Mindfulness Psychotherapeutic Intervention Formulation

Summary

Sophie’s Case Presentation

Sophie, a 31-year-old offender, is serving three years of prison time after being found with class-A drugs. She has been referred by her probation officer to come for therapy. Sophie has had a challenging childhood with an alcoholic dad and a violent mum. Sophie’s family became homeless and lived in a refuge. Her dad was not around and her mum had several alcoholic boyfriends. Sophie and her siblings were taken into social services when she was ten. She experienced neglect in several foster homes where she was also forced into what she refers to as ‘slave labour’. Her experiences made her loose trust in people. She did not do well at school and became pregnant at 16. She had a positive relationship with her child’s father but stayed alone and felt lonely most of the time. She met a new drug dealer boyfriend and was later caught supplying the drugs which led to her sentence. She has difficulty making friends in prison and lacks interest in her previously loved activities and occasionally uses drugs. She lacks enthusiasm and energy and misses her son. She feels hopeless and thinks she is a failure. She has no hope of getting a job in future while out of prison. She regrets abandoning her son and avoids socializing. She wants to find a way to overcome her challenges and become more accepting of her situation. She wants to find new things to do and change her life to the better, and become a good mother.

Possible Causes of Sophie’s Problems

According to Williams et al. (2007) and from a mindfulness perspective, besides people’s suffering and mental health problems being linked to their attempts to hold onto the things they want and those they wish to get rid of, this difficulty may also arise from their worries concerning something, not being in control or their situations/circumstances, and lacking work or the ability to change their lives. The prison life is a source of Sophie’s problem because it takes her ability to control her life away. She can neither live freely like she used to nor make decisions for her life and her child. She feels helpless because she believes that even after her sentence she will be able to find a job or change her life. She has regrets about her past actions like not completing school, neglecting her son and engaging in drug peddling. Feeling helpless and powerless is another source of her mental health problem. The feeling of being unable to take control of one’s life or change it to the better can exacerbate a person’s depressive feelings of loneliness and failure. By being self-critical and viewing oneself as a failure, the negativity drains Sophie of motivation to set life goals or take part in different activities. Feeling helpless and powerless as in the case of Sophie makes her see herself as being defeated, which increases anxiety and depressive tendencies. Sophie’s childhood plays a big role in her temperament and character, she had an insecure attachment with her violent mother and with her always absent father. Her childhood involved a lot of suffering. Besides suffering from bad parenting, she did not get reprieve from foster homes and instead she was passed through hard labour. These situations led to her lack of trust for everybody. According to Bowlby’s attachment theory, individuals who are insecurely attached may become physically distant to others including their parents. Early upbringing and experiences can affect in individual’s behaviour later in life. An individual may become irritable, anxious and wary. The attachment theory also states that insecure attachment may lead to a clingy individual. This is a problem for Sophie, especially when she starts to miss her son. This attachment problem also makes her find it difficult to in prison. She has difficulty making new friends in prison and as a result is lonely. She presents with numerous signs of depression. For instance, Sophie lacks ambitions in life. She isolates herself and shows no interest in activities which she previously loved. Isolating herself from people and lacking interest in activities are sources of her mental health problem because it increases the loneliness and depression in Sophie (The Open University, 2021). The use of drugs is also a problem, especially among prisoners. Evidence suggests that prisoners tend to have emotional difficulties like anger and trouble controlling these feelings. As a result, they engage in substance abuse which offers a short-lived reprieve when they are high but later feel worse as their emotions and memories come back to them, a feeling that Sophie is well familiar with (Auty, Cope, and Liebling, 2015).

Factors Maintaining Sophie’s Problems

In relation to Sophie’s depression, it can be hypothesised based on the mindfulness perspective that she is grasping (holding on) to her past actions, not working hard and completing her education, neglecting her son and engaging in drug peddling. She blames herself for the situation she is in and neglecting her son. In mindfulness, people experience mental suffering when they enter into a habit of hurling or grasping things, whether these are their emotions, thoughts, material things, relationship with people or aspects of their identities. Through this form of therapy, I will make Sophie aware of her hurling away or grasping of things by making her notice the feelings which make her anxious. Bringing to her attention unpleasant feelings, especially those which result in larger anxiety in the background (The Open University, 2021). Sophie’s past as well as her recent actions like neglecting her son and engaging in drug peddling could be responsible for her worry. She may attempt to avoid these feelings become scared. Grasping or holding on to these feelings and past memories could be responsible for maintaining her current mental difficulties or depression. She may be holding onto the past memories and experiences, which makes her feel tense and angry with herself. The use of drugs in Prison is another maintaining factor for her current mental state. Her continued occasional use of drugs in prison even after being arrested and imprisoned because of supplying Class-A drugs also shows that she is grasping or holding on to the drug use because of the short-lived good feeling it gives her. Holding onto these memories and drug taking seem to help maintain the mental difficulty she is currently experiencing. For instance, bringing back her early childhood experiences with a violent mum and an alcoholic father who was always absent can make her sad. These memories may be worsened when she is alone or isolated and not engaged in activities in prison. Since she is less active and avoids making friends, she has a lot of time to think and this is when bad memories come back. The memories or neglecting her son can particularly be painful and may result in regrets, anxiety and depressive tendencies. To try and avoid these memories, she holds onto and uses drugs. However, the bad memories will continue coming back as long as she is isolated or does not make friends and engage in different activities which can help occupy her mind with positive challenges (The Open University, 2021).

