Imagine you are the counselor in this video. Take appropriate notes throughout the session to document important aspects about this client. Submit your notes. Begin working on the Assessment and Treat
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Imagine you are the counselor in this video. Take appropriate notes throughout the session to document important aspects about this client.
Submit your notes.
Begin working on the Assessment and Treatment Plan assignment, due in Wk 2. This sets the stage for your Advanced Counseling Skills Assessment. It is recommended you have a rough draft completed
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Imagine you are the counselor in this video. Take appropriate notes throughout the session to document important aspects about this client. Submit your notes. Begin working on the Assessment and Treat
video transcript: Liz, thank you for filling out the paperwork and for going over the informed consent with me. It’s really nice to meet you in person. So I’d like to start by asking you did something in particular happen, what made you decide to make the appointment for today as opposed to a few months ago or waiting a few more months? I’ve just not been feeling well. I’ve been, I just don’t have the energy to do things anymore and I’m just, kind of looking for answers. I don’t know. I’m here to try to find some help, I guess to figure out what direction I need to go in. Okay, can you tell me a little bit about what’s going on in your life? Um. I would say about two months ago, I moved out of my home with my two kids, moved in with my mom, and… My husband is a little abusive. I just felt like I didn’t want to be there. Okay. Are you safe at your mom’s house now? I’m safe. I just don’t know if I’m doing the right thing. Okay, how long have you been married? About 10 years. And how old are your children? My oldest is nine and my youngest is seven. Are they boys or girls? My oldest is a boy, my youngest is a girl. If you’re comfortable talking about it now, can you tell me a little bit about the abuse, what happened? It wasn’t anything big, I mean, he occasionally would push me or maybe a coupe times he slapped me but, he just gets really verbally abusive and I just felt like it was escalating, like it was getting worse, so, I ended up leaving. Liz, was there abuse early on in your relationship? I don’t think it was abuse. I mean, we would fight, we argued. He would get in my face, maybe push me a couple times, but… Has it gotten worse over the years you’re saying? Okay. So it sounds like it just recently got to the point where you, did you start to become afraid for yourself, or you just didn’t want to take it anymore, or what was that moment for you where you decided to move out and live with your mother? I’m sorry. It’s okay, take your time. He slapped me in front of my kids, and he said he was gonna kill me or hurt me, or… I didn’t want my kids to see that anymore. I got scared. It sounds like you made a really good decision for yourself and your children. Has he abused the children? No. Did they ever hear anything or apart from what you just mentioned see anything else between the two of you? The last time, they were scared, they were yelling at him to stop. So they did see that and I felt so guilty. Well it really sounds like you’re doing a good job of keeping your kids safe, Liz. Has he tried to contact you or has he come to your mother’s house, tried to get you to come back home? Yeah. He’s tried calling my mother, and, and tells her for me to call him and to answer his calls. I’m not sure, I just don’t know if I’m taking, my kids away from their dad, or if maybe, I don’t know if I need to go back home, maybe he’ll change. I just feel helpless. What does your mom say? What is her opinion? My mom thinks I should go back home. She feels that my kids would be missing out on their, a good parenting home if I didn’t go back. So she’s encouraging you to go back with him? What do you think about that? Are you surprised at her reaction or disappointed at all? Do you wish she would react in a different way? I was a little angry at first and confused but the more we talk about it, the more I’m wondering whether or not it’s the best thing. Do you know if that’s what you want? Or is that what your mother wants? I’m not sure. Sometimes I feel like it’s something that I want. We had our own space there and we had our own house. We had our own family. Yeah. I’m sure this must be very very confusing for you. I give you a lot of credit for coming in today, I know how difficult this must be for you. But we’ll work together and help you clarify what it is that you want and need. Okay? Liz, can you tell me a little bit about any cultural beliefs or religious or spiritual belief that might be a source of strength for you or might be actually causing a little distress for you right now in this situation? I’m Mexican. We have certain values, yeah, we, you get married and you stay married. Liz, were you born here, or in Mexico? No, I was born here. I’m sorry, continue please. Sometimes I wonder if that is why my mother is pushing so hard for me to go back. If it’s because she’s wiser, she’s been down this road before, maybe she sees something that I don’t see, or maybe if I don’t go back, what if I end up alone like her, or struggling like her. So you said she’s been down this road before, can you tell me more about that, please? My dad was pretty abusive. My dad. My