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Any treatment plan for Samantha, regardless of its overall theoretical orientation, would need to begin on a crisis-management level. Given Samantha's revelation that she is HIV positive, she would probably have an overwhelming emotional response. She may even have thoughts of suicide. Thus, the therapist's initial objective would be to maintain close contact with her, and communicate his unconditional acceptance of her feelings. During the first few months of therapy, as Samantha would probably be in a process of grieving, the therapist would continue in this same mode with her, offering her a caring, non-judgmental presence. He may also see the need to contract with her, if she remains suicidal, or for the purpose of finding a support group. He might also, as a condition of her remaining in therapy, require her to maintain regular contact with her personal physician. The approach here would not be an analytic one, with the therapist seeking to label or diagnose Samantha's condition. Rather, the approach would be phenomenological, with the emphasis on understanding how Samantha is perceiving her own reality. Above all, the therapist would be working to build with Samantha a trusting, empathetic therapeutic relationship, one in which she feels safe and understood.
In time, if Samantha is willing to continue her therapeutic journey, the therapy itself may change from a "crisis" mode to more of a "growth" mode. In this phase, the therapist can explore with Samantha some of the deeper implications of her life situation, and even use her painful experiences as a springboard to do this. For example, the issues of freedom and choice might be looked at. Perhaps Samantha feels that, because she is HIV positive, she now has less options in life, and therefore less freedom. Yet during this time she may also be encouraged to discover a new sense of freedom, as she realizes that she alone is responsible for making the most out of what remains of her life. Other issues, such as isolation, and anxiety, would also be significant themes of her therapy. Even the issue of death, which Samantha has had to face head-on throughout this whole time, could possibly be reexamined during this phase.
Another way to describe the therapeutic process at this stage is in terms of the therapist's approach to Samantha. As mentioned above, initially the therapist would be primarily non-judgmental and non-challenging. Yet if Samantha demonstrated a desire to make changes in her life, the therapist would begin to incorporate other methods into the therapy. For example, he may occasionally use confrontation, to help her see inconsistencies in how she is viewing her life, or to point out her defense mechanisms. Also, he may become more didactic, perhaps explaining to her the unavoidable nature of anxiety, or the responsibility of absolute freedom. Furthermore, he may point out others who have been faced with a similar situation, and have responded in a constructive way. All along, the therapist would be using his own behavior as a model for Samantha, and appropriately disclosing his own feelings with her to communicate his caring for her.
Although the initial goal of this therapy would be Samantha's survival through her time of crisis, the ultimate goal would be more concerned with her becoming aware of her freedom and of her ability to make choices that will positively influence her life. In other words, through this therapy, Samantha would cease to see herself as a victim who has been dealt a tragic hand, and start to see herself as someone who can be in control of their life in the present. This means confronting long-held assumptions about who she is, and how she relates to the world around her. It also means being willing to experience the anxiety that comes with the responsibility to live authentically, that is, to live without avoiding or escaping from her freedom.
For Samantha, the length of time required for therapy would be difficult to determine. It would depend on her individual rate of progress. The prognosis would also be hard to determine at first, given that she would be in crisis. Yet to the extent that she remained in therapy, and was willing to grow from her experience, the prognosis would be good.
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