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"Willow": A Case Conceptualization

Megan Hyland Tajlili, M.Ed., NCC, LPCA

In her own words...

Treatment Plan

"Last time we met and again today you said that the work has been all me and I want to beg to differ.

You have been so instrumental in the successes that I've gained and are gaining. The questions you ask and the encouragement you give have helped me so much...

I know how I am gaining light and that is because I'm not alone in this process of discovery and change and I really mean it from the bottom of my heart when I say thank you for every thought provoking question or nugget of wisdom you have imparted into my life."

("Willow," Personal Communication used with permission, 11/5/13)

Interpersonal Style & Personality

  • Presents as a 15 year old developmentally: concerned with clothes, boys, impressing others
  • Feels she must please every man she meets
  • Fluctuating sense of self based on who she is surrounded by
  • Irrationally angry at others for perceived small slights
  • Negative self talk and general pessimism
  • Tough exterior - "no one can help me..."

A willow tree symbolizes the ability to adapt and adjust to life versus fighting it. Regardless of our surroundings, we continue to grow.

Relevant History

  • CBT Assumption Testing
  • Assertiveness exercises
  • Bibliotherapy: Boundaries book
  • Letters:
  • to a friend in similar situation
  • to self as a child
  • Role plays/Practice situations
  • Journaling Homework
  • Empowerment through using own voice
  • Processing situations to identify patterns

Multicultural & Environmental Factors

  • Facing multiple oppressions as an African-American Woman from poor community
  • Not "allowed" to be angry or assertive
  • Secretive nature of sexual abuse in African-American community
  • Cycle of violence/abuse within family
  • Never had a true, secure sense of home or belongings
  • FOO issues: Sexually, verbally abusive household
  • Constantly objectified or manipulated by others throughout life
  • Prevailing memory of being "dumb" and "unworthy"
  • Never lived alone. Lived in constant chaos.
  • Past suicide attempt, drug abuse

Presenting Problem

Outcomes

  • Moved out on own
  • Recognize and prevent patterns of self-sabotage
  • Building internal validation
  • Through teaching others how she wants to be treated, she taught herself
  • Stick to and create healthy boundaries in relationships with family/friends/significant others
  • Assertive communication
  • Overall decrease in hostility, increase in coping skills and overall mood

Went from being seen once a week over summer session to once every two weeks for fall semester. Now, recently decided on once a month (bridged with therapy group)

  • Boundary and anger issues
  • Lacking self-worth, love, acceptance
  • Repeatedly looking to fail while wanting to appear perfect to others
  • External locus of control
  • Unsure of career goals

Meet "Willow"

  • XX year old female African-American graduate student with 4.0 GPA
  • Divorced with two children; 17 and 14 (sons).
  • Works 40 hours a week on third shift job while maintaining full course load
  • Lives with other family members in chaotic environment

Meet the Counselor

As a counselor working with college students, I:

  • Forge a strong counselor-client relationship and focus on the individual’s phenomenological experience.

  • Appreciate that the issues that students face stem from identity challenges, the impact of society, and operating in an environment that may not be supportive of their needs and desires.

  • Use a synthesized theoretical framework combining the models of existential philosophy, Adlerian therapy, and the feminist orientation to enact a healthy self-concept and sense of purpose for the students.

  • Allow students to define personal meaning from experience, choose the level of emotional involvement to commit to outside problems, establish a support system and a sense of belonging, and understand the impact of family roles and gender stereotypes on personal expectations.

Meet the Counselor (cont)

  • Assist the student in seeking empowerment through choice, an internal locus of control, and through creation of a new self-definition.

  • Stress self-awareness, insight, and goal orientation as main counseling aims.

  • Teach lifelong techniques for handling challenges, facing hostile environments, and interpreting the constructs of self.
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