Over the years, the decision by therapists to commit therapy sessions to the client has not been an easy undertaking (Coto-Lesmes et al., 2020). As a therapist, it is something that should be undertaken after thorough scrutiny. Before such a decision is made, major considerations must be put in place to establish the commitment between a therapist and a client (Fina et al., 2021). The first phase to determine whether a therapist can provide worthwhile therapy to a client is assessment. In assessment, the therapist needs to consider whether they have the skills and the necessary training to handle the client who has presented themselves to them. In a nutshell, the therapist must be able to provide the care deserved by the client (Every-Palmer et al., 2019). As a therapist, not observing these fundamental considerations before entering into a therapeutic arrangement is unethical and irresponsible (Newman, 2020). In the worse situations, the arrangement could potentially lead to emotional damage to the client and the therapist.
In this case scenario, the study delves into the circumstances of a 23 years old man who is suffering from bereavement disorders. The client has been recommended to an integrative therapist by his ex-girlfriend after witnessing clinical depression and PTSD symptoms on him. The therapist is a BACP-qualified specialist who has enough training in handling bereavement disorders. The therapist also deals with the after-effects of trauma and Post-Traumatic Stress Disorder (PTSD). His specialism presents him in a good position to handle his client’s condition (Trombini et al., 2019). The therapist noted that it had been an enormous step for the client to commit to these therapy sessions since his past encounter with therapists had not been good. As such, it is important to create an interpersonal relationship between the client and the therapist while maintaining appropriate boundaries between themselves (Lawton et al., 2018). The client started therapy sessions six months after his incarceration. Under normal circumstances, therapy should be administered for 8-12 weeks; however, the period for treating bereavement disorder is longer (Iglewicz et al., 2020).
After completing the introductory sessions, it is now time for the therapist to decide which therapy treatment will benefit the client (Krebs et al., 2018). The client’s first impressions during the initial stage of the therapy sessions gave the therapist a sense of direction for the therapeutic journey. In addition, the presentation determines whether the therapeutic direction augurs well with the therapist’s skill (Kustanti et al., 2022). As presented by the client, his problem began at the age of 15 when his childhood best friend died. By 17, another one of his childhood best friends was stabbed to death. The situation was made worse when he was kicked from the school. He got himself into drugs and, although a bright student, he deteriorated in his education.
The client lost meaning in life and did not care about his life trajectory. To defend this behaviour, the client has developed a tendency to get into fights with his peers. The client exhibits maladaptive trauma-related beliefs, affective dysregulation, high levels of dissociation and maladaptive behaviours modeled during the trauma (Righy et al., 2019). He has also experienced a lack of sleep. These experiences are accompanied by paranoia and nightmares. In addition, the client experience fears that he might die just like his best friends. His fears were magnified at the age of 19 after an attack that left him with three stabs. The client has also illustrated an avoidant-ambivalent attachment style (Paghoshi et al., 2020).
To achieve a seamless transition in therapy, it is important to sensitively risk assess what bereavement disorder means to him. This is the primary step which involves honest discussions with the client to determine how his condition manifests (Kaplow et al., 2018). The therapist needs to risk assessing the client for any self-harm or suicidal ideation thoughts. Due to a lack of subjective interpersonal experience between the therapist and the client, it is difficult to apply formal assessment; however, the therapist can use selected questions in questionnaires to achieve inspiration in risk assessment and fully understand the client. At this stage, the main aim is to understand the client’s family history, current situation and any short-term risks, which will enable the therapist to fully explore the client’s condition (Waldron et al., 2019). Although the client is suffering from bereavement disorder, he has a recollection of his condition; therefore, he is resourceful and resilient. As such, the therapist needs to dig deep into the client’s narrative and psychology, which will eventually lift the symptoms of bereavement disorder.
During the preliminary sessions, the client has presented with an array of defence mechanisms, reparenting, intense empathy, resentment towards parents, boundaries and substance abuse. The therapist has noticed that the client has had a dismissive and inconsistent relationship with his mother since he was young. His mother used to discipline him without a valid reason. As a result, the corporal punishment meted on him could have changed his neural responses to environmental threats just like in other maltreatment; this scenario is exhibited by the high level of paranoia and anxiety experienced by the client (Costa, 2020). The client possesses an anxious-ambivalent attachment style. This behaviour manifests in his life in a variety of ways; fear of rejection, insecurity within his romantic relationship, low self-esteem, fear of abandonment, difficulty trusting others and clingy behaviour (SALEEM et al., 2019).
