Shirley, a young woman of twenty-three, was referred for crisis counseling by a local hospital after being seen in the emergency room with a complaint of being unable to breathe. She was in a reported state of panic, certain that her lungs were about to collapse. The next day, accompanied by her aunt, the arrived at a Mental Health Center. She appeared calm, neatly dressed, and cooperative as she entered the office, showing no indication of being unusually upset.
Counselor: Tell me why you are here today, Shirley.
Client: I’ve been so upset and I’ve had an emotional shock really, partly because my leg has been lengthened and all my life it has been shorter than my right one. And then past problems too.
Counselor: What was it that brought you in today in particular?
Client: I went to Valley Hospital and they advised me to come here.
Counselor: Why was that?
Client: Because everything was so upsetting to me.
Counselor: Why did you go to the hospital last night?
Client: Because I was so upset and I couldn’t hardly breathe. I felt like my lungs were going to collapse or something. And every time I hear the sound of s’s it’s like a thrill. And I was upset before. I had gone there the day before yesterday, and I was blowing my nose real hard to get the rest of it out—it was all dry inside my nose. Then something popped inside my ear, and then I started feeling worse.
Counselor: What do you mean upset?
Client: Just past experiences and the shock of my leg on top of it.
Counselor: What are your past experiences?
Client: Well, my father was trying to make advances, and I felt that I had to, because I didn’t know what he would do to me. I have always been afraid of him because he talks real loud and he has always harped on me—"Do it this way, do it that way"—you know. He says that he was only trying to teach me how to do it.
Counselor: What do you mean it? Sex?
Client: Yes. I left home a couple of years ago because of this. He started in again and made me promise not to tell my mother. When he did it the first time, my mother was in the Midwest with my sick grandfather. He had cancer of the brain. My dad started in then, and he made me promise not to tell her after she had come home . . . because he would just deny the whole story.
Counselor: What happened yesterday that made you feel so upset?
Client: I kept seeing visions of the devil. Day before yesterday I went in the bathroom, and I looked in the mirror and it was red, you know. Like a cat’s face. And yesterday it was black, and thoughts kept going through my mind.
Counselor: Thoughts of.
Client: Just bad things, like talking real sharp to everybody and just being real mean. . . . The more I talked about it, the worse it got. I started to panic and couldn’t breathe, and my chest started hurting, and my stomach started getting sick, and I was getting headaches. But all this has gotten worse since that thing popped in my ear.
Counselor: What finally made you decide to go to the hospital last night?
Client: My thoughts weren’t straight. They were confused. I kept getting a prophecy, and I kept writing down everything that came to my mind. My aunt says that that’s not right. So she called a pastor. So I talked to him, and then when I got real bad he came over and tried to talk to me about it some more. Then I felt at peace about it and went to sleep, but then the next morning I was back the same way again. . . . Just like the devil was on the outside of me this time—you know—and he was trying to get in there and taunt me of those pasts that I have had.
Counselor: Could you see him?
Client: Well, not clearly.
Counselor: Could you hear him?
Client: The voice was the thoughts.
Counselor: Were the voices coming from inside or from outside?
Client: From inside.
Counselor: What were they saying?
Client: I can’t even remember now. (Pause.)
Client: All of it has just hit me all at once.
Counselor: How has it hit you?
Client: Well, one night I was laying in a bed and praying to the Lord that He would heal my legs because I felt sure that He would. All of a sudden I felt a transformation of life like I was just going back. Then last Tuesday my aunt went to Bible study, and I was at home by myself with her son. All of a sudden something came over me and I was playing the part of a baby and other times I was playing the part of Jesus, and all of a sudden I was playing the part of a baby myself… and these smells I have been getting.
Counselor: What kind of smells?
Client: Like smells of evil or something.
Counselor: What does it smell like?
Client: Like a burning or something or kind of an evil smell. Before all this had started I kept getting all these chills. I couldn’t get warm enough.
Counselor: And then you started smelling evil? How did you know it was evil that you smelled?
Client: I don’t even know if it was evil or not. It was just that awful smell. I just couldn’t stand it.
Counselor: What did it smell like?
Client: Oh. .. . (Long pause.)
Counselor: Have you ever smelled it before?
Counselor: How do you know it smelled awful?
Client: It was just like a mass growth or something. it was like a sickening smell. When I lay down 1 feel much better than when I’m sitting up. Then I get these panics when I breathe real hard and my chest hurts, and it feels like my arms are going to collapse, and I felt like my heart was going to stop at the hospital last night. I kept getting these pains in my hips and my legs and a real cold tingling all over my legs as if He was healing my legs even more. Even my aunt says my legs are both the same length now. She said possibly that’s part of the reason I’ve been so upset because of the shock, because I’ve had this all my life.
Counselor: What do you think we can do for you here?
Client: I don’t know. Just that I’ve been referred here and that I need help. That’s all I know.
Counselor: How do you think you need help.
Client: Mentally I guess. (Pause.) But I feel that if my dad would just apologize and accept the Lord that I would be at complete peace.... My aunt said that I should ask the Lord for forgiveness if I was going to be able to forgive my stepdad for this because he might be mentally ill. So I prayed to the Lord and told the Lord that I did forgive him.
Counselor: Do you feel guilty?
Client: (Pause.) Well, I feel guilty because I’m telling people about all this when it might make my family get a divorce—you know. I’ve always felt that people wouldn’t accept me because of my past, so I feel that everywhere I go I’ve got to tell them so that they will accept me.
Counselor: I see. And do they accept you?
Client: Yes, and I didn’t realize it. And I told my Grandma Alice, and she said we figured your dad might be mentally ill because he had done this to my sister too. And in that prophecy that I had—it was about ten pages long it seemed like—he was performing blasphemy against his son. He was going to be endangering my mother’s life.
Counselor: This was in the prophecy that you got?
Client: Yes. And to get some money out as soon as I could afford it so that she could take me back and see them so that when my dad saw my legs and how happy I was, that I would be at peace. Ijust kept having the urge and I kept telling my aunt and my uncle that they had to get my parents here. I feel that the sooner they accept the Lord, then the better I will be.
At this point the counselor excuses herself to consult.
- Getz, William, Allen E. Wiesen, Stan Sue, and Amy Ayers; Fundamentals of Crisis Counseling; Lexington Books: Massachusetts; 1974
The article above contains foundational information. Articles below contain optional updates.
Personal Reflection Exercise #5
The preceding section contained information about a deductive model case study in the form of excerpts from a crisis interview. Write three case study examples regarding how you might use the content of this section in your practice.
Using the Deductive Model, what was Shirley’s therapist able to identify as her four primary coping mechanisms?
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