dad would hit my mom. There were times when she wouldn’t even come out of the room because she was bruised or because she didn’t want us to see her that way. He ended up leaving anyway. Oh, he left her? Did he abuse you? No. Did you witness anything? I did. You did? How do you think that effected you? I still think about it. It plays a role in my head. I feel like I’m reliving that. I don’t want my kids to see that, I don’t want my kids to have those memories. Yeah, I can understand that. So it sounds like your mother is trying to protect you from, like you said it sounds like she’s not very happy and she’s alone, is she in another relationship, did she ever get remarried or… No, she never got remarried. She just raised us and she works, so she’s, it was about her kids. Can you tell me what one of your strengths is, Liz? What do you mean? Well what is it, what is something about yourself that you really know to be true? Can be a personality trait, something that you know will get you through almost anything. Can you think of anything right now? I love my kids. I love my mom. I think I love my husband. Can you tell me a little bit about your support network right now? I don’t have very many friends. I have one friend. Here you go. Thank you. I have a friend named Karen, who’s been pretty much there for me. Have you been friends for a while, a long time? We’ve been friends for about a year now. What is she like? She’s fun. She’s crazy I guess, like normal women are. But she listens to me, she doesn’t judge me. She accepts me for who I am. I think she cares about me. She’s the one who suggested that I seek some counseling and, I didn’t want to but, I thought it was probably a waste of time in the beginning but I, lately I haven’t been feeling well. I just feel, I’m against the wall right now. Tell me a little bit more about that, in terms of everyday how you’re feeling, how you’re functioning. How have you been sleeping the last few weeks, months, since you’ve moved out? How has it been? I don’t sleep. I wake up, sometimes I feel like I can’t sleep, I feel… Like last night for instance, I was up at two in the morning and I couldn’t go back to sleep. I feel like I have this pressure in here, like I have all these thoughts that are going through my mind. Sometimes I don’t want to be here. I don’t want to do this anymore. I feel like I’m not pleasing everybody, I feel like I’m not pleasing my husband, like I’m not pleasing my mother. I’m hurting my kids. I don’t want to do that. Sounds like you have so much pressure that you’re putting on yourself. No wonder you’re not feeling good, no wonder you’re having a hard time organizing your thoughts and getting some sleep. Have you ever experienced anxiety before, Liz? Usually it’s like you described it, racing thoughts and sometimes we have a hard time breathing or catching our breath, it feels like our heart is pounding, have you experienced that before? That sounds about right. Sometimes I can’t even get up on time to get my kids ready for school because I don’t end up falling asleep until two, three in the morning because I’m thinking about things. I just, I guess that’s what it is. Well it sounds like you might be feeling, obviously very sad and very hurt and very lost and a little anxious which makes sense, all those emotions kind of go hand in hand, but feelings like anxiety will definitely keep us up at night. Usually we find that they either cause us to not fall asleep or we fall asleep and then we wake up in the middle of the night and then we have a hard time falling back asleep which is what you just described. So then when you do finally fall asleep, you said you have a hard time waking up because you’re tired? I’m exhausted and I just don’t feel like I have energy to do anything, I don’t have, I don’t want to do anything. I feel like I’m waking up to do the same thing over again. Does this happen almost everyday? It’s starting to feel like it. Yeah. And it’s just been getting worse and worse or it’s since you moved out, or even before that, can you recall? I feel like it’s getting worse. I feel, it started off with me wanting to leave and when I finally did, I don’t know if my kids are happy. They’re constantly asking for their dad. Have they seen him, or talked to him? Just over the phone. Have you talked to him or he’s just talked to your mother when he’s called? I try to avoid his calls because I know, I know that he could convince me to come home. So I haven’t really talked to him. Okay. Is there anything in your day right now that brings you joy, Liz? Anything that you can enjoy? Makes you feel good? My kids. My family. I have a sister who’s pretty cool. My friend. Where is your sister, tell me about your sister. She’s my younger sister. She’s pretty independent. She’s not married. She has a career. Doesn’t have any kids. Does she live here? No, she’s moved. She’s in Washington now. That’s where she lives. She lives a pretty amazing life. She’s asked me to maybe find a job where she’s at and come out there with her but… What do you think about that? That sounds exciting. I don’t know if I’m ready for that. I mean, what do I bring to the table? She’s got this career and she’s, she’s always been strong. And she’s pretty, and she’s smart. And you don’t think you’re any of those things? I don’t feel it. Have you ever thought any of those things about yourself? I’ve never really thought about it. I mean the only thing I can remember is