In addition to the four basic assumptions of the MCC model, it is believed that there are eight core fears or concerns that will typically arise for chronically ill or impaired individuals. These core fears and concerns include: fear of being abandoned, fear of being isolated, fear of being stigmatized, concerns about being dependent on others, concerns over losing control of one’s own life, concerns over expressing anger or negative emotions, concerns about changes in self-image, and fear of dying (Shapiro & Koocher, 1996).
While not all of these may be applicable to every patient at every time, it is important that the clinician understand and is prepared to address any and all of these fears or concerns, as well as how to incorporate solutions into an holistic approach to therapy and medical treatment. As previously mentioned, an holistic approach is important when addressing medical crisis, and one aspect of this is involvement of the therapist with the medical team (Roberts, Kiselica, & Frederickson, 2002).
For treatment to be truly comprehensive and effective, it is essential that the medical team understand what the patient may be going through on emotional or social level, so that they can better address fears or concerns related to their care or the disease process. A thorough understanding of the patient’s diagnosis is also important for the therapist to assist the patient in setting realistic goals for modifying their lives, while maintaining compliance with medical treatments and prescription regimens.
Additionally, patients may not always be willing to confront certain issues related to new treatments, surgery, or dying, and so do not inform the therapist of these procedures, and it may be up to the therapist to tactfully introduce the subject, particularly if it is acting as a barrier to successful adjustment. Particularly in the case of an adolescent diabetic, like Jeff, it is important that the therapist and medical team collaborate to provide treatment. Death in such a young individual with diabetes is not normally a concern – as long as medication and diet compliance is maintained.
However, serious complications and death are a very real possibility for any diabetic if their medication and diet regimens are ignored. Keeping in mind the MCC model, an appropriate therapy goal for Jeff would be to ensure he is properly educated in the risks associated with his disease, and his medication and diet requirements, and to address any fears he may have about the uncertainty of his disease or about dying. Education is generally the best method of ensuring treatment compliance, and training Jeff to ask questions of his care providers is an important step (Schulz & Masek, 1996).
In addition, since Jeff is 16-years-old, he will very soon be entirely responsible for his own medical care, meaning that his parents will no longer be making medical treatment decisions for him. Thus, an appropriate goal for Jeff would be to acquire the skills needed to be an assertive and informed patient so that he is prepared to assume responsibility for his care (Shapiro & Koocher, 1996). The therapist can assist him in learning to take control of his care, as well as help the entire family make Jeff’s transition into adulthood with a chronic disease an easier experience and alleviate fears or conflict that may arise.
Besides simply educating Jeff regarding the risks inherent in non-compliance, it is important that the therapist collaborate with him, and his parents where appropriate, to develop routines and creative ways for Jeff to manage his medications and diet without feeling stigmatized by his peers, or socially isolating himself. For example, addressing Jeff’s parents concerns, or Jeff’s concerns, about allowing Jeff to self-administer his insulin and providing him with a special portable case and a watch with an alarm so that he can engage in after-school activities with friends and still maintain his medication regimen.
This kind of goal setting (moving Jeff into taking an active role in managing his own medications and diet) is also an important part of fostering Jeff’s independence and helping him to overcome fears about being dependent upon his parents, as well as overcoming his parents’ possible fears about Jeff’s capability to successfully and responsibly manage his illness.
As a 16-year-old with a chronic illness, Jeff is most likely experiencing a unique developmental dilemma, as he wishes for independence, but has more reason to fear independence than most adolescents, since it makes him responsible for managing a serious chronic illness in addition to all of the normal life stressors and tasks a young adult must learn to effectively cope with. Another appropriate therapy goal could include learning effective coping and de-stressing skills, like time management skills and how/when to ask for help, as well as learning healthy ways to express anger or negative emotions.
Therapeutically, learning to express his anger or negative emotions in healthy ways can help Jeff to feel more in control of his life and boost his confidence, which will probably help to lessen his fears of being stigmatized, as it provides an avenue for Jeff to learn to talk about his diabetes in a safe environment. Becoming more comfortable with his diagnosis himself, and addressing any fears of being stigmatized or feelings of embarrassment can help Jeff overall in his social interactions.
Additionally, as he feels more comfortable talking about his illness and expressing himself emotionally, he is more likely to maintain compliance with his medical treatment – particularly his diet. For example, when Jeff is out with friends one afternoon, they decide to go to a local cafe for sodas. Instead of excluding himself with no explanations out of embarrassment or fear, which probably only serves to alienate his friends and isolate himself, Jeff decides to go along and tells his friends about his diabetes when he orders a diet soda or a water instead of his usual Mountain Dew.
Thus, Jeff has managed to successfully modify his life and enjoy many of the same activities with his friends as before. Perhaps fortunately, Jeff’s diagnosis came at the best time (since we must assume it would have come sooner or later), as identity crisis is a normal developmental stage for adolescents. Thus, one of the goals of therapy would certainly be to encourage Jeff to a positive perspective on his illness, and incorporate it into his self-image in a positive way, instead of as a limiting or undesired aspect of his life and self.
The tendency to separate our sense of self from our physical bodies is a particular challenge to those who are dealing with a chronic illness like diabetes, and learning to effectively re-arrange our ideas of who we are while keeping our illness from taking over, in either a positive or negative way is an important therapeutic task. Conclusion In summation, there are a number of different goals that would be appropriate for Jeff, and it is the therapist’s role to act as facilitator and encourage the client to do as much as possible for himself, including taking an active role in working with the therapist to set goals for therapy.
To review, Jeff’s goals for therapy are as follows: a) Address any fears or concerns Jeff may have about his illness, particularly with regards to maintaining compliance with medication and diet b) Teach Jeff the skills necessary to be a proactive and responsible patient c) Collaborate with Jeff and his family to develop life modifications that will help him to maintain compliance with medication and diet
d) Teach Jeff effective and healthy coping skills and stress management techniques, as well as provide a safe environment for Jeff to learn to express anger and negative emotions while he becomes more comfortable talking about his illness e) Encourage Jeff to take a positive view of his illness, especially as it pertains to the development of his identity and self-image This is by no means a complete list, and any hypothetical situation cannot completely address the individual needs and issues of various patients.
However, as the MCC model asserts, the issues faced by patients dealing with chronic medical illness or impairment are highly predictable, thus it is useful for the therapist to engage in hypothetical training and can lead to significant insight and self-awareness as we “create” a patient for study. References Klein, S. (1995). Media: ‘Taking Charge: Overcoming the Challenges of Long-Term Illness’. Exceptional Parent, 25(5): 65. Retrieved May 4, 2009 from Academic OneFile. Pollin, I. (1995). Medical crisis counseling: Short-term therapy for long-term illness. New York: Norton.
Roberts, S. , Kiselica, M. , & Frederickson, S. (2002). Quality of life of persons with medical illnesses: Counseling’s holistic contributions. Journal of Counseling and Development, 80(4): 422-434. Retrieved May 3, 2009 from EBSCOHost. Schulz, M. & Masek, B. (1996). Medical crisis intervention with children and adolescents with chronic pain. Professional Psychology: Research and Practice, 27(2): 121-129. Shapiro, D. & Koocher, G. (1996). Goals and practical considerations in outpatient medical crises intervention. Professional Psychology: Research and Practice, 27(2): 109-120.