Medical Crisis Counseling

One experience that had great impact to my developmental stage occurred within the context of a sudden dissolution of a long-time romantic relationship. Being left by someone who has been a part of my life for so long, it almost feels like I was suddenly handicapped—the experience was truly devastating. This was exacerbated by feelings of rejection, inadequacy, anger, add to that the stigma of letting a seemingly perfect relationship “go to the dogs,” so to speak.

This event has had a huge impact on my self-esteem—I felt my zest and passion for life dry up, and indeed, it came to a point when I was on the verge of breakdown, in all physical, spiritual, and emotional aspects. The first few weeks after the break-up were the hardest. Although I knew there is no way I can undo what’s been done or change the way things turned out, I found it hard to accept the fact that the relationship is gone. I found passive acquiescence difficult.

In many different levels, I felt incapacitated by the sudden loss of a person whom I considered a part of my being, the bedrock in which I stand on, and the lifeline to my sanity. Aside from the emotional aspect, how I live my day-to-day was greatly affected. “Symptoms” that I am still not completely over this person include severe depression and feelings of alienation. I never realized the magnitude of its effect until I started missing school, forgetting appointments, and in a lot of ways, letting myself go—during this period, I started shutting myself off from the world.

Intervention came in the form of close friends who tried to console me during this difficult time of adjusting. I noticed that I get invited to go out more, perhaps their own way of helping me get my mind off things and move on. One person who has been instrumental in my recovery is my best friend, who has been in a similar situation and recognized that what I’ve been doing is detrimental to my physical, emotional, and social well being. She has served as a sounding board for my woes and provided the emotional support I needed.

At my friend’s behest, I also considered seeing a professional in order to receive formal counseling. A few sessions with a psychologist helped me sort out my feelings and face some issues that I have been bottling up since the breakdown of my relationship. I countered the feeling of helplessness and lack of direction by taking up some hobbies and concentrating on things that would keep me busy and occupied. Part of adapting with my new lifestyle also includes setting a few goals for myself: I focused on my strengths as an individual and looked at my newfound independence as an opportunity to explore these strengths.

My personal goals include completely adjusting emotionally to having the person from my former relationship cut out of my life and moving on to finding other sources of support. Eventually, with some hesitation, I tried dipping my feet into the dating pool again. I also aimed towards a holistic “healing” approach by trying to be a better person, physically, emotionally, and intellectually. As time went on, I learned to see my experience as a blessing rather than a curse—a chance to start a new chapter in my life and to understand myself better in ways that I never would have known if it wasn’t for this event.

I also feel that I have put the limits of my spirit, my strengths, and the essence of my whole being to the test—and I came out of it a stronger and better person. I learned that life is about learning and living—that no matter how bleak and dreary one’s situation may be, there are ways to overcome these obstacles. Though not medical in nature, this episode in my life has put my coping and adapting skills to the test. Through the things and ordeals that I’ve been through as a result of this event, I feel I can handle whatever difficulties may come my way in the future.

Part 2: Learning Outcomes 3, 5 (5 lines/issue) Chapter 3. `Getting Started` Chapter 4. `Eight Issues of Chronic Illness` The MCC model is a solution-focused short-term approach to therapy. Based on the text, discuss setting appropriate goals for each of the eight issues with a 16-year-old with insulin-dependent diabetes. Be sure to take into considerations the developmental needs of an adolescent. Control Insulin-dependent diabetes is currently incurable, and treatment is something that has to be continued indefinitely.

The uncertainty of the treatment’s duration is disquieting to a person who is suffering from a long-term illness, and this realization often leaves a person with a sense of helplessness, a psychological paralysis where one feels powerless to control one’s life. As such, with a counselor’s help, the patient and his or her family must identify the areas where control is still possible. In this case, it includes understanding the pathological, as well as psychological nature and ramification of the disease.

