Case Study: The Case of Margarita, Part 2

Case Study: The Case of Margarita, Part 2Intake Information (background for the Part I assignment)Margarita is a 26-year-old Puerto Rican woman. She was born in Puerto Rico and moved to the United States as a teenager. Her husband is African American and has lived in the United States his entire life. The couple has been married for five years. They have two children together, a boy age three and a girl age one.Margarita is seeking counseling due to reported “anger outbursts.” She states that she becomes so angry with her husband that she thinks of physically harming him, although she does not remember anything that he does specifically to provoke her anger. She denies any physical violence but has gone as far as grabbing a knife and threatening him. She does respond to his verbal attempts to calm her. She reports feeling relief after the “explosion.”Margarita has an MBA and is very intelligent. Recently, she was accepted to law school and will be starting in three months. Her husband holds a prominent position in their community and he is 10 years older than she. She states that he never gets angry with her and just tells her that “things will get better.” In the assessment, you discover that it appears he is somewhat of an enabler (minimizing her outbursts), but he is very good to her. Margarita does admit that she is fearful that her husband will leave her due to her behavior. She reports that they do not communicate well, he maintains the house, and they rarely experience intimacy or sex.Margarita also discusses feeling depressed most of the time, but she has to put on a “game face” to do her work. Her husband and her parents are the only ones who see her depressed side. She holds an important position with the community development board in the county where she lives. She also reports that she often experiences anxiety in social situations, avoids going places where she may be socially judged, and has no friends, but she does feel confident in structured work projects where she is in charge. She also reports having panic attacks on occasion and has had thoughts of suicide. She often thinks that she is not pretty enough or nice enough to have friends, although she truly wants to have quality friendships. She is always in a mode of self-doubt and admits to constant negative internal dialogue.She denies any drug or alcohol abuse or history. There is no physical or sexual abuse in her past. She states she saw a counselor about six times in college after the death of her best friend. She states she felt she should have been the one who died in the car crash and not her friend, although she was not even involved in the accident. She did not feel that the counseling was helpful. At that time, she took Paxil but had an extreme negative reaction. She is reluctant to take medication at this time.Case Notes from Sessions 1–3 (background for the Part II assignment)Following her intake session, Margarita made a commitment to six sessions of therapy with you. She responded well to your counseling interventions during the first three sessions, and you see evidence that you and Margarita have established a good rapport. She has been on time for her sessions and has openly discussed experiences she has had at work and at home, adding a little more detail each week. She has reported that she continues to feel overwhelmingly strong anger at times, and she still feels quite despondent about this and her life in general, although she strongly denies suicidal intentions.In the second session, you initiated a discussion about cultural differences you have with Margarita, giving her an opportunity to articulate how she might be concerned about your understanding of her (based on your ethnicity, gender, age, or background). She said that she is confident that you can understand her, based on your interactions so far, but if she develops concerns she will let you know. You are resolved to remain vigilant to evidence of breaches in rapport and address these immediately, should they occur.At the end of the third session, you and Margarita identified some specific goals that she would like to work on to “move the ball forward” in her life. You then prioritized these goals and asked her to think about them before your next session to be sure they were the best fit for what she most wants to change. You are beginning your fourth session with Margarita, ready to work on her priorities for change in her life, from your chosen theoretical approach.