Termination Note Name: Altamash Karemi Age: 10 years Sex: Male Therapist: Saba Rehmat

Altamash Karemi had oppositional defiant trends along with disturbed social relationship with parents, peers and teachers and learning difficulties. Parental guidance was offered to his parents fortnightly to enhance his relationship with them and certain behavioral plans were proposed to include Altamash in various activities to direct his frustration. Weekly sessions with Altamash Karemi were conducted and he was taught to resolve peer issues through modeling by the therapist or offering him different solutions. Moreover, he was reeducated about his disruptive behavior and its impacts on others which motivated Altamash Karemi immensely to behave otherwise. Art and Play therapy was used to channelize his dissatisfaction and teach him positive social interaction with peers and parents. Most importantly, he generalized healthy relationship with therapist to his parents and teachers. Fortnight meetings with the concerned teachers were done to guide them and get feedback about Altamashs behavior. Moreover, they were instructed to reinforce his positive behavior and elimate punishments as much as possible. His defiant attitude has reduced considerably but he still needs to enhance his social skills and boost self- esteem. Proper assistance to parents and Altamash is encouraged to maintain the gains from therapy sessions. Recommendations: 1. 2. Parental guidance is recommended. It is strongly recommended that Altamash Karemi should take Art therapy sessions.

3. 4. 5.

Positive reinforcement must be included at home and class room environment. Altamash Karemi may be taught social skills and anger management via Cricket. He must be reassessed after two years.

________________ Saba Rehmat M.phil (Clinical Psychologist)

Anna Conceptualization 4life. Lastly, we will work on validating Annas emotions and putting a name to the emotions thatshe feels on a day to day basis.Theoretical OrientationThe theoretical orientation that I am going to use in Annas therapy is comprised of Gestalt therapy and family therapy. My goal for using Gestalt therapy with Anna is to help her gain awareness of what she experiences on a day to day basis and how she feeds into theseexperiences. I feel that Anna is dealing with much unfinished business which is resulting in her unexpressed feelings of hatred, resentment, pain, anxiety, grief, guilt, and abandonment. Theunfinished business includes her issues from the divorce, as well as her mothers breast cancer,and it is creating unnecessary emotional debris that is cluttering her present-centered awareness.I do anticipate that Anna will have resistance to contact since she has trouble making effectivecontact with the other significant figures in her life. So far she has exhibited projection through blaming Isabelle for why she feels so sad and refuses to accept responsibility that it is herself thatmakes her feel depressed. I feel that through the here-and-now, setting that motivates changeand allows for experiments that Anna will thrive through the Gestalt theory. The goal workingwith her family is to help foster an environment where I can point out family interaction patternsthat perhaps Anna and her family have never noticed when they are interacting with one another.This point of view can help them to identify what it is that is making them not work as a unit andto work towards congruence within the family. My plan is to meet with Anna for once a week,one hour, sessions that continue for six weeks. She will have homework that includes attendingsome outside group for children of cancer parents, or children of divorce, however the sessionswe will engage in will be individual sessions. I then want to incorporate the family into our Anna Conceptualization 5sessions and have four family sessions so what we can work on not only Anna and her issues, butthe family as a unit.TechniquesThe beauty of the Gestalt theory is that there are a plethora of techniques that I canchoose from which are strengthened by our therapeutic relationship. These techniques, whichinclude experiments and exercises, can help elicit some type of emotion, produce some type of action, or achieve a specific goal that we set in therapy and should be conducted only when Annafeels that she is ready to engage in them. To start, I could set up a dialogue between Anna andone of her significant others such as her mother, Isabelle, or her father. Another effectivetechnique is role-playing, where Anna and assumes the identity of her mother and father and actsout a scenario. There is the Empty Chair technique where Anna carries on a dialogue betweentwo conflicting aspects within her to better understand why she responds the way she does andhow she could change these responses to decrease the likelihood of a fight. Staying with thefeeling is another technique, which encompasses staying with an uncomfortable emotion so shecan learn to endure the pain that is necessary for unblocking and can help her to grow.In regards to the family work that I mentioned above, there are specific family orientatedtechniques which can produce change. These include family sculpting where Anna places her family where she views them from her perspective, the family genogram which outlines their family so that I can gather valid information on each member of the family, reframing whichdeals with how the family members speak to one another and deals with helping them to learnhow to change their statements from negatives to positives. Anna Conceptualization 6Ethical ConsiderationsThere is one main ethical dilemma that I must consider with this case which is that Annais a minor. The time where confidentiality could be breached with Anna would include if I foundout she was a harm to herself or others, if the parents request her information , or if for somereason the court requests her information (for example if her parents fight over custody and thecourt needs to deal with the children). Yet, this is such a touchy subject that I must be verycareful when approaching her confidentiality. One other ethical concern for me is her participation in group therapy where confidentiality could be breached by another member.TerminationThe ultimate goal for Anna is to reach the point where she can self-regulate as anorganism and can successfully interact with others around her. When looking for success intherapy I want to look to see if Anna has increased awareness of herself and if she has a better understanding about her emotions. I also want to look for her to assume ownership of her experiences instead of her making others responsible for the way that she is thinking, feeling or doing. Lastly, I want to observe to see if Anna has an awareness and acceptance of responsibilityand understands not only her actions but also the consequences that come along with them, andlook to see that she has moved toward internal self-support so that she is not only able to ask for and get help from others, but to more importantly be able to give to others. With the familysessions I want to help her family to understand Anna as well as understand themselves and howthey each family member fits together to make one unit. Once I

can see that they are not onlycommunicating more effectively but are having more empathy for one another I will suggest thatthe family come and see me o

Anna Conceptualization 6Ethical ConsiderationsThere is one main ethical dilemma that I must consider with this case which is that Annais a minor. The time where confidentiality could be breached with Anna would include if I foundout she was a harm to herself or others, if the parents request her information , or if for somereason the court requests her information (for example if her parents fight over custody and thecourt needs to deal with the children). Yet, this is such a touchy subject that I must be verycareful when approaching her confidentiality. One other ethical concern for me is her participation in group therapy where confidentiality could be breached by another member.TerminationThe ultimate goal for Anna is to reach the point where she can self-regulate as anorganism and can successfully interact with others around her. When looking for success intherapy I want to look to see if Anna has increased awareness of herself and if she has a better understanding about her emotions. I also want to look for her to assume ownership of her experiences instead of her making others responsible for the way that she is thinking, feeling or doing. Lastly, I want to observe to see if Anna has an awareness and acceptance of responsibilityand understands not only her actions but also the consequences that come along with them, andlook to see that she has moved toward internal self-support so that she is not only able to ask for and get help from others, but to more importantly be able to give to others. With the familysessions I want to help her family to understand Anna as well as understand themselves and howthey each family member fits together to make one unit. Once I can see that they are not onlycommunicating more effectively but are having more empathy for one another I will suggest thatthe family come and see me once every six months for the next year, and after that it will be onan as needed bas