Client History and Therapy Plan: Hypothetical

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(7-3) Final Project Submission: Client History and Therapy Plan
Alexandra Perkins
Southern New Hampshire University

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General Description of Client
Case Study
The client this treatment plan is designed for is Doris. Doris was born and raised in
Arkansas and resided with both biological parents. During childhood, she struggled with her
father’s alcoholism. Doris has one sibling, a younger brother, who has always gained favoritism
within the family over Doris. As a result of her socialization, “She says her parents were stricter
with her than with their son and emphasized the importance of marriage as well as the woman’s
dependent and inferior role in that relationship.” Both of her parents are devoutly religious. Doris
dropped out of high school in the tenth grade and since has maintained jobs as a manicurist,
waitress and cashier.
Doris and her husband have been married for three years with no history of marital issues
and recently, within the past six months, she gave birth to her son. Without any medical
complications, Doris claims she has “adjusted well to the baby, but she reports just not being
able to feel much of anything except tired.”
In the past two months, Doris and her family relocated to Houston so that her husband
could pursue music. Unfortunately, Doris is not receiving support from her husband as he has yet
to find a steady job. Also following the move, Doris began engaging in sexual affairs with
coworkers.
Currently, Doris’ husband is asking her to increase her workload to be able to provide
better for their family. She has expressed her desire to leave her husband and child with no solid
plan for how she would follow through with her desires. She is concerned with what would
happen to her son but insists she does not want to take her son with her when she leaves.

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Maladaptive Behaviors
Doris has expressed that she wants to leave her son and husband but gives little indication
as to a specific trigger. It was indicated that this family is struggling with finances and that Doris
was socialized to believe that women were inferior and submissive to men. This conflict in her
identity may be causing maladaptive behaviors as she searches to cope with her new life. She
may want to absolve herself of all responsibility by leaving her family.
Additionally, Doris is showing symptoms of a depressive episode (may be MDD) with
peripartum onset. The DSM-V illustrates that a depressive episode with peripartum onset is
reflective of mood and anxiety symptoms following pregnancy. Doris’ statements of “not being
able to feel much of anything except tired” lead to this conclusion. Since peripartum depression
is “unique with respect to the degree of neuroendocrine alterations and psychosocial functioning”
(APA, 2013), factors to consider in treatment should include the impact of breast-feeding and the
risk factors associated with further pregnancies. Furthermore, a risk assessment is necessary to
conduct in the case that Doris is also experiencing suicidal ideation. Without a plan for her
absence, this impulsive behavior is concerning and puts her at an increased risk for suicide.
Theoretical Orientation
Gestalt Therapy
Gestalt therapy is a humanistic method of psychotherapy with focuses on the human
experience and subjective reality. The goal is to help the client develop an awareness of current
psychological and physical needs. This form of “whole-person” seeks to treat individuals by
inciting change in the current moment. Gestalt therapists claim, “change occurs when one
becomes what he is, not when he tries to become what he is not” (Brownell, 2012). Doris is

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struggling with the definition of her identity; she may feel as though she does not have enough
time for herself, financial difficulties, etc. Through this approach the counselor would insight
change into her current situation spontaneously and without effort through awareness of what
and she is thinking, feeling, and doing in the present moment (Brownell, 2012). Rather than
creating solutions, this approach will assist Doris in understanding why she is choosing to leave
her family, whether she actually is going to leave her family, and bring together her health,
wholeness, and actualization of her self-efficacy. Success is dependent upon several factors.
These factors include both the “personality type and ego strength of the counselor and client, the
length and aims of the counseling, the circumstances in which the counseling takes place, the
holistic energetic process of the client, the recent present and past life experiences of the
client…” (Woldt & Toman, 2005).
Techniques and Interventions
The sole goal of Gestalt therapy is to increase the awareness of the client. Through this
awareness, it is believed that the client will come to understand who they are and how their
current decisions are keeping them from being this version of themselves. Gestalt therapy can be
defined as “a totality of mutually influencing forces that together form a unified interactive
whole” (Woldt & Toman, 2005). The goal of the therapist is to be authentic and help them to
understand “change occurs when one becomes what [she] is, not when [she] tries to become what
[she] is not” (Brownell, 2012).
Here and Now. The first technique I will implore with the Gestalt approach will be
“here-and-now” awareness. The goal of this intervention is to bring focus to the present moment.
The therapist will begin by asking Doris questions about the present moment and her feelings
toward such. For example, if the therapist beings to notice Doris becomes uncomfortable and

