Case study: You work at a community health center and the client, Luisa, was referred by a physician at the clinic because she has not been attending her scheduled appointments with the doctor. The doctor is concerned because the woman is having some health symptoms such as high blood pressure and high cholesterol and the doctor suspects the woman is not taking her medication as prescribed.
Your goal is to engage Luisa and understand the barriers to her meeting with the doctor consistently and taking her meds as prescribed. Identify any moments in the session where you felt stuck or unsure about how to progress……
Evaluate the effectiveness of the questions you asked during the session.
Reflect on whether your questions were open-ended enough to encourage exploration and reflection, or if they inadvertently steered the conversation away from the root of the problem.
Reflect on what might have contributed to these stuck points. Did you encounter any blind spots in your approach, such as assumptions about the client’s experience or barriers to empathizing with their perspective? Consider alternative strategies you could have employed to break through the impasse and get to the root of the problem.
Reflect on techniques such as gentle confrontation, reframing, or using metaphors to bypass resistance and foster insight. Reflect on Therapy Session Transcriipt:
Hello Louisa, what brings you in today? Um, I think my doctor is a little upset with me, so she forced me to, you know, she’s like, go figure it out, you know, so, here I am. So, it seems like you’re having some miscommunications with your doctor maybe, or, um, some barriers to communication, can you kind of describe, like, what that looks like for you guys? So, basically she’s, she feels like I’m not taking my meds as prescribed, um, I cancel appointments, and, you know, um, she’s upset about that. But, it’s complicated, and so I think that in the ten minutes I have with her, I can’t really get into it.
Yeah. And so, yeah, that’s been the issue. That makes sense, you kind of just go in there and she sees you and kind of sends you on your way.
Um, when was the last appointment you did make it to see her? Um, last month. And then, since then, what are some of the issues that have been arising that have been stopping you from getting to your appointments? So, basically the issue is, after I come out of the doctor, I go to reception, and they’ll say, okay, the doctor wants to see you and your mom, you know, so I’m like, alright, you know, I can, um, get here for 4.30, so 4.30 or later any day. And, um, I work at the public library from 8 to 4, bus takes about 40 minutes if the planets align, um, but I can leave work, like, 50 minutes early, whatever.
So then they’re like, oh, we don’t have any appointments at that time, can you do Wednesday at 1.30? And I’m like, how am I going to do that? Like, they’re like, well, take your lunch hour at work. And I was like, it would take, I would have to take a two and a half, three hour lunch for that to work. Because, like I said, it’s like 40 minutes, my appointment with the doctor is only 10 minutes, but then, you know, I don’t know if you know how long we wait before we see a doctor, it’s probably 40 minutes.
And then I’d have to take a 40 minute bus ride back, like, that’s not a lunch hour, right, that’s half a day. And so, um, so I just struggle with, like, all I need is an appointment that isn’t during my work hours. And so what happens is, they don’t give me any other option, and then I say, you know, can I, if I do an appointment during the day, can it be virtual? Because in that case, I can go into the office and close the door and, you know, have an appointment, but I, you know, and without the transportation end of things, like, that would be very doable.
But they’re like, no, the doctor has to check your blood pressure when you’re here. So, I feel like I’m in this place where, like, it’s not my fault, like, you know, but, so, I’m not sure how to fix it. Have you tried communicating to your doctor some of your concerns about your transportation, or just the reception people? Because sometimes doctors, like, they can kind of, they know their schedules better than the people at the front, and
they can kind of, like, tweak their schedule to help you.
I don’t think this doctor knows her schedule better. I think she puts everything on reception, and I’ll say, oh, well, you know, I need an evening appointment. She’ll say, oh, well, I’m here, you know, till 7 on Tuesdays and Thursdays.
Have them give you an evening appointment. I go out there, they’re like, they’re all booked. And then we become in this stalemate.
And then, like, I don’t know how to fix that. I feel like they should fix that. They should be more flexible with your schedule.
And even if they have to, like, you know what, we’re going to give you an appointment that’s six weeks out instead of four weeks. So, because then we can give you an evening. But they only write the scriipt for 30 days.
So, then I don’t have meds. So, like. So, since you haven’t seen your doctor in a month, have you now been missing dosages of your medication? Well, I have to call and say, you know, can you give me a refill? And they call it in.
And sometimes that can take, like, days before they do it. So, it does become a problem. So, have you been taking your medicine consistently? When I have it.
Is your doctor aware that you haven’t been able to receive your medication? Sort of. You know, like, I get two minutes with her. So, it’s like, I just explain, like, oh, I ran out and it took a while to get it.
Like, I don’t get into every detail because I don’t have that kind of time with her. You know, she really drives the time we have together. So, how is this? How have you experienced that? You know.
Do you find that she’s somebody that’s, like, supportive to you right now? Or can you kind of describe the relationship that you have with your doctor? I think she cares. I think she’s busy. You know, they have a person going in that office every ten minutes.
Like, that’s hard. Yeah. So, you don’t really feel like she, like, cares about your problems because she’s just kind of, like… No, no, no.
I think she cares. I just think she’s overwhelmed. You know.
Alright. We can call it there. Okay
