Case Summary and Presenting Problems

Case Summary andPresenting Problems

As atreating therapist, I came across Mary on television, in one of thoseevenings after work, who introduced herself as a post-graduatestudent, but now working permanently in one of the well-known firms.Mary appeared to be anxious and depressed, couple with her confessionthat she was experiencing relationship issues. Luckily, she appearedto be focused on finding a solution to her problems. Those were someof the issues that we, as the treating therapists, had come across inour daily work. She saw them as enough reasons to seek professionalhelp from a therapist. She said, however, that she had a counsellorbefore, but she was not sure of what to expect next.

Maryappeared interesting to me. In the 1960s, an interesting idealtherapy client was described as attractive, intelligent, open,honest, and ready to be helped (Greenberg &amp Watson, 2005). Afterobserving Mary for some time, she appeared an interesting person.This is because she appeared motivated and ready to work,open-minded, curious and contemplative, communicative, trusting ofthe therapy, enough symptoms to keep it simple and interesting,tolerance for ambiguity, and sparring. As a treating therapist, theobservations I made from Mary were among what my therapy colleagueshad, at some point, say to be their ideal attributes from a client.

It istrue that I like when clients are motivated to figure out a problem,are ready to try new experiences, and is willing to look insidekeenly. I found Mary interesting since when such ideal elements areobserved in a patient, and when they are in the correct place,therapy sessions tend to progress smoothly. McLeod (2005) noted thatstretching teeth to motivate, communicate, and collaborate, is a lotof work. As the treating therapist, a large section of my work is totry and help clients identify and learn what motivates and discouragethem, and in addition, harmful paradigms and rigid beliefs theyappear to cling to, and curiosity about themselves. Therefore, Marywas interesting because of her open-mindedness, motivation, and theintrospection.

From her life, Mary said she, at some point, had felt testy and downfor a while now. She is a Caucasian woman, who saw it fit to seekcounselling for her problems, which from my observation as a treatingtherapist, showed clear signs of depression and anxiety, which she inher interview, had attributed it to the problems in her relationship.She has had conflicts with her family members. In her maritalrelationship, Mary and her partner had before engage in increasingand incessant number of arguments. She said it was typical of herdepression, anxiety, and behavioral nature, especially when they goout to party and drink. From her life, it was evident from myexperience that counselling was a viable option to solving Mary’sissues.

According to McLeod (2008), there are clients, during a counsellingsession that take time to be build trust and be open-minded. As forMary, there are instances in her story about her life that shows shewill be open during the counselling sessions. First, it tends to takequite some time to open up to someone, especially about what one hasgone through in his or her life. This is because it is influenced bynumerous factors. These factors are the same as those of Mary:client’s previous experiences, especially on relationships. Marynarrated she, at some point, had worked with another therapist. Thismeant that she would be easy to open up. Greenberg &amp Watson(2005) observes that for a client to trust and easily open up, thenhe or she at one point, would have experienced psychotherapy outcomesand other interventions on openness and trust from other treatingtherapists.

If a client, for example Mary, requires treatment and is hesitantabout counselling, then building a rapport is of importance. This isin the sense that unless there is a rapport, it is highly unlikelythe client and the counselor would not work well. First, the treatingtherapist should be well-prepared to handle the client, be unrushed,calm, prepared and ready to put one’s problems away for the entiresession. Secondly, the environment should ne trusting and safe. Thecounsellor should take time to make it appealing, pleasant settings,clean, restful, uncluttered, and perhaps a cup of coffee with nointrusions (Greenberg &amp Watson, 2005). Thirdly, the treatingtherapist should be aware of who the patient is. This is because forfollow-up sessions, the therapist should be in a better position toremember the client’s name and their problems. The therapist shouldalso develop an accepting nature of the client’s issues since thiswill make the client to be trusting and more open. It is important toremain less surprised and non-judgmental.

Presentation ofProblems

Mary’s problems, she claim, was a result of shaky relationship. Inthe interview, Mary describes herself to be a “social drinker”.Interestingly, she described her pattern of drinking to be 3-6consumption of drinks, which was occasioned by 2-3 each of drinksweekly. This she claim, could have contributed to her not workingrelationships. I watched her keenly and noted that she wasexperiencing a number of depressions, for instance, she appear to bedepressed most of the days. Events in her life caused some and othersare the chemical changes in her brain. Mary narrated that she wasintroduced into relationships at an early age because she wasdepressed with life, and worried of her loneliness. At the age of 14,she had already undergone two relationships, which had not worked outwell. At the company of her cousins when she was only 16, she wasintroduced to an older person. She had engaged into the relationship,which eventually resulted into her being used and disillusioned.

