In-depth Cases

Case 1

Name Susan

Sex Female

Marital Status single

Age 20 years

Diagnosis: HIV Positive lactating mother\defaulter and drug addict

Background information

The case is of Susan a 20 year old lady who stays in Eastview, she gave birth to a baby girl and
is admitted at Mbuya Nehanda Maternity Hospital. The baby was born prematurely so she had to
stay in the hospital for some time for the baby to gain the required weight to be discharged. She
is a commercial sex worker and she was also showing signs of drug withdrawal symptoms and
she admitted that she has been using drugs and sometimes she would just start shouting in the
ward demanding to discharged with her baby.She is also refusing to feed her baby at the
stipulated times therefore leading to misunderstandings with the nurses. According to Susan she
was born in Gokwe into a family of 4 children which is 3 boys and 2 girls, her parents passed
away when she was 8 years old and she went on to stay with her paternal grandmother. She
narrated that things were tough and at the age of 16 she came to Harare looking for work as a
house maid, she worked for sometime but later left the job and started living with her elder
brother which is when started using drugs because her Brother was also into drugs. She needed
money to survive that is when she ventured into sex work and started staying by herself, and later
fell pregnant but she doesn't know who the father of her child is. She also said she is able to take
care of her child and is not willing to give her to Social Services because they help each other
with her friends in taking care of their babies. There was need to conduct an in-depth therapy
case, addressing the issue of being a mother, drug and substance use and sex work (challenges, is
it something that she really wants to do in life and her expectations).

Genogram
Intern drew a genogram together with the client. It helped to build a rapport with the client. As
postulated by McGoldrick (1985), a genogram shows the client and the therapist a graphic
display of the family, including the family's patterns of illness and psychosocial problems. The
genogram brought that client has 2 siblings. Both are female and are married. Both his parents
are late. The client was once married and divorced

First session

Date

Objective: Client worker rapport building and problem diagnosis

The counsellor welcomed the client and offered her a seat, greetings and introductions were
made. There was nothing in-between the client and the counsellor. There was a social chit- chat
with the client to ensure that the environment is welcoming to the client. All the ethical issues
were discussed by the counsellor to the client such as confidentiality and informed consent which
the client understood, accepted and consented. The counsellor took her time to explain the
importance of the counselling process, noting in particular the fact that it was not meant to blame
her but rather to help. The counsellor asked the client if she was aware of her case. The client
was aware and issues of ART defaulting, being a mother, drug and substance use and sex work
were noted as the reasons why the counselling process was necessary with her. The client agreed
after she was also made aware that the counselling process was going to take 5 sessions. .

Treatment goals:

The goals of the helping process were to:

 Ensure that the client regularly adheres to ART medication by end of the counselling
process.
 Ensure that the client has improved parenting skills on her child by end of the counselling
process
 Ensure that the client is fully conscientized on substance abuse and its implication.
Second session

Date

Objective: Improved adherence to ART medication through psycho-social education.

The counsellor and client discussed the feelings of the client about her condition and issues

which were pushing her into commercial sex work. The client expressed bitterness for having

contracted HIV\AIDS due to the need to get money for survival. The counsellor comforted the

client and awakened her on the dangers of not adhering to ART medication. She was offered

ART adherence support and through empthathy and a non judgemental attitude she was helped to

accept her HIV status. The counsellor used Existential therapy to counsel the client. The

counsellor had used the cognitive behavioural therapy to remove the irrational thoughts or

perceptions about the causation of her HIV status. The counsellor also applied the Existential

therapy to instil the sense of worth in the client. The counsellor made sure she had positive and

welcoming attitude and managed to make the client felt comfortable. The client was encouraged

to art attend doctor’s appointments and ART refill appointments. The counselor and the client

also discussed on if anyone else knows her HIV status. She said her friends and her paternal aunt

is aware of that. The counselor took advantage of this to ask if anyone upon her consent could be

engaged to continue providing ART adherence support when the counsellinng session finally

ends. The client agreed verbally and the counselor proceeded to engage her aunt virtually. The

aunt agreed to the task and the counsellor concluded the session. The date for next appointment

was set and the client was encouraged nnot to miss it.

Third session
Date

Objective: improved parenting skills through a positive parenting session.

The client came for another session on the agreed upon date. The counsellor greeted the client
and quickly had a recap of what was discussed in the previous counselling session. The client
was able to restate all the details of the session and what she learned. The counsellor introduced
the goal for this current session and it was all about how she is naturing her child as a
commercial sex worker. The client insisted that she loves her child and through the technique of
probing, the counsellor asked her about the care of the child when she is out with her work
during the night. The client pointed that sometimes she leaves the child sleeping home and just
lock the room. The counselor discussed the dangers of that behavior based on her knowledge of
child protection issues. She then discussed the possibility of rendering custody of the child to the
Department of Social Development (DSD). However, the client refused and the possibility of
having the child taken care of by her aunt was discussed. The client proposed having a maid after
issues of parental attachment with the child have been discussed. A list of the rights of the child
were also discussed and these include the right to protection, right to education among others.
The session was concluded and the client was happy about the session. Next appointment date
was set and the client agreed to come.