getting married and having kids. That’s my role. That’s my life. What am I gonna do? Go out there and struggle some more and maybe be extra baggage for her? If you stay away from your husband, do you see yourself following in your mother’s footsteps or do you think there might be something, another option for you, something different for you? I don’t know, that’s what I’m so afraid of. I don’t want to end up like that. I love her and she’s a great mom but, I didn’t get married to end up with a broken marriage or to be alone, or to have my kids without a dad. I was taught that that’s what we have to stand up for, what we believe in and what’s right. Is your husband Mexican as well? Yes. Does he see any problems in your marriage or in any of his behaviors? He apologizes. He apologizes afterwards and it just seems like it’s gotten worse. So I don’t know. I don’t know if he’s apologizing because he means it or if it’s, just to get me to stay. Liz, it almost sounds as if at this moment in your life you think you only have two options. Which are to go back to him, the way things have been, or to follow in your mother’s footsteps. Do you think there might be a possibility of a third, even if you don’t know what it is yet? Do you have any hope for that? What else could there be? I don’t have options right now. Do you have any hope during in your day to day activities? Anything again that you do that makes you smile, makes you think about the future, or something different for yourself? I, I’d want to go back to school if I could, or maybe get a job or something, but… You said that you’ve been feeling really tired, do you feel tired even when you get a full night’s rest, do you ever get a full night’s sleep? Do you think the fatigue is from not sleeping enough or from something else? I just think I have a lot in my mind. I don’t know if I, even when I sleep it feels like I’m still tired. I feel like this pressure. I don’t know how to explain it but I feel this pressure like I can’t breathe sometimes, and then all these thoughts of uncertainty, like am I doing the right thing, am I not doing the right thing? Am I the one that’s abusing my kids? Am I the one who’s hurting them? In what way, what do you mean? I mean, I took them away from their home. I took them away from their dad, I took them away from what they’ve known, where they’re comfortable. When you were younger, did you ever wish that your mother would leave your father when she was being abused? Yeah. How do you handle it, Liz, when you start having those memories of your childhood? It seems like they’re kind of intermingled with your present situation. What do you do? I get angry at myself. You’re pretty hard on yourself, huh? Sounds like it. Maybe I just don’t, I guess I didn’t see it that way but I now I’m wondering whether this is supposed to be my life. It sounds like between what you experienced in your childhood and then in your marriage that you have a lot of people’s opinions in your mind, trying to help you figure out who you are and what you want and where you want to go. That must feel very heavy sometimes to carry that everyday. It’s like you want to please everybody, and I just I feel like I’m failing at that. How have you been at taking care of yourself? These last few months, how are you eating, are you getting any fresh air, exercise? Well, I guess if there is a positive side to this, I’ve lost weight. I rarely eat, I don’t have the appetite. I don’t want to eat, I don’t feel like eating. I make my kids food, but that’s because they have to eat. But you don’t want to eat? I don’t feel like eating, I don’t feel like… It’s hard for me to even take a shower sometimes. I rarely put makeup on, I don’t, I don’t find any type of pleasure in getting ready and trying to look good, I don’t… Liz, have you had any thoughts about hurting yourself? Hurting anybody else? My objective, my biggest concern of course is to make sure that you’re safe and to build trust between the two of us. Can you tell me a little bit about you being safe? Sometimes I don’t want to be here anymore. Do you think about what you would do? How that would be? What if my kids were better off? I wouldn’t disappoint my mom if I wasn’t here. I wouldn’t be hurting the people that I love if I wasn’t here. What about you hurting? It sounds like you’re just trying to keep yourself safe actually. Sounds like you’re the one who’s been hurt for a really long time. Maybe it’s time for you to feel better and to take care of yourself. How often do you think those thoughts about, I wish you will. I’d love to be happy. I would love for everything to be perfect. But? Is there a but in there? I just don’t know how. I just don’t know how to fix it. Well, I’ll tell you, you’ve taken the most important, biggest, and hardest step. You made the appointment and you showed up today. I’ve sat on that side of the room and I really do in my own way, I, I understand how difficult it could be. It takes a lot of courage, it truly does, to come in and have hope, because even if you don’t feel it, the fact that you’re here, means that you have hope, and that is what we’re going to bank on. That’s where we’re gonna start. And that’s what we’re going to build on. So it’s okay if you don’t feel it right now but you made it in. That means that there are possibilities that you can feel better, that you will find the answers that you’re needing. But I’m concerned that you really are coming down very very