Therapist's Guide to Clinical Intervention - Sigmund Freud

150 2. Assessing Special Circumstances
3. How easy/difficult is it for the ill person to ask for help?
4. How freely is support given by others?
5. How difficult has it been to accept help/support from others?
6. What are the practical demands of the situation (routines, needs, wants,
financial stressors, time demands, time for self, etc.)?
7. What are the helpful/useful community based resources such as home
health, etc.?
8. Role play scenarios with individual and family members/partner.
9. Facilitate reality checks for objective evaluations.
10. Talk to physician regarding limitations/prognosis.
4. Stigma
A. Issues of self-acceptance.
B. Facilitate development of social skills and belief system to deal with the attitudes of
others.
C. Be aware of the different social impact on the evaluation of men versus women.
Males are more likely to be viewed as being more damaged and heroic, whereas,
there is a tendency to view females as weak, ineffective, and being self-absorbed or
feeling sorry for themselves.
5. Abandonment/Rejection
A. This issue may be more emotionally distressing than the fear associated with dying.
There is a double bind for the individual: (a) There is a fear of abandonment, but
they also feel bad about being a burden, (b) They want the care, but are aware of
the difficulty that it poses on others. This is also a bind for caregivers who want to
give the necessary care and offer comfort and feelings of security, but also wish that
they did not have to deal with the problem.
B. It is extremely important to facilitate clear communication and joint decision
making as soon as possible.
C. An awareness for the issue of caregiver burnout may prevent it from happening.
With interventions such as acknowledging the caregiver's sacrifices and building in
respite breaks into the regular routine caregiver burnout can be circumvented. For
this to be successful, the individual must be sensitized to the caregiver's need for
time away/breaks.
D. Reframe breaks as part of a functional pattern of long-term management to
alleviate the interpretation of abandonment/rejection.
E. Facilitate utmost self-reliance.
6. Anger
A. Identify, validate, and constructively redirect the anger.
B. Be aware of the possible lack of awareness or denial for feelings of anger.
C. Reframe anger as a normal response to frustration when an individual is unable to
control their life or illness.
D. Facilitate appropriate expression of anger. Possible modes of expressing anger
include, appropriate ventilation, humor, talking, activity, meditation, etc.
E. Facilitate identification of the positive aspects of life: strengths, opportunities, and
life pleasures.
7. Isolation/Withdrawal
A. Physically unable to continue in previous life activities such as work, social life, and
other normal activities. Promote development of abilities.
B. Be aware that the consequences of social, physical, and emotional isolation can
include increased depression, hopelessness, and despair.
C. Being cutoff from friends and family significantly increases the risk of sickness and
death.