If this client were to be seen on an ongoing basis, describe thetypes of change or outcomes one could realistically expect to seein this client, in light of the problems mentioned earlier usingthe identified approach in therapy. Be specific and show how theprocess of therapy with this counseling approach would lead to theoutcomes intended .Utilize either of the following theories:Gestalt, Behavior, or CBT

Background Data

A brief description of data from the intake form is providedhere:

           Age: 39

           Sex: Female

           Race: Caucasian

           Marital Status: Married

           Socioeconomic Status: Middle class

           Appearance: Dresses meticulously, is overweight, fidgets constantlywith her clothes,

           avoids eye contact, and speaks rapidly.

           Living Situation: Recently graduated from college as anelementary-education major,

           Lives with husband (John, 45) and her children (Rob, 19; Jennifer,18; Susan, 17; and

           Adam, 16).

Presenting Problem

Client reports general dissatisfaction. She says her life israther uneventful and predictable, and she feels some panic overreaching the age of 39, wondering where the years have gone. For 2years she has been troubled with a range of psychosomaticcomplaints, including sleep disturbances, anxiety, dizziness, heartpalpitations, and headaches. At times she has to push herself toleave the house. Client complains that she cries easily overtrivial matters, often feels depressed, and has a weightproblem.

History of Presenting Problem

Client’s major career was as a housewife and mother until herchildren became adolescents. She then entered college part time andobtained a bachelor’s degree. She has recently begun work toward acredential in elementary education. Through her contacts withothers at the university, she became aware of how she has limitedherself; how she has fostered her family’s dependence on her ownlife. As a part of the course, she participated in self-awarenessgroups, had a few individual counseling sessions, and wrote severalpapers dealing with the turning points in her own life. One of therequirements was to write an extensive autobiography based on anapplication of the principles of the counseling course to her ownpersonal development. This course and her experiences with fellowstudents in it acted as a catalyst in getting her to take an honestlook at her life. Ruth is not clear at this point who she is, apartfrom being mother, wife, and student. She realizes that she doesnot have a good sense of what she wants for herself and that shetypically lived up to what others in her life wanted for her. Ruthhas decided to seek individual counseling to explore her concernsin several areas:

• A physician whom she consulted could find no organic or medicalbasis for her physical symptoms and recommended personal therapy.In her words, her major symptoms are these: “I sometimes feel verypanicky, especially at night when I’m trying to sleep. SometimesI’ll wake up and find it difficult to breathe, my heart will bepounding, and I’ll break out in a cold sweat. I toss and turntrying to relax, and instead I feel tense and worry a lot aboutmany little things. It’s hard for me to turn off these thoughts.Then during the day I’m so tired I can hardly function, and I findthat lately I cry very easily if even minor things go wrong.”
• Ruth is aware that she has lived a very structured anddisciplined life, that she has functioned largely by taking care ofthe home and the needs of her four children and her husband, andthat to some degree she is no longer content with this. Yet shereports that she doesn’t know what “more than this” is. Althoughshe would like to get more involved professionally, the thought ofdoing so frightens her. She worries about her right to think andact selfishly, she fears not succeeding in the professional world,and most of all she worries about how becoming more professionallyinvolved might threaten her family.
• Ruth’s children range in age from 16-19, and all of them arenot finding more of their satisfactions outside the family and thehome are spending increasing time with their friends. Ruth seesthese changes and is concerned about “losing” them. She is havingparticular problems with her daughter Jennifer, and she is at aloss how to deal with Jennifer’s rebellion. In general, Ruth feelsvery much unappreciated by her children.
• In thinking about her future, Ruth is not really sure who orwhat she wants to become. She would like to develop a sense ofherself apart from the expectations of others. She finds herselfwondering what she “should” want and what she “should” be doing.Ruth does not find her relationship with her husband, John, at allsatisfactory. He appears to be resisting her attempts to makechanges and prefers that she remain as she was. But she is anxiousover the prospects of challenging this relationship, fearing thatif she does she might end up alone.
• Lately, Ruth is experiencing more concern over aging and losingher “looks.” All of these factors combined have provided themotivation for her to take the necessary steps to initiateindividual therapy. Perhaps the greatest catalyst that triggeredher to come for therapy is the increase of her physical symptomsand her anxiety.

PsychosocialHistory

Client was the oldest of fourchildren. Her father is a fundamentalist minister, and her mother,a housewife. She describes her father as distant, authoritarian,and rigid; her relationship with him was one of unquestioning,fearful adherence to his rules and standards. She remembers hermother as being critical, and she thought that she could never doenough to please her. At other times her mother was supportive. Thefamily demonstrated little affection. In many ways Ruth took on therole of caring for her younger brother and sisters, largely in thehope of winning the approval of her parents. When she attempted tohave any kind of fun, Ruth encountered her father’s disapproval andoutright scorn. To a large extent this pattern of taking care ofothers has extended throughout her life.

      Onecritical incident took place when Ruth was 6 years old. Shereported: “my father caught me ‘playing doctor’ with an 8-year-oldboy. He lectured me and refused to speak to me for weeks. I feltextremely guilty and ashamed.” It appears that Ruth carriedfeelings of guilt into her adolescence and that she repressed herown emerging sexuality.

      In hersocial relationships Ruth had difficulty making and keepingfriends. She felt socially isolated from her peers because theyviewed her as “weird.” Although she wanted the approval of others,she was not willing to compromise her morals for fear ofconsequence.

      She wasnot allowed to date until she completed high school. At the age of19 she married the first person that she dated. She used her motheras a role model by becoming a homemaker.