Fourth session

Date

Objective: Ensure that the client is fully conscientized on substance abuse and its
implication.

The client came for the third session. As usual, the counselor started off with a recap of the
previous session. The client expressed indepth awareness of the contents of the previous session
and she stated that she was really helped. The counsellor introduced the purpose of the fourth
session to the client, which is to discuss the issue of substance abuse. The counselor using the
conscientization theory by Paulo Freire asked the client if she was aware of substance abuse in
her life. The client was not aware and education was provided. The effects of drug and substance
abuse discussed include poor health, abusive behavior among others. Using the client centered
theory by Carl Rodgers, the client was asked on the best way which she think can be used to curb
substance abuse in her life. She noted that the real cause is stress which comes from lack of basic
necessities. Given this, a referral was written to the Department of Social Development for
welfare assistance. The client was happy about the move and she promised to stop the habit of
abusing substances. the counselor made her aware of rehabilitation services if the habit persists.
The counsellor ended this session by preparing the client on termination of the counselling
contract in the next session after a review of the set goals. The client was a little bit touched to
realize that the counselling contract is about to cease. However, the counselor encouraged her
that if she needs professional counselling services on any arising matter, she is welcome to the
offices.

Case 2

Name Jack

Sex Male

Marital Status widower

Age 80 years

Diagnosis: Old age welfare concerns

Background information

A case of Jack a 80 year old male patient who was brought to the hospital by a neighbor after
suffering from malnutrition, dehydration and acute kidney injury.He has no known relatives and
stays at a farm in Chishawasha, therefore his neighbors are the ones who contributed money for
him to be brought to the hospital. Jack is originally from Malawi and he came to Harare when he
was 28 years old in search of greener pastures and he came with his Uncle and they started
staying in Mufakose. After sometime he married and was blessed a son after some years they had
a misunderstanding with his wife and they separated but upto this day they never reconnected. At
sometime he worked in Highlands as a gardener and he married again and they were together
until they later moved to Chishawasha when here retired but his wife later passed away.
Therefore he has been staying alone, when he was still strong he would do some menial jobs at
the farm but he is now struggling even to get food and no relatives to look up to because the
Uncle he came with to Zimbabwe also passed away. He also wishes to stay in a residential home
for the elderly but was suffering from indecision because sometimes he would say he wants to go
back to Chishawasha and stay there because his neighbors will take care of him. Therefore there
was need to have an in-depth case exploring the man's history, his preferences on placement,
challenges and expectations.

Genogram

Intern drew a genogram together with the client. It helped to build a rapport with the client. As
postulated by McGoldrick (1985), a genogram shows the client and the therapist a graphic
display of the family, including the family's patterns of illness and psychosocial problems. The
genogram brought that client has 2 siblings. Both are female and are married. Both his parents
are late. The client was once married and divorced

First session

Date

Objective: Problem exegesis and relationship building

In this first session, the counselor was concerned about building a healthy and professional
relationship with the client. The counselor gave the client a very warm welcome, and asked her
to sit comfortably at a close by chair. The greetings were made and the counsellor introduced
herself to the client as a trainee counsellor and asked her the consent to proceed with the session.
The client agreed to be counselled by the trainee counsellor and the counsellor asked about the
client’s details. The issues of ethical considerations were clearly discussed and the client gave
her full consent and signed the consent form. The goals for the counselling process were clearly
spelt out and the client was duly informed that this process will take five counselling sessions on
different dates. The client agreed to continue with the session and the date for the next session
was set.

Treatment goals:

The goals of the helping process were to:

 Refer to the Department of Social Welfare for placement at an old people’s home.
 Provide supportive counselling and ensure that the client feels supported by end of the
counselling process.
 Ensure that the client is emotionally stable at the end of the counselling process through
grief counselling.

Second session

Date

Objective: Provide supportive counselling and ensure that the client feels supported

The client came for the second session. Informed by the biopsychosocial model on the makeup
aggregate of a human being, the session started with a social chit chat to properly establish the
mood of the client on that particular day. The client was in a very good mood and the session
started. The counsellor introduced the purpose of the session to the client. The client used the
tree of life tool to highlight the fact that even in his old age, the client still has hope and he can
still live a very good life. The counsellor also used the systems theory to paint a picture to the
client that he is not alone but that there are various systems around him that can support him. The
counsellor also discussed a compendium of rights for the client, to make him realise that he has
right to be looked after at his old age. The client felt excited for the informative session and he
really appreciated the counsellor. The counsellor concluded the session after setting a date for the
next session.