Factors that Might Help Facilitate Change

From the mindfulness point of view, I will help Sophie to look at her patterns of memories, and past experiences. This will give her an opportunity to explore her ideal of what a good or normal state of mind is and why she is holding on some feelings tightly. This will allow Sophie to think deeply about what state of mind she wishes to be in. Given that she is currently willing to find a way to overcome her challenges and become more accepting of her situation, and that she wants to find new things to do and change her life to the better, and become a good mother, it is the opportune time to let her realize how her memories and regrets affect her mental state and the ability to change to the better. Her interest to change can be an appropriate starting point and turning point to begin holding on those past experiences and memories gently rather than tightly. This might allow her to begin to realise that dwelling on the past is more hurting than finding new friends and engaging in various activities which can influence her mind positively. This can also be an opportunity for Sophie to channel these memories and use them as a motivator to change her ways and take on a new leaf and create life goals for the things she would like to achieve while outside. For instance, rather than concentrating on the pain she experienced in the past, she can learn from her past failures and avoid getting into similar troubles, like supplying drugs. Instead, she can set goals such as amend her relationship with her son, forgive her parents. She can also plan to find a job after serving her time in prison and engage in positive activities in her community. Finding a job might also give her a chance to live with her son again. These might give her something positive to fight for rather than to stay less energetic and less enthusiastic about life. Encouraging Sophie to see the way her memories and past experiences cause her depression (blaming herself) can make her acknowledge her responsibility for some of things that happened, accept her current situation and find ways to change by creating new relationships and finding new things to do. As a therapy approach, mindfulness has the potential to allow Sophie to learn coping strategies, especially how to live with her past memories and the experiences without necessarily spiralling down with them into depression and despair.

Interventions and Ways to Work with this Clien

Besides showingFuture therapeutic work with Sophie should draw on mindfulness to help her learn how to understand her challenges. and discussing with her learn how to make sense of her past experiences and memories. , Tthere are specific mindful techniques which can be used to help her change and improve to the better. One of these methods is meditation. This technique can help Sophie to notice or determine her tendency to respond to her problematic or difficult feelings. According to Nanda (2005), these can help her stay aware with her initial feelings instead of letting them spiral into depression. Meditation can help her notice her experience curiously and how they affect her everyday life. For instance, she may begin to realise what causes her lack of energy and motivation to engage in activities in the prison and why she is finding it difficult to make new friends. Through meditation, she may begin to see the different stages which lead to her feeling anxious, stressed, bored or depressed. She may also begin to see what she can do differently while experiencing these emotions and feelings. Meditation may help Sophie to cultivate compassion for herself and learn to stay with the difficult past experiences and memories, by being compassionate and mindful about them rather than blaming herself and living with regrets (Nanda, 2005). Mindfulness techniques like meditation have been found useful and helpful for prisoners in tackling mental health challenges like suicidal, anxious and depressive tendencies. The approach offers a cost-effective and useful method of tackling these challenges. It also helps prisoners deal with their anger by learning emotional regulation techniques (Chambers, Gullone and Allen, 2009). It has also been found useful in overcoming substance abuse issues. It also reduces the re-offending tendencies after their time in prison, giving them new techniques of surviving out of prison by changing and engaging in healthy relationships and new helpful activities (Auty, Cope, and Liebling, 2015).

Conclusion

To help individuals like Sophie, Therapists can make use of the mindfulness approach that can allow the patient to find or locate their source of suffering and find outdetermine the factors which maintain them. This approach also allows individuals to understand, and accept their emotions, feelings and thoughts rather than cling on or hurl them. Through this approach, they may find different things or factors which can facilitate change and address their addition, anxiety and depression problems. By learning useful mindfulness techniques like meditation, individuals experiencing mental difficulties can learn to occupy their minds with positive energy and thoughts, make new life goals, make new friends and find various ways of changing to the better.

Auty, K.M., Cope, A. and Liebling, A., (2015). A systematic review of meta-analysis of yoga and mindfulness meditation in prison: effects on psychological well-being and behavioural functioning, International Journal of Offender Therapy and Comparative Criminology, vol. 60, no. 13, pp. 1–22.

Chambers, R., Gullone, E. and Allen, N.B., (2009). Mindful emotion regulation: an integrative review, Clinical Psychology Review, vol. 29, no. 6, pp. 560–72

Nanda, J., (2005). A phenomenological enquiry into the effect of meditation on therapeutic practice, Existential Analysis, vol. 16, no. 2, pp. 322–335.

The Open University, (2021a). Week 20 Mindfulness. DD310 Counselling and forensic psychology. Lecture notes

The Open University, (2021b). Week 17 Attachment-based approaches. DD310 Counselling and forensic psychology. Lecture notes

The Open University, (2021c). Block 4 introduction. DD310-20J Counselling and forensic psychology. Lecture notes

Williams, M., Teasdale, J., Segal, Z., and Kabat-Zinn, J., (2007). The mindful way through depression, New York, NY: The Guildford Press.

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