THE CASE OF MARIA: AN INTEGRATIVE APPROACH
Maria's case presents a lot of personal and intrapsyche dynamics that may be evaluated using an integrated approach. For the purposes of clarity and continuity, this case study is presented from only one of the integrative approaches, the narrative perspective.
The use of an integrated narrative approach with Maria may produce effective results if her counselor is culturally competent and understands the impact of her ethnic heritage as a Hispanic woman. The Hispanic tradition has a religious history and social perspective that Maria's more acculturated life path is at odds with in many ways.
From the narrative approach, a counselor would assess that the turmoil in Maria's life represents a theme-based story complete with antagonistic symbols, protagonist aspirations, an engaging plot, and a yet-unexplored conclusion. Using a simple narrative exercise, the counselor, who is working from the person-centered theory, invites Maria to write a story in her own words about her journey.
In this interview, Maria shares her life story and what experiences have brought her to this current place and time. The main character in Maria's story is herself, a being at odds with her own regrets, emotions, and relationships. Maria has illustrated struggle as a narrative field with conflictual relationships, difficult life choices, and obligations. These themes have led to life changes and stressors that have formed a pattern of guilt, frustration, hopelessness, and inner conflict as expressed through her insomnia and crying spells.
In the exploration of Maria's narrative, the counselor and Maria process themes of joy, despair, hope, and fear. Through the integration of the narrative approach with a person- centered framework, Maria becomes aware of her own actualization and growth over the years. Within the life narrative for Maria are consistent patterns of identity, loss, and transition. Maria is able to begin to see how her relationships with the other "characters" in her life have aided or challenged her throughout her journey. From this point on in the counseling process, Maria and her counselor begin to plan strategies for reauthoring her current life script and role assignments.
Maria begins her reauthoring with elements in her social and cultural environment. As she feels drawn to her family of origin and children, Maria creates goals for nourishing and reconnecting those relationships that she deems essential rather than obligatory. As a proud Latina, Maria has expressed feelings of shame as she believes her narrative has diverged away from the values and practices of her parents' heritage. With the assistance of her counselor, Maria begins to see that she still has the power and responsibility to create a life story that will honor her own cultural and familial values.
Maria's insomnia and crying spells are a part of her life narrative as well. Ideally, as Maria becomes more aware of the feelings of guilt and shame and those cognitive ruminations, the insomnia and crying will begin to decrease. Maria may see her current emotional state as a plot twist or theme that has been a consistent part of her life story. In narrative perspectives, Maria is the hero of her own story and will have to take on her antagonist to move along in her journey. She can make plans to reestablish her identity along the major themes and plot elements in her narrative. As Maria's actualizing tendency becomes stronger, she is no longer focused on the limitations of her life but develops strategies for a better here and now.