This case study (Assignment 3.2) that I completed for CNS 741: Theories & Models of Counseling outlines how a counselor with a grounding in feminist therapy may be able to work with the client to meet her goals. This case study discusses a host of interventions, including group therapy for women. It briefly touches on the impacts of bias and discrimination, as well as how they can be combatted within counseling. Click here to download a PDF version.
Feminist Therapy Case Study
Client’s name: Evelyn Client’s age: 23 Estimated # of sessions required: 30 Theoretical Perspective: Feminist Therapy Setting: Women-only psychotherapy group
Client History: Evelyn is a college-educated journalist whose mother worked in the higher-education field. Her father left their home when he divorced Evelyn’s mother. Evelyn was only four years old at the time and although she expressed her desire to go with her father, he replied briskly and left without her. Evelyn has a history of politicized opinions and interest in spirituality, specifically the teachings of St. Thomas Aquinas. She also has a history of avoiding situations that cause her anxiety, such as public speaking. Additionally, she reports that this anxiety often manifests in physiological symptoms.
Presenting concerns: Evelyn seeks counseling due to her desire to improve her relationship skills and address her dependent habits. Evelyn also wants to forward her career in journalism, but feels that her fear of public speaking and hesitancy to own her publications may reduce her work options. Finally, she is facing uncomfortable physiological symptoms in times of high stress and anxiety.
Actual or core issues: Through her hesitancy to take responsibility for her journalistic work and her hesitancy to state her opinions, it is clear that Evelyn feels uncomfortable when she is not validated and liked at all times. The assumption that “one’s character structure is shaped by one’s previous interpersonal relationships” links Evelyn’s father’s departure from her life to her fear of abandonment and desire to remain self-sufficient (Bender & Ewashen, 2000, p. 298). Furthermore, Evelyn is currently conceptualizing her behaviors as dependent without seeing the influence of society on these habits. Her father’s desertion was likely the first of many instances where Evelyn’s need for relationships was devalued although her attachment was actually functional and appropriate.
Course of treatment and interventions utilized: Treatment has incorporated behavioral techniques into a feminist framework. Evelyn and I mutually decided that a women-only group setting would be the best environment for her. Carolyn Enns (1992) asserted that “ group experience provides an ideal format for helping women deal with self-concept issues” and explained how such a setting allows for “practicing new skills in a safe environment” (p. 9). Although Evelyn has historically felt dependent on others, the women-only group has allowed her to acknowledge her own “worthwhile contributions” (Enns, 1992, p. 11). This community setting also helps participants feel less isolated in their experiences (Bender & Ewashen, 2000).
Assertiveness training will help the group identify a range of options that can be used when direct communication is necessary (Enns, 1992). Assertiveness training helps combat the detrimental effects of ways in which women are often socialized to act. For example, girls are often taught to be modest. However, this can affect performance in some situations, such as presenting knowledge to colleagues. In these situations, women may face discomfort that can “manifest as anxiety or fear” (Smith & Huntoon, 2013, p. 447). In other words, “Women are expected to adhere to a rigid set of expectations, and both over-adherence and deviation from these behaviors are labeled mental illness” (Murdock, 2013, p. 382). Evelyn experiences this when she encounters physiological illness before public speaking. Gender-role analysis has led Evelyn to re-conceptualize what she sees as dependent behavior as simply the values she was taught by society (Murdock, 2013). This shift in perception has eliminated the self-blame Evelyn feels over her behaviors. The group was intentionally not limited by diagnostic specifications that could “obscure commonalities in women’s experiences” (Murdock, 2013, p. 385).
In lieu of formal diagnoses, the group created a therapy contract at the start of treatment (Murdock, 2013). This document stated that all participants were equal partners in the therapeutic process. The overall purpose of the contract was to enumerate guidelines that would give “value, voice, and visibility to the complex life stories of each participant” (Bender & Ewashen, 2000, p. 300). The contract was posted to the meeting room wall during each session. After laying out therapy guidelines, I shared some of my experiences in an effort toward self-disclosure (Murdock, 2013). I explained how, like them, I faced challenges balancing societal expectations of women with my independent choices. I directly spoke to Evelyn about the physiological symptoms I experienced in college before presentations. Building rapport through acknowledging common experiences allowed us to approach challenging issues rather quickly.
I then introduced progressive muscle relaxation (Murdock, 2013). This relaxation technique set the tone for each session and was incorporated into exercises such as systematic desensitization. These techniques have helped Evelyn manage her physiological systems when she becomes anxious. After practicing relaxation training, each participant made a list of her fears, from least to highest intensity. Evelyn included speaking to a small group as a minimally anxiety-inducing activity, while the highest ranked activity was speaking from a podium to large group. In one session, participants were broken into groups of four and asked to role-play challenging situations, which combined assertiveness training with systematic desensitization for Evelyn (Murdock, 2013). Eventually, Evelyn was asked to speak about her progress at the graduation we had planned. This addressed her public speaking fear, while allowing her to share her achievements. Although she acknowledged feeling anxious, Evelyn used relaxation techniques to successfully give a short talk to the large group. Thirty sessions were scheduled to allow participants to address their fear hierarchy “without disturbance” (Murdock, 2013, p. 158).
Counseling goals: Evelyn should begin viewing her behaviors and challenges within a larger gendered societal context. The relationships and skills built through group sessions will equip Evelyn with a sense of security, which will allow her to better balance her desire for trust and autonomy within her romantic endeavors. Evelyn will also reduce her need for everyone to like her at all times and will begin to make decisions based on her own interests. As Enns (1992) summarized, successful therapy will allow Evelyn to “develop new attitudes toward the self, [including] accepting one’s own feelings as valid, learning to please oneself, identifying personal strengths, and accepting imperfections” (p. 9).
Anticipated outcomes of counseling: Helping Evelyn to make decisions she feels comfortable with will be the result of successful therapy. As Evelyn leaves therapy equipped with new skills and relationships, she will be ready to advance in her career without fear of failure or negative feedback. As she begins to have more faith in her competency and a heightened ability to share her knowledge and achievements, she can begin to reveal her unique opinions and successes within the journalism industry. Through assertiveness training, Evelyn will ask for what she wants and needs, and will comfortably navigate negotiations. Once she has confidence in her independence, Evelyn will be able to date without the need for excessive attachment. Finally, Evelyn will leave therapy with relaxation techniques that she can use when she becomes anxious.
References: Bender, A. & Ewashen, C. (2000). Group work is political work: a feminist perspective of interpersonal group psychotherapy. Issues in Mental Health Nursing, 21(3), 297-308.
Enns, C. Z. (1992). Self-esteem groups: A synthesis of consciousness-raising and assertiveness training. Journal of Counseling & Development, 71(1), 7-13.
Murdock, N. L. (2013). Theories of counseling and psychotherapy: A case approach (3rd ed.). Upper Saddle River, NJ: Pearson Education, Inc.
Smith, J. L. & M. Huntoon. (2013). Women’s bragging rights: Overcoming modesty norms to facilitate women’s self-promotion. Psychology of Women Quarterly, 38(4), 447-459.