  1. Relationship Problems

Duringher junior years and part of her senior, Mary was introduced tolesbianism. She also came out bold, after insistence from herfriends, as a lesbian to the parents and family. She also resumedunhealthy relationships. After her undergraduate, Mary and herpartner of close to 2 years, (Alex, age 27), moved together into anapartment, since both were now working permanently. Mary narratedthat they both started to decrease their rate of drinking sinceconcerns on their finances began taking its toll. Unfortunately,their relationship entered a rocky phase. They began fighting almostdaily. The fights were about misappropriation of funds, dishonest andinfidelity in their relationship.

  1. Depression and Anxiety Problems

FromMary’s background, her problems are viable for counselling. Theseproblems include depression, variety, and relationship issues (bothwith the family and spouse). It should be noted that these threeissues are interrelated. This is because main causes of hertumultuous relationships are as a result of depression and anxiety.These issues are viable to therapy sessions in that they are major asa result of apprehension and fear, nervous thoughts, and worry(McLeod, 2008). Since anxiety for example, creates a sense ofdiscomfort, they often present a lot of energy. Individuals thatundergo such kinds of situations, for example, Mary, requirecounselling sessions that guarantees them protection and assuranceaimed at minimizing such levels of discomfort and fear. Again, sincedepression and anxiety cause problems in relationships, such clientsrequire advice on their relationships. Depression revolves around theidea of life being hard and les hope on situations ever gettingbetter. Therapy sessions would thus aim at working the client’srelationships to work for the better and offer hope. This way,depression levels would tend to drop.

Therapysessions are often about the clients’ current situations. McLeod(2008) observes majority of counselling sessions to be characterizedby clients with relationship issues, depression, and anxiety. Heobserved that these problems are a result of the patients’background, from when they were young, the experiences they have onceundergo through in life, situations they are currently in, and thethings they have engaged in before. All these situations tend toaffect a person in one or the other, and as a result, the person maydemand a solution. More often than not, finding solutions to thethree issues are often through therapy sessions with a counsellor.Therapy process helps the patient view life from a differentperspective, which makes therapy viable.

  1. How Depression and Anxiety Affect Client’s Relationships

As observed from what Mary about her rocky relationship, it isevident her depression and anxiety contributed greatly to the issuesin her relationship. First, Mary confessed the lack of propercommunication with her spouse and family members. This is becausedepression and anxiety resulted in minimal attention given to thepartner, less involvement of everything, and constant irritation toeverything around a person (Greenberg &amp Watson, 2005). Mary,because of her anxiety and depression, engaged constantly with herpartner and family on high conflict, withdrawal on a number of issuesduring family gathering, and lack of communication. On the flip side,these examples can also result in increase in levels of depressionand fear of losing one’s partner and family.

Treatment Goals

  1. Goal 1

After careful observation of the client (Mary), the first goal willbe to identify a better treatment option for depression, which is achange of lifestyle. This is because there is no “single size fitsall” kind of treatment option that cures depression. It isimportant to work on this goal since the client in question hasdepression issues, which stems from her social nature and how sheperceives life as a whole. To work on this, the client should beready to exercise and be socially supported. What is expected fromthis goal will first be determined by what the client will berequired to do. Mary should engage in regular exercises, which itsexpected outcome will be the reduction of her depression levels andalso chemist boost in her brain, which include endorphins andserotonin (Greenberg &amp Watson, 2005). Mary is also expected toengage in social support groups, which will help her reduce hermental and physical isolation. She is required to keep regularcontact with her family and friends. Expected outcome should bereduced stress and depression levels and isolation.

  1. Goal 2

The client in question is suffering from anxiety, which isgeneralized anxiety disorder (GAD). It is important to work on thetreatment of the disorder because when it is not treated early, thecondition is long-term. What should first be worked on is discussionof viable options available for the disorder. The client should bepresented with all the available options of treatment, the pros, andcons, to ensure she is aware of potential risks involved and sideeffects. Expected outcome is that the client should be capable ofmanaging her anxiety levels, with frequent supervision and visits tothe therapist and handling of the condition. Again, outcome shouldinclude relaxation of muscles during such situations that tend toprovoke anxiety.

  1. Goal 3

Relationships present meaningful part of every person’s life. Ashaky relationship may prompt services of a counsellor. The client inquestion craves a healthy relationship, and that is why is importantto work on solving it. McLeod (2008) admits that healthyrelationships bring fulfillment and happiness, a strong bond with ourloved ones, colleagues, and family. It also ensure healthy productiveoutcome to whatever one does. It is also to work on this because theclient is in a position where one problem is interrelated withanother. Here, the expected outcome revolves around the client’sability to developing a fulfilling and healthy relationship with herfamily and partner.


Greenberg, L. S., &amp Watson, J. C. (2005). Emotion-focusedtherapy for depression. Washington, DC: American PsychologicalAssociation. Retrieved from

McLeod, S. (2008). Person Centered Therapy. Simply Psychology:Washington, DC: The Association. Retrieved from