The client’s romantic relationship illustrates his attachment style. He fears that his girlfriend may be cheating on him, and thus he thinks she might abandon him. As a result, he ensured that the relationship would not work by sabotaging it. He feared his relationship with his girlfriend would replicate that of him with his mother. Furthermore, the client was made to think and behave in a particular way as every male; his mother’s expectations and culture have reinforced these beliefs. As a result, the client has continued suppressing his emotions as he believed it was inappropriate for a man to express his feelings (Archer & Mills, 2019). The deaths of his childhood best friends further heightened the client’s fear of abandonment. After losing his two childhood best friends, he started indulging in drugs. He was eventually kicked out of school, and, as a result, he developed anti-social behaviour. To prevent emotional abandonment, he has been using suppression as a coping mechanism and intoxicants to act as a self-soothing mechanism to forget what happened in his life. This condition has been attributed to the client not having a supportive caregiver (Fassbinder & Arntz, 2021). Since then, he has been facing heightened emotions of anger, nightmares, distress, and anxiety.
Throughout the client’s relationship, there has been an increasing moment of emotions; the traumatic experiences and suppressed emotions need to be brought to consciousness for the client to experience them. The client experienced chronic depression and later indulged in alcohol and hard drugs to escape reality. He further disconnected from his friends and family (Mihalits & Codenotti, 2020). During his time in jail, he was entirely sober; as a result, he was unable to suppress emotions and thoughts. These experiences enabled him to feel that he could briefly speak to someone about his predicaments. The client has appreciated the importance of expressing his emotions and understanding his feelings and behaviours better. However, it is unmanly for a male to express his feelings. The therapist’s responsibility is to make the client understand the defense and its significance in one’s earlier life. Through understanding these experiences, the client will be able to drop away from the defense mechanisms and focus on a brighter side of his life.
Delving further into the topic, not receiving appropriate caregiving has a devastating effect on the client; the traumatic events may have contributed to the client’s resentment towards his parents. Traumatic events or negative parenting coupled with little caregiving support contributes to this mechanism (Di Giuseppe et al., 2019). The client may be required to explain some shameful events during the sessions; as such, he may be overwhelmed by the experience forcing him to erect barriers, such as not attending the sessions or avoiding some discussion topics.
The therapist has the required training to fully provide therapeutic healing regarding the client’s bereavement disorder. With this client, the therapist will use an integrative method of; psychoanalytic, humanistic, and TF-CBT approaches. In this sense, the humanistic approach is essential in offering techniques and skills to enable the client to understand the feelings he had been neglecting all his life. The therapist will apply the psychoanalytic approach to release the suppressed experiences and emotions. The TF-CBT’s role in therapy is to handle the client’s specific PTSD symptoms (Wise, 2018). Bereavement therapy is essential in helping clients come to terms with feelings emanating from past traumatic experiences and handle denial aspects, anger, and depression (Belsher et al., 2019). In addition, the therapist needs to assist the client in handling issues emanating from his avoidant-ambivalent attachment. This will help him to be adaptive to his future relationships. Generally, the integrative method will assist him in understanding, expressing, self-actualise, and healing his wounded self because of his inconsistent relationship with his mother, promoting a healthier interaction between him and others.
Conclusively, the therapist needs to consider several considerations before committing to a client. In this, they should be able to provide beneficial therapy to the client considering the setbacks the client may put them through. In this scenario, the client has presented several traumatic events which might have resulted from the deaths of two of his best friends as he was growing up. The therapist needs to attend to these early traumatic life experiences. The client has developed behaviours and defence mechanisms that may prove difficult for the therapist to offer therapeutic healing. As such, the client has to assure the client that they have the capacity, reflexivity and resilience to commit to them emotionally. In addition, it is the therapist’s ethical responsibility to ensure the client’s psychological well-being and provide effective therapy.