Case Study: The Case of Margarita, Part 2
Intake Information (background for the Part I assignment)
Margarita is a 26 year old Puerto Rican woman. She was born in Puerto Rico and moved to the United States as a teenager. Her husband is African American and has lived in the United States his entire life. The couple has been married for five years. They have two children together, a boy age three and a girl age one.
Margarita is seeking counseling due to reported “anger outbursts.” She states that she becomes so angry with her husband that she thinks of physically harming him, although she does not remember anything that he does specifically to provoke her anger. She denies any physical violence but has gone as far as grabbing a knife and threatening him. She does respond to his verbal attempts to calm her. She reports feeling relief after the “explosion.”
Margarita has an MBA and is very intelligent. Recently, she was accepted to law school and will be starting in three months. Her husband holds a prominent position in their community and he is 10 years older than she. She states that he never gets angry with her and just tells her that “things will get better.” In the assessment, you discover that it appears he is somewhat of an enabler (minimizing her outbursts), but he is very good to her. Margarita does admit that she is fearful that her husband will leave her due to her behavior. She reports that they do not communicate well, he maintains the house, and they rarely experience intimacy or sex.
Margarita also discusses feeling depressed most of the time, but she has to put on a “game face” to do her work. Her husband and her parents are the only ones who see her depressed side. She holds an important position with the community development board in the county where she lives. She also reports that she often experiences anxiety in social situations, avoids going places where she may be socially judged, and has no friends, but she does feel confident in structured work projects where she is in charge. She also reports having panic attacks on occasion and has had thoughts of suicide. She often thinks that she is not pretty enough or nice enough to have friends, although she truly wants to have quality friendships. She is always in a mode of self doubt and admits to constant negative internal dialogue.
She denies any drug or alcohol abuse or history. There is no physical or sexual abuse in her past. She states she saw a counselor about six times in college after the death of her best friend. She states she felt she should have been the one who died in the car crash and not her friend, although she was not even involved in the accident. She did not feel that the counseling was helpful. At that time, she took Paxil but had an extreme negative reaction. She is reluctant to take medication at this time.
Case Notes from Sessions 1–3 (background for the Part II assignment)
Following her intake session, Margarita made a commitment to six sessions of therapy with you. She responded well to your counseling interventions during the first three sessions, and you see evidence that you and Margarita have established a good rapport. She has been on time for her sessions and has openly discussed experiences she has had at work and at home, adding a little more detail each week. She has reported that she continues to feel overwhelmingly strong anger at times, and she still feels quite despondent about this and her life in general, although she strongly denies suicidal intentions.
In the second session, you initiated a discussion about cultural differences you have with Margarita, giving her an opportunity to articulate how she might be concerned about your understanding of her (based on your ethnicity, gender, age, or background). She said that she is confident that you can understand her, based on your interactions so far, but if she develops concerns she will let you know. You are resolved to remain vigilant to evidence of breaches in rapport and address these immediately, should they occur.
At the end of the third session, you and Margarita identified some specific goals that she would like to work on to “move the ball forward” in her life. You then prioritized these goals and asked her to think about them before your next session to be sure they were the best fit for what she most wants to change. You are beginning your fourth session with Margarita, ready to work on her priorities for change in her life, from your chosen theoretical approach.
Theoretical Framework and Application 2
You will select one theory of psychotherapy studied in Units 5–9 (one of the pragmatic approaches—such as cognitive, CBT, and REBT—feminist, multicultural, family systems, or a postmodern approach) to describe, analyze, and then apply the theory to the case study of Margarita, which now includes additional information based on her initial sessions with you. You may also choose one primary theory and integrate concepts from one other theory. The areas you should focus on when analyzing the theory are listed below. This APA style paper should be 6–8 pages (excluding references and title page), so select the information carefully, using the most relevant and applicable.
- Brief description of the theory’s origin (background, how was it developed, who created it) and basic philosophies (its view of human nature, theory of change, view of psychopathology, the role of the counselor).
- How this theory aligns with your own philosophy, values, and views of the therapeutic process.
- An evaluation of the research evidence supporting this theory, with an example of a current study.
- The appropriateness of this theory for diverse populations.
- Goals you will work on with Margarita (make sure the goals align with the chosen therapeutic approach).
- Interventions and techniques you will use with Margarita, based on your theoretically established goals. Be very specific. Assume that you will have up to three sessions with her.
- Cultural considerations you will keep in mind while using this therapeutic approach with Margarita.
- Strengths and limitations of using this theory with Margarita.
- References: You must have a minimum of 5 scholarly resources. All references must be from peer reviewed academic journals, and should be no more than 10 years old. The optional readings for each unit will help you begin your research. You may cite the course textbook and other textbooks, but your papers should draw primarily upon scholarly resources. You must use proper APA style to list your references. Refer to the Capella Online Writing Center’s APA Style and Formatting module for more information.
- Length of paper: The body of the paper must be 6–8 pages, not including the reference lists, abstract, or the title page.
- Written communication: Develop accurate written communication and thoughts that convey the overall goals of the project and do not detract from the overall message. Your paper should demonstrate graduate level writing skills.
- Formatting: Use APA (6th edition) formatting, including correct in text citations, proper punctuation, double spacing throughout, proper headings and subheadings, no skipped lines before headings and subheadings, proper paragraph and block indentation, no bolding, one inch margins all around, and no bullets. Refer to the APA Style and Formatting module for more information.
- Font and font size: Times New Roman, 12 point.
The following articles are recommended examples of integrative approaches but not required for this unit:
- Castonguay, L. G. (2006). Personal pathways in psychotherapy integration. Journal of Psychotherapy Integration, 16(1), 36–58.
- Consoli, A. J., & Jester, C. M. (2005). A model for teaching psychotherapy theory through an integrative structure. Journal of Psychotherapy Integration, 15(4), 358–373.
- Disque, J. G., & Bitter, J. R. (1998). Integrating narrative therapy with Adlerian lifestyle assessment: A case study. Journal of Individual Psychology, 54(4), 431–450.
- Duba, D. J., Graham, M. A., Britzman, M., & Minatrea, N. (2009). Introducing the “basic needs genogram” in reality therapy based marriage and family counseling. International Journal of Reality Therapy, 28(2), 15–19.
- LaTorre, M. A. (2007). Integrative perspectives. Perspectives in Psychiatric Care, 43(3), 151–153.
- Lazarus, A. A. (2005). Is there still a need for psychotherapy integration? Current Psychology: Developmental, Learning, Personality, Social, 24(3), 149–152.
- Tønnesvang, J., Sommer, U., Hammink, J., & Sonne, M. (2010). Gestalt therapy and cognitive therapy—Contrasts or complementarities? Psychotherapy: Theory, Research, Practice, Training, 47(4), 586–602.