What is meant by Affirmative psychotherapy?

My client was a married woman who had no children. She was in close relationship with her family i.e. her brother, mother, and husband. The client has no psychological symptoms depicting mental illness, but her liberty had been entangled with complex or multiple ethical conflicts related to change of ideas and decisions on sexual orientation and being a parent. The client had to make multiple challenging decisions to achieve what she wanted, because all of her decisions had diverse psychosocial implications either on her or her family. The client wanted to change her current sexual orientation status from heterosexuality to homosexuality (lesbianism).

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She also had the desire of being a parent but was not comfortable with the responsibilities. She came from a conservative family and thus could not mention or make liberal decisions such as leaving her husband in order to pursue her lesbianism desires or decide not to have children because of career interests. The client wanted the counselor to guide her overcome her challenges and express her new sexual orientation without feeling guilty. This case had some strong and weak areas the counselor could effectively develop. For instance, it was easy to formulate or conceptualize the case and provide diagnostic input, but it was very difficult to develop an effective treatment plan and assess therapy outcomes because the decisions on issues of sexual orientation have various social implications and are strictly personal.

Conceptualization of the case and diagnostic input would utilize the mental status examination (MSE), which is a psychometric diagnostic tool that has been used for quite a long time in social work, clinical psychology, and psychiatry. In this case, the use of the MSE was to determine functioning and self-presentation levels of the client (Polanski & Hinkle, 2000). The client was not free to express her situation especially her feelings on sexual orientation. It required the counselor to rephrase the questions severally in order for her to come out clear about her feeling on sexual orientation. She also was unsure of her feelings about having children.

The diagnosis of the client situation basing on discussion and non-verbal communication showed that she lacked emotional support and self-esteem to face the potential resistance from her parents, and express her liberal decision, which she viewed to differentiate her completely from the rest of her family (DeLucia-Waack, 2006). She also had the problem called dependent personality disorder because her independent decisions psychologically dependent on the decisions and personalities of others (Sperry, 2012). For instance, she did not have the desire to have children but when she encountered parenting lesbian couple she decided that having children was a possibility. Additionally, her sexual orientation was heterosexuality and was married to a man but the lesbians influenced her to reconsider. On the other hand, she could not adopt the influenced personality because her parents had conservative ideas and thus feared to express her new desires, which led her to develop her psychiatric problem.

The treatment plan entails active participation of the counselor in influencing the client make an independent decision through emotional support, enhancing client’s self-esteem, and guiding or discussing the independent implications of her decisions. The action plan on the issue of having children was based on the field of reproductive health and parenting as a means to establish a balance between career interests and parenting (Wingood & DiClemente, 2002). A challenge however existed in formulating action plan to enable her make a decision about sexual orientation because the issue is treated with a lot of social negativity and has no substantial scholarly basis for guiding and counseling (Whitman & Boyd, 2003). However, Success on the critical sexual orientation issue may depend on whether the client develops self-esteem to enable her make independent decision, not influenced by her mother’s pressure for her to have children and express conservative ideas or the personalities of the lesbian couple she had encountered.



DeLucia-Waack, J.L. (2006). Leading Psychoeducational Groups for Children and Adolescents. SAGE

Polanski, P.J. & Hinkle, J.S. (2000). The mental status examination: Its used by professional counselors. Journal of Counseling and Development, 78, 357-364

Sperry, L. (2012). Handbook of Diagnosis and Treatment of DSM-IV Personality Disorders. London: Routledge

Whitman, J.S. & Boyd, C.J. (2003). The Therapist’s Notebook for Lesbian, Gay, and Bisexual Clients: Homework, Handouts, and Activities for Use in Psychotherapy. London: Routledge

Wingood, G.M. & DiClemente, R.J. (2002). Handbook of Women’s Sexual and Reproductive Health. New York: Springer

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