Running head: CASE STUDY: ALAINA 1

Case Study: Alaina

Tammy Daniel Coles

Walden University

CASE STUDY: ALAINA

Case Study: Alaina

Alaina is a 40 year old Caucasian woman born to professional parents of diverse ethnic

backgrounds. It is unknown if her parents were immigrants or born in America. Some of the

most pertinent information gathered from the case study intake includes, but is not limited to, the

following. Alaina is the middle child in her family and both siblings are in professions that

require higher education. She previously worked as a high school teacher but left the field after 2

years, citing “high schoolers with raging hormones” as the cause. Alaina’s mother was an

elementary school teacher for 2 years before becoming a homemaker, then a substitute teacher

and finally a fulltime administrative assistant at an elementary school for one year. Presently

Alaina is working in an office creating curriculum for managers. She notes that she dislikes the

deadlines and the “pressure to get the product out” aspects of the position.

Alaina holds a Master’s degree and has a strong history of academic success. Given the

professions of her parents and siblings, it appears her family values higher education and

academic achievement. Alaina notes that she has considered going back to school but has

reservations. There has been a suggestion that Alaina become a school psychologist, but she

notes that she does not like the idea of returning to the bureaucratic aspects and testing aspects

required of an educational setting.

Alaina cites becoming a sports writer covering professional tennis matches or basketball

games as one of her dream careers. She also notes considering careers as an editorial assistant for

a publisher, a technical writer, and a recreation planner for adults. Considering Alaina’s cited

dislike for “deadlines and getting product out”, it would be important to dig deeper in order to

explore if those aspects could be deal breakers in her dream careers. Alaina points out that she

2

CASE STUDY: ALAINA

wants to be able to spend time with her children so that they aren’t “shipped off to daycare

providers all of the time”. This may suggest that a part-time position or one that offers flexible

hours may be ideal. Her previous experience as a high school coach should be examined more

closely to explore recreational coaching as a career option.

Alaina is married and the mother of 2 children. Her daughter has a mild learning

disability. The experiences surrounding her daughter’s learning disability, diagnoses process,

and placement in special classes may be tainting Alaina’s perceptions of a school psychologist

position, so it would be important to examine carefully. Alaina watches her family’s diet very

closely and notes a career as a dietician as a consideration. Alaina is noted as being athletic and

working out is also listed as one of her hobbies. Considering a career as a personal trainer may

be an option to suggest depending on career interest inventory outcomes. Alaina notes that her

husband has a history of alcoholism and she has anger issues that led to couples counseling 3

years prior. She cites that the counseling was helpful, and states that her husband supports her

effort to find a new career, so there is no initial data to suggest that there are any barriers there.

Alaina has a long standing history of depression in the form a dysthymia diagnosis and

presently takes a moderate dose of fluoxetine. Merill (2010) notes that dysthymia is most

common in women with a long-term medical problem such as anxiety, drug abuse and addiction.

Dysthymia is also most commonly found in those with a family history of depression, but

Alaina’s case study doesn’t suggest that she meets either of those criterion. Her symptoms

described during the past two weeks also don’t fit the diagnoses. It would be a good idea to

review her diagnoses for accuracy and to work her primary care provider (PCP) to ensure that

her medication hasn’t stopped working. Fluoxetine is often effective for many different

3

CASE STUDY: ALAINA

depression and anxiety related disorders, and working with her PCP to review her current

dosage, her compliance in taking the medication as directed and the effectiveness of the

medication may need to be reviewed. Alaina report of two weeks of anxiety and depression

related symptoms may indicate the medication may have stopped working, the dosage may need

to be increased, or Alaina may not be taking the medication as directed. Her symptoms may also

be related to the anxiety of beginning career counseling, so again review if the reported

symptoms are situational would be important. Alaina’s complaints of not feeling “jazzed” could

be a side effect of her medication but, it would be important to rule out any symptoms that may

suggest a misdiagnoses.

Dysthymia symptoms include a persistent low or dark mood and feeling “jazzed” isn’t

something that is common in individuals with the diagnosis (Merril, 2010). Examining further

could rule out other possibilities or missed comorbid diagnoses. Encouraging Alaina to discuss

all of her symptoms with her PCP (not just the sleep related ones) during her appointment in 2

weeks and working with her PCP to create a supportive environment where Alaina felt

comfortable divulging all of her symptoms will help keep her mental health in check. Assessing

how much Alaina’s mood disorder is affecting her work and how much her work has been

affecting her mood are important pieces to examine. Alaina cites that she has been in counseling

twice over the past 8 years, with an instance of close familial suicide being the instigator of

counseling 6 years ago. The cause, duration and timing of the other round of counseling are not

specified in our current case study information.