Being an adolescent, the patient should already be capable of understanding and making decisions about his condition, and so his or her participation in the decision-making process should be taken into account—this would help facilitate the feeling of control. Setting realistic goals would help the patient feel that he or she can still take charge of his or her life. Self-image A life-long disease can take a huge toll on a person’s self-image, especially during adolescence where a person is most self-conscious of his or her body and appearance.

A counselor can help the patient face the new reality of his or her condition by exploring current attitude towards that person’s self—the goal should be towards acceptance of his or her new, altered physical and mental state. In addition to this, rather than dwelling on the negative, focus must be redirected towards the patient’s positive attributes and those aspects of his/herself that can be controlled. Dependency The need to assert one’s independence is especially strong during adolescence, and having diabetes can evoke intense feelings of fear of loss of one’s independence.

This can be exacerbated by the patient’s fear of being a burden to his or her family. The patient must realize that these feelings are but a natural reaction for patients diagnosed with long-term illnesses. Due to the patient’s age, he or she is presumably emotionally and psychologically competent—the goal then is to facilitate self-reliance but at the same time fostering the ability to ask help while upholding his or her dignity. Building trust and respect in one’s interpersonal relations would figure greatly in the patient’s adjustment. Abandonment

For a person with a serious illness, the fear of abandonment becomes a major issue in his or her life and serves as a defining factor in one’s family relationships. In this regard, it is necessary that the patient’s family and support group affirm their commitment to him or her, or to at least foster open communications wherein future prospects can be evaluated and discussed. Stigma Many people diagnosed with diabetes associate a certain stigma to being dependent to insulin pumps and to constant, regular monitoring of one’s blood glucose.

These things, along with a fractured sense of self-image, may make them feel “abnormal”. For some, acquiring (or even just the possibility of acquiring) serious complications which come with diabetes (such as blindness, paralysis, cardiovascular diseases) can cause feelings of stigma. It is necessary to determine which feelings come from actual social stigma, or which are just manifestations of their own fears. It is equally important that the patient aims toward preserving and reinforcing his or her self-esteem so that he or she would not be easily affected by the negativity others may project onto him or her.

Isolation When dealing with a serious medical condition, it is possible that the patient would develop feelings of isolation or alienation from the rest of the society. It is necessary that the root of these feelings be explored in order to find ways for the patient to cope. Maintaining healthy, loving relationships with others is paramount for the patient to get past this hurdle. Anger Patients with diabetes, especially those with the insulin-dependent type, may present with physiologically related symptoms which can manifest as expressions of anger.

These symptoms include altered states of consciousness, hostility, lethargy, and mania. As such, it is necessary for the patient to determine the difference between the physical sensations that come with the disease and real, psychologically driven ones. Redirecting anger and negative energy towards other things such as hobbies and exercise can help the patient cope with these feelings. Maintaining an open communication with one’s family can also lessen feelings of abandonment or loss of control that make a patient develop feelings of anger, resentment, or anxiety. Death

Diabetes, or any serious medical condition for that matter, can be a constant, unpleasant reminder of a person’s mortality. One important thing that should be stressed to people with this frame of mind is that the quality of one’s life is more important than its length. The patient’s goal therefore should be created in the context living every moment of his life fully, that having a happy and meaningful life need not be hampered by thoughts of death or dying. Part 3: Learning outcomes 3 Chapter 5 `One patient`s Story` Chapter 6 `The Family` Chapter 7 `Group Treatment`

The text presents an adaptation of MCC when working with families. Considering the patient alone and then the family unit: 1) List, 2) Discuss, and 3) Give a possible prevention or solution for four to six conceivable legal and ethical issues that could arise. (Consider such issues as confidentiality; dual roles; secrets from other family members; traditional therapy boundaries such as contact outside of therapy sessions, touching, access to therapist; and therapy setting possibly being in public places such as a hospital room where nurses, doctors, cleaning staff may enter at any time.