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starts fidgeting with her hands when discussing tough subjects, the therapist would respond with
“What are you doing with your hands now?” This question brings Doris’ awareness to herself,
her behavior, and the present moment. This question requires Doris to discuss the uncomfortable
emotions she is currently experiencing. The here-and-now technique recognizes that “dwelling
on the past and fantasizing about the future can be ways to avoid the present” (Palmer, 2011).
Counselors empower their clients by bringing their awareness to the present moment and staying
mindful.
Theory of Paradoxical Change. The theory of paradoxical change dictates that the more
a person tries to be someone they are not, the more they end up staying the same (Overman,
2018). This significant element to Gestalt therapy will be applied to Doris. She struggles to
accept who she is. Her frequent change in occupation, marital affairs with coworkers and
customers, and demands to increase her workload by her husband support this notion. Doris was
raised in a conventional family, but finds her socialization challenged by her current situation. It
is possible that Doris is struggling to find her place in the current moment because it does not
align with the familiarity of her past. The theory of paradoxical change focuses on helping the
client to accept who they are in hopes that the decisions they will come to make will reflect their
truest self.
Empty chair technique. The empty chair technique will be a valuable tool in evaluating
Doris’ thoughts and feelings toward her husband and her son. Through this intervention, the
therapist and client will gain a better understanding of why she suddenly wants to leave her
family and how they would feel about her absence. Is this a result of the extramarital affairs?
How does Doris feel about her husband not having an occupation but asking her to pick up more
hours at work? What is Doris’ relationship with her son? The empty chair technique requires the

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client to sit in one chair and assume the role of themselves, and then switch to the other chair to
play the role of the other individual (Corey, 2017). This technique is a powerful tool as it not
only reveals why the individual feel they are at an impasse, but also sheds light to a feeling
inside themselves that the client may have been previously denying. When using the empty chair
technique, the counselor will have Doris play the role of her husband and her son. Although her
son is still very young, Doris can give him a voice in this conflict so she is aware of how her
absence will affect his life.
Exaggeration Technique. Body language is significant to Gestalt therapy. Body
language is a subtle indicator of thoughts and emotions; “movements, postures, and gestures may
communicate significant meanings” (Palmer, 2011). When the counselor notices body language
such as clenched fists, frowning, crossed arms/legs, etc., they will ask Doris to exaggerate this
movement. The purpose of this technique is to intensify the feeling causing the movement so that
it may elucidate the meaning behind it. For example, if when discussing her relationship with her
husband Doris begins to pull at her hair, the therapist will ask her to exaggerate this behavior in
hopes she will come to understand why she is pulling at her hair in the present moment.
Dream Work. While Gestalt therapy avoids focusing on the past, previous experiences
in our lives can present themselves in dreams. When working with Doris, dream work will be
used to understand how her past may be influencing the how she sees the current version of
herself. In Gestalt dream work, the client will invent scripts for each character or part to
understand the purpose of that element of the dream. Dreams are believed to be a projection of
the self (Palmer, 2011). Through dissection and reflection of each part of the dream, Doris will
begin to understand how her past is influencing her in the present moment.

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Unfinished Business. Doris may have unfinished business that is driving her to leave her
family. In Gestalt therapy, unfinished business manifests in unacknowledged or unvoiced
emotions like grief, anger, guilt, anxiety, abandonment, etc. (Palmer, 2011). When unfinished
business lingers, the client is unable to become fully self-aware. Often, unfinished business is
expressed via physical manifestation such as fidgeting or a nervous tick. The role of the
counselor is to help the client recognize their unfinished business and guide them through it in
the present moment. One method the counselor can help identify unfinished business is by
presenting a similar situation to the client and guiding them through it using the here-and-now
technique. By using similar examples, the client will begin to develop a sense of how they should
address their unfinished business.
Figure Formation Process. At the center of Gestalt therapy is the figure formation
process. This process claims that “Humans are able to constantly shift their cognitive or
perceptual focus” (Sommers-Flanagan, 2012). This process brings light to the environment
around the client so they may evaluate all stimuli. The process of developing self-awareness is
the keystone of the figure formation process. This process helps the client to “shift [their] focus
and then shift it again to embrace here and now awareness and the personal development it might
stimulate” (Sommers-Flanagan, 2012). For Doris, elements of her human experience, including
unfinished business, may provide insight into her desire to leave her family. Only after listening
to herself and achieving awareness of the present moment will she be able to truly understand if
she wants to leave her family.
Conclusion
In summation, Gestalt therapy is the best approach to helping Doris with her personal
conflict. Without a reason for wanting to leave her family, several issues with her self-awareness

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arise. Using Gestalt techniques and the figure formation process, Doris will bring her primary
needs into focus and begin to live in the here-and-now. Rather than being influenced by her past,
Doris will make decisions in the current moment with the awareness of the present moment.
These decisions will be less impulsive and reflect the person that Doris truly is.

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References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental
disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Brownell, P. (2012). Gestalt Therapy for Addictive and Self-Medicating Behaviors. Springer
Publishing Company. https://search-ebscohost-
com.ezproxy.snhu.edu/login.aspx?direct=true&db=nlebk&AN=446161&site=eds-
live&scope=site
Corey, G. (2017). Theory and practice of counseling and psychotherapy (10th ed.). Boston, MA:
Cengage Learning.
Palmer, K. A. (2011). "Gestalt Therapy in Psychological Practice." Inquiries Journal/Student
Pulse, 3(11). http://www.inquiriesjournal.com/a?id=595
Woldt, A. L., & Toman, S. M. (2005). Gestalt therapy. [electronic resource] : history, theory,
and practice. SAGE.