Intake Process

4

CASE STUDY: ALAINA

Looking to a Career Genogram in Alaina’s case, there is a strong pattern of Alaina’s

career path mirroring that of her mother. Alaina’s mother, Melina, modeled a pattern of leaving

careers that were very structured after one or two years but professionally remaining in an

educational setting. Both Alaina and Melina demonstrate a pattern of being more successful in

positions that are part-time and more flexible. Both Alaina and Melina were full time teachers

briefly and both left after 2 years. Melina’s longest position was as a substitute teacher. Alaina’s

longest position was as a high school tennis coach. Both Alaina and her mother held these

positions successfully for several years. Melina’s final fulltime position was administrative in an

educational setting and only lasted one year. Alaina’s current position is administrative in nature

and education focused. Alaina and Melina both spent most of their professional career in an

educational setting. Donna, Alaina’s younger sister also works in an educational setting.

A Life-Career Assessment would be another good tool to use during Alaina’s intake

process. Gysbers (2006) clearly defines each section and what client information should be

gathered in each part. In Section 1, the Career Assessment Portion, working with Alaina to

actively identify the things she liked most and least about each position could help to identify

what career fields most match her interests. We have some like and dislikes from the intake

including dislikes in the form of deadlines, production-focused work, and bureaucratic work

environments. Some likes include sports and dietetics. At this point, her noted dislike for

working with adolescents would need to be further discussed. Her many years coaching youth

successfully and seemingly happily, doesn’t correspond with her complaints about adolescents

that she cites as leading her to leave the teaching profession. It would be important to weigh if

her dislike was situational as opposed to age-group based.

5

CASE STUDY: ALAINA

Using Gysbers’ (2006) Section 2 description, Alaina should then describe her typical day

from the moment she gets out of bed to when she closes her eyes at night. Gysbers suggests

using this section to identify specific life-career themes. Using this section to find those themes

is designed to help Alaina clarify her conscious and unconscious likes and dislikes. In Section 3

Gysbers (2006) suggests having Alaina identify her strengths and obstacles to help clarify any

life-career themes that may be leading to her dissatisfaction. In Alaina’s case, looking at

instances of depression, anger and anxiety during the course of her professional life may help her

find patterns of working in fields that don’t allow her to utilize her strengths. In the final

section, Gysbers (2006) points to the summary as a tool that sets that sets the stage for not only

client self-discovery, but also for clearly identifying the career assessment instruments that are

best suited for an individual client.

Motivation For Counseling

In the case study, Alaina notes that her motivation to seek career counseling at this point

is because “the time is right”. Alaina’s information suggests that she is seeking counseling due to

a dissatisfaction with her current work environment combined with the lack of a clear vocational

direction. Her children are both school-aged, so Alaina may also see the time while her children

are at school as a time to attend school herself. Alaina shows a pattern of relatively short-term

employment and career dissatisfaction related to be in highly regimented positions. Her largest

presenting problem is that she is dissatisfied with her current work environment, the structure,

and the expectations. Looking to Capuzzi and Stauffer’s (2006) explanations of Super’s theory

of vocational development, Alaina seems to be in both a maintenance stage and exploration

6

CASE STUDY: ALAINA

stage. She is exploring more and learning about more opportunities while verifying her current

occupational choices.

Issues and Problem Focus

The three most important areas to address in Alaina’s case are mental health, identifying

patterns, and establishing a clear career direction. The most troubling presenting problem that

would need to be addressed would be Alaina’s current mental health. Starting with Alaina’s

mental health and working with her primary care physician, it would be important to closely

examine her symptoms that had persisted during the past 2 weeks. The duration in relation to her

professional satisfaction needs to examined, but given that she stated had been considering

seeking counseling for over a year and that she hasn’t specifically noted any issues that would

have prompted Once mental health is ruled out as the primary causation, helping her recognize

and identify career patterns and making connections in relation to her mother’s vocational

history could help Alaina gain self understanding. Utilizing a combination of skill and career

interest assessments such as Holland’s Theory, a Vocational Preferences Inventory, the Career

Thoughts Inventory and a General Aptitude Test Battery could help reaffirm or redirect Alaina’s

career direction (Capuzzi & Stauffer, 2006).

Professional Relationship With Client

According to Hill and O'Brien (2003), the important part of developing rapport with

client is to develop an atmosphere of unconditional acceptance, empathy, respect, and positive

regard. The first step in establishing a solid relationship with Alaina would be to establish clear

guidelines, rules, and expectations of counseling. Clarifying these things up front help a client

feel like they are in a safe, supportive, and structured environment (Hill & O’Brien, 2006).

7

CASE STUDY: ALAINA

Being compassionate, caring, and empathetic with Alaina’s concerns is an essential piece.

Listening carefully to her concerns and paying close attention to what is being said, as well as

the underlying motives that aren’t being spoken will help get to the root of Alaina’s issues.

Capuzzi and Stauffer (2006) discuss using skills such as reflecting, asking open-ending

questions, identifying and naming specific strengths, clarifying values, role-playing, spot-

checking, task setting and establishing “yes, buts” as important ways to keep the counseling

environment productive, supportive, and nurturing. In terms of multi-cultural concerns,

considering elements such as Alaina’s nuclear familial influences, her and her parent’s

education, her social class presently and as a child, what types of expressiveness she uses, any

gender relational concerns she may have, and how she learned to define and deal with emotions

could all impact how to approach therapy with Alaina (Sue & Sue, 2003).

