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Case study

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Order Code: SA Student Chrysolite Medical Sciences Assignment(10_23_37812_705)
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Assessment-3

Case study

Theo, 35yo, is an experienced builders labourer and a keen amateur cricketer. He is married toAngie, 33yo, part-time legal secretary, with two childrenEsther11yo andZoe8yo, both at the same primary school. Theo was injured when a concrete block dividing wall collapsed on a building site for an industrial development (insufficiently secured, windy day). His lower right leg was crushed, leaving him with a badly broken ankle, compound fractures of his tibia and fibula, and significant ligament damage to his knee. His bossDaniel,46yo bricklayer, was killed beside him, having pushed Theo aside as the wall fell. Daniels wifeRoseran a caf near the site, heard the collapse, and ran to the site. Theo saw her immediately after the accident, screaming as other workers tried to rescue Daniel (who most likely died instantly). Daniel and Rose have three children:Hamish(22yo, studying law),Callan(20yo, apprentice chef), andOrla(16yo, final year in secondary school).

Theo missed Daniels funeral because he was still in hospital, recovering from the first of three separate operations on his right leg. He first had a rod inserted in his tibia, then two weeks later his ankle was fused. A post-operative infection in the leg meant that his bones didnt heal despite the best efforts of the medical staff, and seven weeks after the initial operations, his leg was amputated below the knee. Theo spent a further three weeks in the hospital while his wounds healed, and then another ten weeks in a rehabilitation centre, where he was fitted with a prosthetic leg and re-learned how to walk.

Theo was discharged to his home five months after the accident. Over several attempts by his workplaces Employee Assistance Program organisation to set up counselling with Theo, Theo provided a series of reasons for not being able to begin. Three months after he returned home, Angie contacted the EAP service after finding the card in his wallet and urged them to try again.

Crystalis a 27yo EAP counsellor whose employing organisation provides EAP counselling services for the building industry. She was the counsellor who was asked to contact Theo to organise an initial counselling session. She rang Theo, and he agreed to a session with her via Zoom a few days later.

When their Zoom session began, Crystal welcomed Theo, explained who she was and what she does. She let Theo know that EAP counselling is free for him (as his workplace pays for it), and that she can see him for up to four sessions. Theo raised his eyebrows when she said it was free for him, but otherwise didnt ask any questions. Crystal asked him where hed like to start, and Theo said, I dont know what do you need to know? Crystal asked him to tell her a bit about himself and how hes been going. The following is the transcript of their conversation.

Theo: Ive been getting by, I suppose but Ive been better, thats for sure. You know I lost my leg?

Crystal: Yes, Im very sorry to hear that. I imagine its been very difficult to get used to.

T: Yep. Having to learn to walk all over again, its been I was going to say a pain in the you know but mainly its a pain on my stump. You wouldnt credit how much a leg thats not even there can hurt. And even when Im not on it. You wouldnt wish it on your worst enemy.

C: The pain sounds pretty bad

T: Its relentless. It gets so bad I wake up in the middle of the night and have to take something just to get back to sleep. Pretty much anything really Ive got these painkillers theyve prescribed me, but half the time they dont even touch it. Sometimes the only thing that helps is a rum and coke, and thats going easy on the coke. Its the only bloody thing that makes me feel half normal.

C: So you find that a drink helps you with the pain?

T: Ah, if it was only one drink then Ange wouldnt mind, would she?

C: So more than one then, I gather

T: I do what Ive got to do to get through it. Im not a drunk, mind you like I dont get wasted or anything like that. Just so I can relax and not be scratching at it all the time, and get back to sleep.

C: So youre having trouble sleeping?

T: Its shocking sometimes. I wake up and my hearts pounding. Its like I dont know where I am or whats going on. Its gotten so Ill go to sleep in the lounge so I dont wake Ange. Between that and the scratching

C: Its itchy, where your leg was amputated?

T: Like you wouldnt believe. The weird thing is its like Im wanting to scratch my ankle, and its not even there anymore, so you cant do it. Sometimes I scratch the end of the stump, which is well, Ange doesnt like it, and shes forever telling me not to scratch it, and I tell her I cant, and well you know what thats like. Its not good.

C: So yes, thats not good. I guess it might help me for you to tell me what a typical days like for you at the moment.

T: Huh. Well not much, really. A lot of Netflix, if Im honest.

C: Which would be a big contrast to before your accident, I imagine?

T: Well yeah I had two legs then. I could do a decent days work, play cricket with my mates. Even help around the house, get into the netball practice my girls like to do. Now Im pretty much useless. Cant do a thing. Sorry, I was about to swear then.

C: Theo, I dont mind you swearing if thats what needed.

T: Well it might be stronger language than youd be used to, is all I mean.

C: You might be surprised [smiles]. You were saying about work?

T: Well, I liked it. Hard yakka [work] a lot of the time, but a lot of good laughs at work too. And I was earning pretty good money as well, which well you know, its a lot tighter now. I used to do a lot of overtime, especially on the big jobs, and get shifts on Saturdays which were extra cash if you know what I mean. I'm on compo [compensation], but none of thats counted in on it. Who knows whatll happen with work from here, too.

C: Have you given any thought to what you might do for work from here?

