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Treatment/Intervention Plan

Maria's desire to work on these issues is paramount. Her current depression and hopelessness are paralyzing. A medication consult may be necessary if her depression does not abate and/or her suicidal ideation increases. Her current defense of withdrawal is not working, and she entered counseling expressing appreciation for an appointment. She seems to be motivated to change.

The goal of counseling is to understand Maria's current condition because through this process, Maria also gains perspective. First, it is important to discuss her cultural background, feelings she has about the counseling experience, and any cultural or gender differences or similarities that may exist between Maria and the counselor. If she has any concerns, a referral will need to be made immediately. Next, it is important to hear her story of the current pain. She will face her fears while she focuses on the issues prompting the depression: the separation from her family, the painful relationship with her husband, the relationships with her children, and her identity as a teacher. In all areas, Maria has experienced loss and meaningless (hopelessness).

Ultimately, she will gain freedom by acknowledging her struggle and being heard and respected by the counselor. She will confront her anxiety about choosing a direction from this point in her life. Maria has moved counter to her parents, family, and culture. In seeking to establish herself in the world, Maria has found others in her life to be like arrows pointing her in different directions.

Her withdrawal has occurred over several years and has been in reaction to external pressures threatening her relationship with her children and her own integrity. Maria has developed a pattern of relating through others, which was enforced by her culture. It became the only sanctuary in a world without meaning or direction.

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