Rogers Case Study Using Person

Rogers

CASE STUDY USING PERSON CENTRED THERAPY

Patient: Carl S., Male, 41 years old appears on presentation to be in good health but is complaining of depression and anxiety. Medical history reveals that a Traumatic Brain Injury (TBI) was experience two years ago in a car accident where Carl had been a passenger in a car sideswiped by a drunken driver. His head hit the passenger's side door window and he was initially diagnose with concussion but lingering cognitive issues revealed right frontal lobe injury and short-term memory loss as well as certain impediments to some activities of daily living (ADL). While physically healed from his injuries Carl finds it a struggle to maintain his existence. He was unable to return to work and has been on disability with no prognosis of being able to go back to his previous occupation of construction worker. His home health care aids have reported distinct behavioural changes and mood disorders over the past several months. The patient's Primary Care Physician has referred him and included his history as well as the fact that he is receiving prescription treatment for depression as well as schizophrenia.

Carl Rogers, one of the founders of humanism, states that we have difficulty in reconciling our ideal selves with our real selves and that what we perceive as ourselves is often clouded by past projections of others who doubted us. Rogers terms this as incongruity and this becomes the cause of all psychological problems for the individual. . His methods puts the client or person back in control and Rogerian Therapy is basically a person cantered non-directive approach whereby the therapist acts as a conduit for the client can view him or herself more clearly. This Rogers perceives as a required psychological adjustment, "...which is characterized by an openness to experience without defensiveness, congruence between self and experience, and living by an internal locus of evaluation rather than by externally determined conditions of worth." (Demorest 2005: 144) In this case Carl's ideal self is now extremely conflicted with the limitation his TBI has caused. After several weeks of meetings and a review of the case history Carl exhibits, oppositional defiant disorder, obsessive-compulsive disorder, and some learning disorder due to his short-term memory deficits. Interestingly he was also diagnosed with possible Asperger's Syndrome and/or schizophrenia several years ago, but this was never followed up by any mental health professional. He may also be exhibiting signs of post-traumatic stress disorder suffered from the accident and loss of his faculties. Carl's case history reveals many disinhibited behaviors such as the use of profanity, inappropriate sexualized language and gestures. These often require a great deal of coaching and cueing from his assistive staff in order to reframe his social comprehension and interactions with others. His affective cognitive disorder presents many daily challenges. However he does appear to maintain orientation to time, place and circumstances and his long-term memory prior to the accident remains intact.

During my meetings Carl' his sort-term memory loss results in him not being able to recall where he was earlier at a specific time/date. Carl cancertianly be impulsive and is often quite easily frustrated, however he is very receptive to positive feedback, validation, and educational instruction to encourage new, positive behaviors. Carl attempts to compensate for these memory deficits by carrying a notebook, which he writes in to remember things he has done or things he needs to do, and refers to this notebook throughout the day. Carl's short-term memory impairment is often the antecedent that leads to agitation and irritability. Carl tells me that while he continues to get very frustrated with his memory loss, but uses humor to cope with these frustrations

As Rogers state, incongruence equals suffering of the psyche. The difference between the perceived Self, the actual Self and the ideal self is certainly on of the primary causes of all psychosis and suffering for the human being. As human beings we have an "idea" or concept of who we are and what we really should be, hence we create an Ideal Self that we constantly strive for, often in vain. If the perceived self, our own self-image, is not aligned with the actual self, how we really are, there will always be personality problems and dysfunction as one relates to one's self and the rest of the world. (Kail & Wicks 1993) In Carl's case this is certainly exacerbated by his TBI.

In some sense if a human being grows in a very healthy and psychological and socially secure and protected environment, congruence should naturally be achieved. If he or she has felt the unconditional positive reinforcement that Rogers advocates, than congruence should be an outcome of certainty. (Vander Zanden 2003) However, even with the best of growth comes change and the self you are today may be different that the self you will be tomorrow, with perhaps different plans and goals. The human being's ability to adapt and change is one of the species greatest strength, but may also keep total congruence just a little out of reach. In Carl's case achieving congruence will require a great deal of adaptation to a new way of living with this TBI.

During the course of our therapy I realized that Carl had several organic as well as psychological issues that needed to be addressed. I knew it was imperative that I not only address these issues but also find a way for Carl to embrace his new self and, after a mourning period, release his concept of his old ideal self so that he may more appropriately address his issues of congruence and self-actualization. Our first interviews went slowly as we not only got to know each other but this also allowed Carl to actually begin to remember me as his short-term memory was reinforced with repetition of my presence. Afterward we worked on addressing what his ideal self had been and where his new ideal self would take shape from.