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Tuesday, December 9, 2008

Case Study: Internet Counseling with John by Tony Astro

The Case of John
Contemporary Issues in Counseling

John: Well… I'm here in counseling because I’ve been feeling really depressed lately. I… um…can't seem to find motivation for the things that I know I need to do. I'm not working now, so basically I sleep. And I don't really get out of the house much. I am involved in karate…but other than that, there isn't much.

Counselor: Can you tell me more?

John: Well…I just feel so down, so depressed…like no one really understands me. And I don't really want to be around people much because they make me nervous anyway…I don't know what to say [Sigh]. So, I just avoid doing things. It’s hopeless.

Counselor: So you’ve been feeling so unmotivated and hopeless lately that you’ve been unable to work, go out of the house, or be around people. Is that right?

John: Yeah…I haven't worked in about a year. My parents still live in Japan, but they help me financially when I'm not working. I’ve been going to work rehab for the past six months, but they told me I was too sick to work. I would like to work again, but I just don't know how I could do it…..because…I feel so overwhelmed most of the time. And I don't know what to do. I just feel so depressed.

Counselor: You said that your parents still live in Japan. How long you have lived in the U.S., and what is your support system like here?

John: I’ve lived here for about 17 years. I’ve got a few friends here, but they don’t really understand me. They try to help me, but people just take advantage of me, I guess because I’m too nice…I don’t have healthy boundaries.

Counselor: What would you like to see different in your life right now?

John: Hmmm…I’d like to not feel so depressed all the time and have the motivation to do the things that I want to do…like find a job, be more involved in karate, and maybe find a nice woman to be in a relationship with. I just don't want to feel confused all the time… and feel so depressed… and stop all of the thoughts that keep rushing around in my brain. Medication helps some, but not enough. I try to meditate, but it’s really hard. I just keep thinking. I’d also like to have more motivation to get out of my house, because it was really hard for me to even come here today.


John admits to the counselor of having some type of psychological concern and intends an answer. The counselor has already started the first step which is narrative and eventually expands it into a life review.

Davis and Degges-White use the term life reviews as a naturally occurring process in which individuals share their stories through written or oral means. Individuals depend on language to make sense of mental images and on constructed symbols to communicate ideas and intents to others (Davis and Degges-White, 2008).

John’s ability to proclaim his problem of depression: “I just feel so down, so depressed…like no one really understands me” is a good prelude towards going further and trace the roots of his depression. A narrative or life review counseling would be a very appropriate technique to know and bring out questions and answers like:
1. Have you feel this way before?
2. Is there any activities you have done in the past 5 years that helped you not to feel depressed?
3. When and how did you feel that no one understands you?

The 2nd Application to be proposed is to have John try to write down his daily events either through a journal for his own exclusive readings. Have John review anything he writes and observe his self and get back to the counselor for a follow-up.

Davis and Degges-White continues on their studies: Comparing participants' earlier writings with their later writings and asking participants whether they thought the life review activities improved their ability to view themselves gave a more comprehensive perception. Overall, the participants viewed the activity as one that provided personal analysis rather than pure description of past activities or relationships. They generally believed, they did deepen their understanding of themselves, and they felt that looking back did provide opportunity to find connections (i.e., self-actualization). Their comments revealed that the experience encouraged them to undertake a personal search for meaning (Davis and Degges-White, 2008).

Another good indication that he is open to explore and cure his depression is admitting his weakness: “They try to help me, but people just take advantage of me, I guess because I’m too nice…I don’t have healthy boundaries.”

For some men, it is hard to admit any problems even more, to actually acknowledge you have a depression which results to most men susceptible to other psychological illness (for not expressing weakness such as depression).

This widespread inability among men to identify emotions and put them into words has enormous consequences. It blocks men who have it from using the most effective means known for dealing with life's stresses and traumas— namely, identifying, thinking about, and discussing one's emotional responses to a stressor or trauma with a friend, family member, or therapist (Brooks and Good, 2001).

And so, coming from John’s own narrative, setting boundaries is important so that John will not be overwhelmed by the pressure of the people around him who does not understand his culture. Advise John some ideas on how to set boundaries like:

1. Don’t accommodate friends or acquaintance that he thinks takes advantage of him for being Japanese.

2. Encourage John to actually “find a nice woman to be in a relationship with” where he can talk to about the pressures from around him.

3. Encourage John to keep busy or continue his hobby of Karate and find a job just keep him focus on something else. This may just be all he needs: a job.

Counselor should continue to see John for another 6 sessions while making a follow up questions such as:

1. Find other sources of motivation: Have you find resources online as well as in his community that would develop his ways of keeping busy, be employed, and maybe have relationship.

2. Life Review or Narrative in writing: Did his writing ever help? Can he continue to do his journaling, be consistent and patient for another 5 weeks?

3. Wellness Plan: How is John’s health and what are diets and physical activities does John have been doing in the rest of the weeks / months.

John’s willingness to get advice from the counselor is already a sign of health. Continuing to be proactive with all these suggestions and communicate consistently with the counselor should bring positive light to John’s issues.


Davis, N. and Degges-White, S. (2008, Fall2008). Catalysts for Developing Productive Life Reviews: A Multiple Case Study. Adultspan: Theory Research & Practice, 7(2), 69-79. Retrieved November 24, 2008, from Academic Search Premier database.

Brooks, G. R. and Good, G. E. (2001). The New Handbook of Psychotherapy and Counseling with Men. Vols. 1 and 2 : A Comprehensive Guide to Settings, Problems, and Treatment Approaches. San Francisco, Calif. Jossey Bass, 2001
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