mother and sister throughout the session to assist in answering questions or for more clarification. She was able to discuss her big interest in fashion designing and also jewelry making. She had started Instagram account where is able to post for work online.
Doll intake the grass to discussion on the symptoms that are related to her weight loss. Emily had discussed her feelings that’s a weight loss now was likely unhealthier than any stomach virus she could ever contract. She had no rational reason for fearing vomiting nor could he described a situation in which wear vomiting or sickness can occur for her. During the intake and talking about that her excessive weight loss she’s been coughing again and again throughout the session. Her sister had reported that it’s been “Happening forever”. More social content on Emily she has in the pas struggled with appropriate communication with other people. She finds it difficult communicating with others around her age.
In this Emily is having issues with cleanliness as well as being socially connected to others. Emily had stated that she had graduated from high school and college and she came from all very well educated. She also feels that sometimes she feels that when it comes to her excessive hand cleaning it enables her to do her job at the schools with the children. Eyes She was getting into the intake assessment she had also confirm that this particular behavior has started when she was 14 years old. Also when she was 14 years old she was raped by her stepfather Anna was also impregnated and lost the baby. Ever since then she’s been obsessed with the handwashing the cleanliness of everything and has a hard time connecting with everyone beside her mother and her sister. The reason why she is in therapy today is because she wants to learn how to cope with her illness as well as have more support and talk about certain things that were bothering her.
According to the DSM 5 Emily would be diagnosed with obsessive-compulsive disorder which is the presence of obsession compulsion for both. “Obsession is defined by the recurrent and persistent thoughts urges for images that are experienced at some time during the disturbance as intrusive and unwanted and that is most individuals cause marked anxiety or distress. Compulsion is defined as repetitive behavior for example handwashing and other certain behaviors for mental acts that an individual feels driven to perform in response to an obsession or according to that must be applied rigidly. The characteristic symptoms of OCD on have sense of obsession and compulsion. At first the individual tens to ignore or suppress the up sessions for example avoiding triggers for using thoughts suppression to neutralize them with another thought or action example performance compulsion. Most people with obsessive-compulsive disorder both obsession and compulsion. Compulsions are typically performed in response to an obsession. The aim is to reduce justice distress triggered by the other sessions or to prevent a feared event again. OCD is also connected with the reduced quality of life as well as high social impairment as Emily is facing.” (DSM-V).
With this diagnosis they are many things that can be connected to Emily case with OCD based on her history as well as her current action going on. Since she was she was raped she has been traumatized and horrified that this had happen to her. She felt violated as well as disgusted that not only she was raped but she was impregnated by him. The mixing of the blood and the semen inside has really impacted her. As she was going into her adult life she had struggle a lot during high school and college but had some ho manage to pull it together and graduate.; but as she got old the symptoms just got worse until she had finally decided to go to therapy. Before this she has not had any medical history also he had never told her mother or her sister. So she kept it a secret until she had revealed it during the therapy sessions. But now I’m mother has been divorced first stepfather Long back for infidelity but she had never known that he had until she had revealed it in the therapy sessions. Ethically her background is Haitian but culturally they are more Americanized she has explained that they aren’t really don’t the culture they rarely identify as it as well.
The measurements I will take in order to help this patient by focusing on there long and short term goals in order to help her control her OCD. Some of the short term goals that we will worked on are: “Reduce the frequency, intensity, and duration of obsessions and/or compulsions.
Reduce time involved with or interference from obsessions and compulsions. Function daily at a consistent level with minimal interference from obsessions and compulsions.
Resolve key life conflicts and the emotional stress that fuels obsessive- compulsive behavior patterns.
Let go of key thoughts, beliefs, and past life events in order to maximize time free from obsessions and compulsions. Accept the presence of obsessive thoughts without acting on them and commit to a value-driven Life” (Arthur et al 2014 p. 268-269).
As we will work on the long term goal we will also work on short term goals and therapeutic interventions for examples of the short term goals is: “Describe the history and nature of obsessions and compulsions. Obtain a complete medical evaluation to rule out medical and substance-related causes for anxiety symptoms. Complete psychological tests designed to assess and track the nature and severity of obsessions and compulsions. Provide behavioral, emotional, and attitudinal information toward an assessment of specifiers relevant to a DSM diagnosis, the efficacy of treatment, and the nature of the therapy relationship. Cooperate with an evaluation by a physician for psychotropic medication. Keep a daily journal of obsessions, compulsions, and triggers; record thoughts, feelings, and actions taken” (Arthur et al 2014 p. 268-269). As we go through short term goal we will also do some therapeutic interventions. We must include her sister and mother since they are her major support system. Therapeutic intervention would first began with: “Establish rapport with the client toward building a therapeutic alliance. Assess the frequency, intensity, duration, and history of the client’s obsessions and compulsions (consider using a structured interview such as The Anxiety Disorders Interview Schedule-Adult Version). Refer the client to a general physician for a complete medical examination to rule out medical or substance-related etiology for the anxiety. Assist the client in following up on the recommendations from a physical evaluation, including medications, lab work, or specialty assessments. Administer an objective measure of OCD to further assess its depth and breadth (e.g., The Yale-Brown Obsessive-Compulsive Scale; Obsessive-Compulsive Inventory- Revised); read minister as indicated to assess treatment progress. Arrange for a substance abuse evaluation and refer the client for treatment if the evaluation recommends it (see the Substance Use chapter in this Planner). Assess the client’s level of insight (syntonic versus dystonic) toward the “presenting problems” (e.g., demonstrates good insight into the problematic nature of the “described behavior,” agrees with others’ concern, and is motivated to work on change; demonstrates ambivalence regarding the “problem described” and is reluctant to address the issue as a concern; or demonstrates resistance regarding acknowledgment of the “problem described,” is not concerned, and has no motivation to change)” (Arthur et al 2014 p. 270-271).
As we go down the line his client would need more support and advocacy to receive more service and aide. To assist the client in what the need we must first build an alliance with a client and always make sure that they feel empowered when making decision. We as councilors should support the client as well but not become a crunch or impose our ideals on to the client. Once we have developed that alliance then we can supply the client with services that they need based on their needs. Ethical issues are based on the client’s situation and we must follow protocol in order for this to work. We must do what is best for our client as well as help them become as independent as possible. When it comes to OCD psychotherapy would include both cognitive therapy and exposure therapy. As the client complete each interval/sessions we should see a gradual growth with her sessions.