The client, Jane, was a 47 year old staff nurse working full time in a large, acute, general hospital. She had recently separated from her husband and lived with her young adult daughter. Her young adult son lived with his father. Jane had referred herself to the Staff
Counseling Service part of the hospital’s Occupational Health Unit-for help with stress related problems. Her clinical manager had advised her to attend for counseling because of her poor sickness record and apparent distress on the ward. She had attended ‘Relate’ during her marital break up and was aligned to the idea of counseling as helpful.
Jane’s presenting problems were exhaustion, tearfulness, fear of being unable to cop and feeling out of control the effects of long term problems at work and at home. With over 15 years experience in her specialty, Jane had been allowed to work autonomously, make assessments and determine treatments without the necessary authority invested in her post. She had felt the growing burden of responsibility. With increasing staff shortages and patient demands, she felt workload pressures were intensifying. Her recommenda tions for change were ignored ‘nobody’ would listen.’ Her communication with the consultants was described as ‘confrontation rather than negotiation.’ She was feeling frustrated, angry, unsupported, isolated and a nuisance both to management and the consultants. After a particular altercation with the latter she had walked out.
Jane said that her husband had always been unsupportive of her work and had laughed when she described her dispute with the consultants. This was the final straw. She described similarities between her relationship with her husband and the consul tant- all these men talk down to me and there are battles every step of the way. She decided to separate from her husband after 26 years of marriage and resign from her post.
The critical incident that precipitated her attendance in counseling was a man agement request to assist with a task force reorganization of her old department. The thought of returning to an environment where she had given her all and it had not been good enough! elicited great distress, anxiety and confusion about what to do. A Multimodal Fife History Inventory (MLHI) (Lazarus & Lazarus, 1991) allowed Jane to state in her own words the nature of her difficulties:
It started from a culmination of problems with my marital relationship and work pressures, complicated by the serious illness of a close friend. A year after separating from my husband I felt very depressed and angry. I had made poor choices in life and missed out on emotional support. Loneliness was a strong feeling. The thought of returning to a previously difficult work setting reinforced all my problems.