T: You what? You think Im going to put whats left of me out there again? Im not taking any more risks Ive got to look after myself, I nearly wasnt here as it is.

C: So that must be really tricky, I imagine? I mean, you liked your work, you liked working itself, and of course you liked being paid too. So thinking youre not going to go back to it...

T: WHAT!?[Theo jumps back and looks away from the screen. Hes obviously been frightened. Behind him a womans face can be seen briefly its Theos wifeAngie]

T: What the? Youknowyou cant sneak up on me like that!

Angie: Sorry love I didnt mean to I just wanted to make sure you were okay, see if you needed a coffee or one of your tablets?

T: Look, dont talk about those now, I mean half the things dont do anything, the others you dont want me to take cause they actually bloody work. Anyway, Im talking with this counsellor here

A: Oh, sorry. Have you told her

T: Look, just leave us alone will you?

A: But I worry about you, you havent been yourself

T: Of course Im not myself. Im not all here anymore am I, I mean look at me.

A: I dont mean that, Theo I just want to help if I can. I want to make sure your counsellor knows whats going on so she can help.[Angie speaks directly to Crystal on the screen]Thats what you need anyway, isnt it?

C: Uh well, whatever will be most helpful for you both, of course its up to you, Theo. Would you like

A: Im sorry, Im Angie. Theos wife.

C: Yes, of course hello Angie. Theo, would you

T: Yeah, sure, whatever. You want to talk, Ange, you go for it. You will anyway

A: I dont want to get in the way here Theo, its just I want to make sure youre getting the help you need. You know you havent been yourself ever since that day, is what I mean. You used to be funny, you were always cracking the girls up, and me too. You dont joke around with us theres no laughing anymore, just yelling. And you never see your mates, wed see them and their families all the time. I could never get you and them away from watching the footy! You dont do anything like that anymore. Ricky and Boris, they ring up, you dont even want to take the calls. I dont know if youre texting them or not when youre on your phone, I dont know if its to a friend or with that bloody online gambling. Its like youre I dont know, its like you dont even want to be here half the time.

T: Jeez, why dont you tell her what you really mean? Give a man a break, will you? How would you be if you had this?

A: I dont know, Theo, and whats more I cant know if you dont tell me, can I? You sit in the dark and check your phone, youre spending more than we can afford on betting, you drink more than you ever did. And youre not doing those exercises they said you had to do: you said they told you that you wont get better if you dont. Youre not even looking after yourself.[A is teary]

T: What do you mean? How shallow are you? Of course Ive put on weight. I cant work, its not like I can even go for a walk without paying for it with my body in pain afterwards.

C: Theo, Angie, could I just

A: Oh god, Im sorry, Ive just taken over here, havent I? And I dont even know your name

C: Im Crystal. Its alright, Angie: I can see theres a lot youre wanting to share. I know you want to make sure I can be as helpful as possible Theo. And to you, of course and your girls: youve got two girls, I think, havent you?

A, T:[together]Yes, thats right[they laugh as theyve spoken the same words at the same time].

T: No, you go, love.

A: Yes, Crystal. Two girls: Esthers 11, and Zoes 8.

T: Theyre both more like fifteen year olds, the way they go on!

C: Right, thanks. I look forward to hearing more about them as well. But for now, one thing I still dont know much about is what actually happened could you tell me more about that day?

A: Look, I might leave you two to it then, is that all right love?

T: Yeah, sure Ange[Angie waves to Crystal on the screen and leaves the room]yeah, I dont know, Crystal I start talking about that and Ill lose it again I reckon[shakes his head, grim-faced].

C: Im sorry, Theo. What would be easiest in terms of us approaching this, do you think?

T:[sigh]Yeah, sorry. Its just if those bastards hadnt have been cutting corners on safety, Id still be working Id still have two legs and Danny

C: Sorry, Theo Danny?

T: Dannys the only reason Im still here. If he hadnt pushed me when the wall cracked I just froze, he yelled and shoved me, and then he was gone. I could see one arm, watching the others throwing blocks of concrete around, trying to get it out.

C: Theo, Im so sorry it sounds awful, to be hurt like that, and to see your friend

T: I wish it was me when Im trying to go to sleep, sometimes its all I can think about. I cant get the images out of my mind.

Questions:

Question 1(15 marks) a. What are the major issues for Theo that could be addressed in counselling?

b. Which of these issues might Crystal address first in a short-term counselling setting?

c. Which of these issues are more suited to being addressed in longer term counselling and why?

Question 2(15 marks)

Design a short-term intervention plan for Theos counselling, drawing on therapies outlined in this subject. Explain your rationale for interventions selected, how they might be used and why they are appropriate for a four-session timeframe.

Question 3(5 marks)

What are some of the critical considerations for Crystal in providing feedback to Theo about the way he presents and potential approaches to treatment?

Question 4(5 marks)

Further along in Theos counselling, Crystal and Theo mutually agree that Theo would benefit from additional counselling. How would you go about sourcing appropriate referral options what would you be looking for?

Question 5(10 marks)

What ethical considerations are present for counsellor, Crystal in her work with Theo? In your answer, please consider the setting of EAP, online therapy, and multiple stakeholders (Theo, Ange and the HR manager who is keen for Theo to return to work).

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  • Posted on : November 21st, 2024
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