Drs. Sue (2003) also suggest having up-to-date information regarding issues impacting

women, recognizing that most counseling theories are male-centered, maintaining awareness of

oppression and sexism, assessing a client’s attitude of benevolent sexism, helping the client to

realize the impact of gender expectations, and refraining from expressing counseling attitudes

that constrain life goals for women as important pieces of working with women. In Alaina’s

case, evaluating her attitude regarding her perception of responsibilities at home and her gender

role could be helpful. Utilizing this approach may help to identify Alaina’s feelings regarding

being a mother, a wife, and balancing work with home. Utilizing the Motivational Interviewing

Approach as discussed by Capuzzi and Stauffer (2006) and being aware of where Alaina is in the

Transtheoretical Model (TTM) of Behavioral change is another great way to inform treatment

planning and help keep Alaina on track for success. Knowing where Alaina is in Super’s life-

8

CASE STUDY: ALAINA

stage combined with her readiness for change can help inform the treatment planning and keep

Alaina actively involved in the treatment process.

Career and Educational Information

With Alaina, she has a huge economic advantage in the form of reduced tuition through

her husband’s work if her career choice leads her to return to school. In addition to career

interest inventories, directing Alaina to research career interests using a CIDS system may be

helpful. Helping Alaina to look at the job descriptions and duties associated with some of her

“dream” careers may change her perception of the work related to those fields. She holds a

bachelors degree in English with a minor in Journalism, and noted careers as a sports writer, an

editorial assistant for a publisher, a technical writer, and a recreation planner for adults as career

options being considered. Helping her research those and comparing them with her likes dislikes

will be a strong tool in informing her career decisions.

If she decides to pursue any of the journalism related careers, using O*net or an online

CIDS like CIS provided by the University of Oregon to identify degree programs and internship

opportunities will help put her on track. Another great resource for Alaina may be to contact

individuals working in fields that she is considering and conducting informational interviews.

Meeting individuals in those career positions she is most interested in and learning about the

work involved from the “source” may give her confidence in choosing a direction. Self-

confidence doesn’t seem to be an issue for Alaina at this point but seeking out resources to give

her clarity and a sense of direction are going to be most productive. All the pieces should evolve

in Alaina establishing a clear career goal and recognizing the path that she needs to take in order

to achieve success.

9

CASE STUDY: ALAINA

Providing Alaina with research homework assignments that help her evaluate each piece

will give her a strong sense of direction. Some homework assignments that Hill and O’Brien

(2003) specifically suggest include journaling, keeping a log of what situations cause negative

feelings throughout the day, making a dream schematic of what a “perfect life” would look like

and what types of things a client would do if money weren’t an object, and creating a family tree

that utilizes the career genogram and relates thoughts and feelings regarding family interactions

with career choices. This could be particularly useful in relating how Alaina viewed her

mother’s thoughts and feelings related to her work and making career changes.

Follow Up Activities

One of the most important aspects of maintaining change is accountability. Developing

an action plan and holding Alaina accountable for each part during the process is important.

Using the TTM and Motivational Interviewing Skills, maintenance means making Alaina aware

of previous destructive behaviors and teaching her to resist the urge or temptation to fall back

into past habits (Capuzzi & Stauffer, 2006). At the point of termination, Alaina should have

developed a clear action plan at the maintenance stage and should be taking the appropriate steps

to reach her goal. That may mean taking a Graduate Readiness Exam (GRE) and applying to

attend graduate school, preparing her resume and seeking employment in a particular field or it

could mean that she is actively involved in an internship program.

Alaina should be held accountable for both self-check-ins and periodic counseling follow

ups at 1 month, 3 months, 9 months, and 1 year. Follow up activities including maintaining her

mental health, keeping her medication and physical health in check, following up regularly with

her primary care provider and utilizing proper coping mechanism (journaling, behavior

10

CASE STUDY: ALAINA

management, etc.) to overcome her obstacles are all elements that Alaina will continually need

to maintain. Periodic self-check questionnaires and counseling reassessments should help

discover any complications as they may arise. Hill and O’Brien (2003) specifically note giving

feedback and support through difficult changes as important follow-up activities to help a client

achieve their goals. Hill and O’Brien (2003) also point to making referrals and offering

additional resources as important parts of client follow-ups/

11

CASE STUDY: ALAINA

References

Capuzzi, D., & Stauffer, M. D. (2006). Career counseling: Foundations, perspectives, and

applications. Boston, MA: Pearson Education.

Gysbers, N. C. (2006). Using qualitative career assessments in career counselling with

adults. International Journal Educational Vocation Guide, 6, 95-108. doi:

10.1007/s10775-006-9102-4

Merril, D. (2010, August 13). Pubmed health. Retrieved from

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001916/

Hill, C. E., & O'Brien, K. M. (2003). Helping skills, facilitating exploration, insight, and action.

(7th ed., pp. 70-73). Washington D.C.: Amer Psychological Assn.

Sue, D. W., & Sue, D. (2003). Counseling the culturally diverse. (4th ed., pp. 103-219). New

York, NY: John Wiley and Sons.

12