Third session
Date

Objective: Ensure that the client is emotionally stable at the end of the counselling process
through grief counselling

The client came for the third session and received warm welcome from the counsellor. After
being offered a sit, the counsellor greeted the client. The counsellor introduced the client to the
session and the goal thereof. The counsellor asked to explore a bit about his relatives and
feelings. The client pointed that he was aggrieved by the passing away of all his closeby worse
by the fact that he was a foreigner. The client actually mentioned the fact that in most cases he
thinks of his relatives who passed away. The counsellor then took his time to comfort the client.
Using the principle of purposeful expression of feelings, the counsellor allowed the client to cry.
Also, using the principle of empathy, the counsellor handed over a small piece of cloth to allow
him to wipe his tears as they come out. The counsellor reminded the client of his rights and the
support which is available at his disposal based on such entitlements. The counsellor used
positive talk and talk therapy to ensure that the client feels comforted and relieved. When the
client became calm, the counsellor concluded the session and agree a date for the next session.

Fourth session

Date

Objective: Refer to the Department of Social Welfare for placement at an old people’s
home

The client came for the fourth session just as agreed upon in the previous session,

Case 3

Name Regina

Sex Female

Marital Status widower

Age 19 years

Diagnosis: child placement\welfare

Background information

A case of Regina a 19 year old lady, who is a Mother of two and she stays on the streets with her
Mother . She came to the hospital because her 3 year old child was hit by a car and leg broke
whilst they were at a robot asking for handouts. According to Regina she was born in a family of
2 but she does not know her father and she started staying on the streets when she was 12 years
with her Mother and little brother. She said they used to stay in Epworth and her Mother would
come in town selling sweets and some stuff but they later on moved to stay in town because they
could not afford rent anymore because the support system they used to have which is her
mother's sister moved to South Africa and could no longer help them . That is when they started
begging at robbots but the little brother later went on to Bindura to look for work. She was
impregnated by a man who also stays on the streets . Whilst her child was in the hospital, she
approached the Department of Social Welfare offices at the hospital seeking help concerning the
welfare of her children as she felt they were not safe living on the streets and wished if they
could be placed in a children's home . Therefore the student saw the need to conduct an in-depth
therapy case highlighting several issues her upbringing, the placement of children in an
institution (it's advantages and disadvantages).

Genogram

Intern drew a genogram together with the client. It helped to build a rapport with the client. As
postulated by McGoldrick (1985), a genogram shows the client and the therapist a graphic
display of the family, including the family's patterns of illness and psychosocial problems. The
genogram brought that client has 2 siblings. Both are female and are married. Both his parents
are late. The client was once married and divorced

First session

Date

Objective: Case profiling and rapport building

The counsellor welcomed the client and gave him a seat. The counsellor and the client sat facing
each other with nothing in between them. The social chit-chat was made the counsellor so as to
build an easy communication platform. The client was asked his reason for visiting the
counselling room. He recited his story. The ethical issues such as consent form, confidentiality
and its limitation or breeching of confidentiality was clearly discussed. The counsellor assured
the client that whatever discussed during the counselling session will not be used for any other
purposes without his consent. The client agreed to go for the counselling process.

Treatment goals:

The goals of the helping process were to:

 Enhance client’s financial literacy by the end of the counselling process

 Refer child for placement during the course of the counselling process
 Provide psychosocial support to the client

Second session

Date

Objective: Enhance client’s financial literacy

The client came for the second session on the agreed upon date. The counsellor greeted the client
and warmly offered her a chair to sit. The atmosphere was relaxed by a social chit chat and the
client was flexible to talk. The counsellor made the client aware of the purpose of this second
session. The counsellor kick started by asking the income generating ventures that the client was
involved in.she stated that she was involved in begging and sometimes she goes home without
any money. The client was educated on market linkage skills and other casual labour activities.
The session came to an end and date for next appointment was agreed upon.

Third session

Date
Objective: Placement of the child at an institution

The counsellor and the client discussed about the safety of the child without a suitable home to
inhabit. Using the conscientization theory, the counselor educated the client on the advatages of
having the child placed at an institution, under the overall care of the Departmennt of Social
Development. The client mentioned that she could not properly take care of her child. Taking
cognizance of the systems theory, the client used the six tier knowledge to find if among the
relatives there is someone who may be willing to assume custody of the child. No one was found
and s referral letter was written to the Department of Social Development followed with a
phone call followup since the client had mentioned that she once visited the Department to no
avail. Reception of the referral letter was confirmed at the Department of social Development
and they were now looking upto doing further assessments. The counselor promised the client to
make ongoing followups regarding the case. Date for the next session was set.

Fourth session

Date

Objective: Ensure psychosocial wellness through the provision of psychosocial support

services to the client

Second session

The client came for the fourth session and was offered a sit to sit. The session started with a
social chit chat to ensure flexibility and fluidity of the session. The counsellor asked the client to
retell what she had learned in the previous session. The client demonstrated apt awareness of the
previous session. The counsellor quickly introduced the purpose of the fourth session, which is to
ensure that the client is psychosocially well through the provision of psychosocial support
services. The counsellor used the talk therapy technique to get rid of stressful predicaments in the
client.