Feel free to use other issues. ) Confidentiality It is only natural for patients to have issues with confidentiality. They expect that only people involved in the monitoring of their care can see their medical files and that discussions with medical practitioners about their condition are conducted discreetly and privately. As such, employing ethical behavior with respect for the patient as well as his family’s confidentiality is not just a necessity but a medical practitioner’s obligation.

If there are issues raised in a session, which the counselor thinks others, beside him/herself, should know, the counselor must obtain express approval from the patient first. Dual roles During counseling, it is possible for counselors to assume dual, or ever multiple roles. These roles can include being a friend or being another source of emotional support for the patient. While this can help the patient tackle some issues or alleviate negative feelings, it might create an unhealthy dependency to the counselor.

MCC should not be impersonal, but at the same time, expectations as to what the counselor can or cannot do must be set in order to prevent confusion regarding roles. Since the goal of MCC is to reinforce strengths, it should help the patient and his family focus in developing healthy support dynamics, as well as optimizing functioning within the constraints of the patient’s illness or disability. Secrets from other family members One of MCC’s goals is to restore equilibrium to the system by attempting to provide the patient and his family with the information necessary to enable them to cope with the illness better.

However, a counselor must always demonstrate a commitment to ethical principles, and this includes the ability to keep secrets when dealing with patients and families. Integrating what the counselor has learned from a family member into subsequent sessions with the patient is possible without violating the trust and confidentiality. Traditional therapy boundaries Crossing traditional therapy boundaries, such as contact outside of therapy sessions can be a real issue when it comes to MCC, especially when the counselor becomes thoroughly involved with a patient’s life and feels the need to monitor his or her progress.

However, it is important that professional boundaries are established and maintained, although the counselor should still be open to providing assistance in emergencies as appropriate. Determining the patient’s need, whether or not he would require additional care, and setting expectations in the onset of therapy would help maintain these boundaries. Part 4: Learning outcomes 3, 5 Group treatment using the MCC model is discussed in chapter 7. Discuss what a support group can add to the treatment of a client who is receiving individual counseling.

In the treatment of a person with a serious medical illness, a support group is one of the most effective strategies. A medical diagnosis affects every aspect of a person’s life; thus a support group is important in providing complete care for the patient, giving them the best potential for leading full lives. A support group is a relief system for the patient. Most patients with severe illnesses would generally want to gain more control and feel emotionally and physically better. Persons who are diagnosed with severe illnesses experience anger, shock, and fear, particularly of physical suffering and death.

As in many other situations, confronting and accepting the reality of the problem is usually better than refusing to acknowledge and suppressing emotions about it. Being able to vent out feelings about their diagnosis about their experiences allows them to realize that their emotional reactions were normal and expected, and that they were not “abnormal” in the psychological sense. Support groups provide normalization for the patient. Many persons who undergo group counseling will agree that what’s most important is that they saw that they were not alone, and knowing how others cope with disease certainly helps.

Support groups help in making the patient aware that there are other persons who are and have gone through similar ordeals. In group counseling, many issues that patients may have been afraid to bring up with others are more easily addressed, because they are more comfortable with the knowledge that the others in the group are experiencing the same thing. Through the group, patients receive much needed social support. Support groups greatly aid in lending a sense of normality to the ill person’s situation. The ability to express their feelings with sympathetic persons who they know understand perfectly gives them a sense of solidarity.

The fear of rejection and pity, which are typical reactions, is reduced significantly. The support group also provides practical knowledge on ways in which the patient can cope and adapt to their illness. Humor, for example, can serve as a coping mechanism; and it is certainly much easier to be humorous about an illness with others who share the illness. In sharing their stories with each other, they will acquire what are essentially preparatory “life experiences” that can help them to behave more positively towards others about disclosing their illness.

By discussing their hopes for the future and the things that gave meaning to their lives, they also gain a more positive outlook and are less likely to consider suicide and experience depression. They realize that the suppression of fears and other negative emotions has no real benefit. The effects are not limited to the psychological, however. There is some evidence that points to the potential of support groups to actually help in the survival rate of patients.