Question

Ellen S. was referred to the clinic shortly after her "miscarriage." She was a 32-year-old woman who was employed as an administrative assistant for Mr. Johnson. She and Mr. Johnson had recently terminated their 2-year-old love affair because Mr. Johnson was unwilling to divorce his wife because of his children. Although medical tests indicated that she was not actually pregnant, Ellen had shown classic symptoms of early pregnancy during the 3 months when she believed she was pregnant. She ceased menstruation, was chronically fatigued and nauseated, and had gained weight. Ellen was raised by fundamentalist religious parents with whom she still loved. She had been told repeatedly about the sins of sex and alcohol. Her affair with Mr. Johnson was her first relationship. Assume you are Ellen's therapist: 1. What issues do you think are important to the development of Ellen's problems? 2. How would you treat Ellen? Justify your answer.

Answer 1

Ellen's Issues and Potential Treatment Approaches

1. Psychological Distress
2. Internalized Conflict
3. Identity and Self-Esteem

Treatment Approaches for Ellen:

• Cognitive-Behavioral Therapy
• Supportive Psychotherapy
• Family Therapy

What are the problems?

1. Potential Issues Contributing to Ellen's Problems:

Psychological Distress: Ellen's "miscarriage" and the end of her affair likely caused significant emotional distress, including grief, depression, anxiety, and feelings of isolation.

Internalized Conflict: Her religious upbringing and its emphasis on the "sins" of sex might lead to internal conflict and guilt regarding her affair.

Identity and Self-Esteem: The affair's end and the "miscarriage" could impact her sense of identity and self-worth, potentially leading to feelings of inadequacy and shame.

2. Treatment Approaches for Ellen:

Cognitive-Behavioral Therapy (CBT): To help Ellen identify and challenge negative thoughts and beliefs contributing to her distress, develop coping mechanisms for managing stress and anxiety, and foster healthy self-compassion.

Supportive Psychotherapy: To provide a safe and non-judgmental space for Ellen to express her emotions, process her experiences, and explore her feelings about the affair and "miscarriage."

Family Therapy: If appropriate, family therapy could be helpful to address any family dynamics contributing to Ellen's issues and offer support from her loved ones.

Justification for this Approach:

CBT's focus on cognitive restructuring and behavioral change can help Ellen address the negative thought patterns contributing to her distress and develop coping mechanisms to manage her emotions effectively.

Supportive therapy provides a safe space for emotional processing and exploration, which is crucial for Ellen to heal and move forward.

Family therapy can address any family dynamics impacting Ellen's mental health and provide additional support.