KATHRINA: Learning to cope with anxiety:
Kathrina, a Native American in her early 20s, comes to the clinic where you work as a behaviorally oriented therapist. Assume that this is your initial meeting with her and that you know nothing else about her. Also assume that she would very much like to become involved in short-term behavioral counseling, mainly to deal with chronic anxiety that is getting in the way of her personal and professional life.
Some Background Data:
During the initial interview Kathrina tells you:
“I’ve just got to learn how to cope with stress. I feel as if there’s a dark cloud over my head – a constant feeling of apprehension. I’m so worked up during the day that when I try to go to sleep, I just toss and turn most of the night, ruminating over everything that happened to me that day. I keep telling myself that I’ve got to get to sleep or I won’t be worth a damn the next day. I just lie there and can’t seem to stop thinking of what I did or will do the next day. When I do get up the next morning, I’m a basket case. I sell real estate, and lately I’m getting more anxious about my future.
I’m fearful of contacting people because I might say the wrong thing and blow the potential sale, and I’m afraid they’ll notice my anxiety. I just don’t seem to be able to relax at any time. And what’s even worse is that I feel less able to cope with stress now than I used to. Stress is getting the best of me, and I’m afraid that unless I can learn to recognize and deal with the situations I’m in, my anxiety will do me in.”
Kathrina also tells you that she is experiencing many problems in leaving home and feeling that she can make it on her own. She says that she is not following the family “program” and lets you know that her parents are disappointed with some of the ways in which she is living. She does not want to cut herself off from her family, yet she has trouble in being everything her parents expect of her.
Assume that you and Kathrina agree to several counseling sessions to help her deal with her anxieties. Specifically, she wants guidance in learning coping skills that she can use on her own. Working within a behavioral framework, demonstrate how you would view her as a behaviorally oriented counselor and how you might proceed for several sessions.
Questions to answer:
1. How do you view Kathrina’s anxiety? How will your answer to this question have a direct bearing on the manner in which you work with her in your sessions?
2. What cultural themes would you pay attention to, if any? To what extent would you focus on her alienation from her family? Would you be inclined to focus more on her anxiety? Her stress? Her concerns over not living up to the expectations of her family?
3. What might you want to know from Kathrina about the ways in which her cultural experiences have affected her? If you are from a different background, would you expect any difficulties in understanding and working with her?
4. What specific behavioral procedures might you employ during your sessions? What suggestions would you make to Kathrina for work she can do by herself outside of the sessions?
5. What ways can you think of to teach her how to cope with stress? What self-help or self-management techniques could you suggest?
6. How might you deal with Kathrina’s insomnia? How might you design a program for her that would help her relax and sleep at night?
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