hard on yourself and it sounds as if you’re kind of forgetting that it’s your husband, I’m sorry what’s his name? His name is Robert. Robert. That Robert sounds like he’s caused quite a bit of pain. And you’re just trying to heal it. I know he’s a good guy. I know he’s, I know somewhere deep inside he is a good man. I just wish I could help him change. Do you think your mother could have changed your father? I don’t know. As a little girl, did you think you could change your father? We tried. We thought when he was smiling or laughing or playing with us, that he was happy. And then what would happen? He would pretty much pick fights with my mom, sometimes for no reason. Then there was a full blown fight, and the next thing you know, she was pretty much his punching bag. Do you ever find that you in your adult life and in your marriage, you had moments where you felt the same feelings you felt when you were a little girl, either thinking you could change him or feeling helpless, feeling a combination of feelings of strong and then weak and afraid? I guess I never really thought about it. So what was it about your sister that caused her to decide to go to Washington? Why do you think she did that? Maybe she had bigger dreams. She had better dreams. She always says she wanted to explore the world that she wasn’t gonna end up like mom. What is her relationship like with you and your mother? We have a pretty good relationship. My mother is, she likes to talk trash sometimes because she feels like she’s not around or she’s not available. My sister calls me, she checks up on me and she’s, she says she loves me. No matter what I decide to do. But she kind of encourages you to move out there with her? She does. So it sounds like your sister and your friend, Karen, are your biggest supporters of you finding another option instead of going back. Yes. Okay. Yeah. I think they both want me to be in a different situation. Maybe have a different life. I just don’t know if I have the energy or the confidence. Do you ever remember a time, Liz, when you had more energy and had more confidence in yourself? I was much younger. How young were you? Probably 18 or 19. Do you remember that person? Okay. Does she ever come out these days? I haven’t thought of her until now. Okay, well that’s a start. Do you ever go out with Karen, and do things just the two of you? Yeah, we, we’ll go have lunch. Sometimes she’ll leave work so she can come and hang out with me for a little bit. I don’t have any money so, we’ll just make whatever there at my mom’s, whatever we have available. Burritos or whatever, you know, or chorizo. Can you laugh a little bit with her? I actually feel good when I’m around her. Okay, that’s good. That’s really good. Yeah. She makes me smile. She’s a good friend. Good. You know, Liz, I’m just wondering, I know that you said that you’ve lost your appetite. Can you tell me if anything else has changed in terms of how you’re coping day to day with your mood, specifically, and even if you can give me a little family history, is there any, are you smoking cigarettes, are you using any substances or drugs at all, anywhere from caffeine, cigarettes, alcohol, and to other drugs to help you cope, has any of that changed? I suppose I probably would if I could afford it. I would probably take up drinking or smoking or whatever else. Well maybe it’s for the best that you can’t afford it right now. So you’re not drinking excessively? I drink coffee just to try to stay awake throughout the day but, that doesn’t seem to help. Not during the day time anyways I’m super tired during the day time, at nighttime I can’t sleep. I’m confused. Okay. We’ll clarify that for you, we’ll organize all that. Is there any history in your family for substance abuse? Or even in your marriage with Robert? Any alcoholism or any drugs? My husband drinks. It started off just on the weekends. It gradually became a problem. He would drink during the week. I was okay with it on the weekends. I was okay with him staying out. Just so we wouldn’t argue anymore. Slowly he started drinking during the week. Sometimes he wouldn’t get up in time to go to work. When I’d call him out on it, he’d get angry. Was there ever any relationship between his drinking and the abuse? In the beginning, yes. Then I guess he thought it was okay for him to if we would argue or even the smallest things, and he wasn’t drunk, he would just get in my face, and he’d call me all these names. He’d say that I was worthless, that I wasn’t gonna amount to anything. I couldn’t make it on my own. That I would never leave him. It must be really hard when you hear those messages over and over again. Was there any drinking in your family when you were growing up? Your parents? My dad. My dad was a drinker. We just knew. We just knew there was gonna be a fight, that there was gonna be a problem. That’s why I would get angry with my mom. I’d get angry with her because she never left him. I guess I don’t want my kids to be angry with me, either. Yeah. Liz, it’s understandable that you would be so conflicted right now. But like I said, there’s a lot of hope here and that is what we’re going to build upon. Okay? It looks like we only have a couple of minutes left to our session. It was really, really great meeting you and having you in here today. So, we can set up your next appointment, and discuss how we’ll proceed with treatment. How does that sound to you? Okay. Great. Thank you