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Section 11
Effective Use of 'Carbonated Thoughts'

Question 11 | Answer Booklet | Table of Contents

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In the last section, we discussed three concepts regarding crisis counseling following rape.  These four concepts are McDonald’s phases of reaction, guilt, and an intervention technique for rape victims in crisis and their partners.

In this section, we will discuss four concepts regarding therapeutic crisis intervention in the case of a premature birth.  These four concepts are four tasks for the mother of a premature infant, assessing the family, interventions, and anticipatory planning.  We will also discuss the "Carbonated Thoughts’ technique.

Carla and John had been married 4 years, and had a two year old daughter.  When Carla was seven and a half months pregnant with the couple’s second child,  John’s company transferred them to another city.  Within a day of moving to their new home, Carla went into premature labor and delivered a baby boy.  Because the new town was 150 miles from their old home, Carla delivered under the care of an obstetrician she had never personally met, in a hospital that was not familiar to her.  Although the baby did well, two months after his birth Carla entered a crisis state in which she was no longer able to care for the baby.

Crisis Intervention for Premature Birth - 4 Concepts

♦ #1 - Four Tasks for Mothers of a Premature Infant
The birth of a premature baby, even when anticipated, is a stressful situation for even the most healthy family.  There is a sense of emergency at home and in the hospital, and both staff and parents feel anxiety for the newborn.  I felt a first consideration regarding therapeutic crisis intervention in the case of Carla and Jim was the four tasks for mothers of a premature infant.  Mason and Kaplan have identified four tasks that a mother of a premature baby should work through in order to come through the experience in a healthy way.

4 Tasks for Mothers of a Premature Infant
1. She must realize she may lose the baby.  This anticipatory grief involves thinking of withdrawal from the relationship already established during the pregnancy.
2. She must acknowledge ‘failure’ in her perceived maternal function to deliver a full-term baby.
3. After separation from the infant as a result of a long hospital stay, she must resume her relationship with the baby to prepare for its homecoming.
4. She must prepare herself for the job of caring for the baby through an understanding of its special needs and growth patterns.

♦ #2 - Assessing the Family
A second consideration regarding therapeutic crisis intervention for Carla and Jim was assessing the family after the special care infant has been brought home.  My first concern in assessing Carla’s state of crisis was to examine the precipitating event.  Carla’s crisis state began during a visit from John’s mother, who had been highly critical of Carla’s ability to care for the baby.  

Carla stated, "She was just constantly making comments like, ‘I can’t understand why he cries so much.  You must be doing something wrong.   My children always slept through the night by two months!’  All day long, comments like that!"  Jim was reluctant to intervene, and on the second day of his mother’s visit, Carla became extremely upset, cried uncontrollably, and took to bed, refusing to care for the baby.  In talking with Carla, I discovered that prior to this event, she had experienced strong symptoms of anxiety, insomnia, exhaustion, and fear over her ability to care for her son.

I next assessed Carla’s sources of situational support.  Clearly since she had recently moved, Carla had not had time to establish a strong network of friends in the area.  John was extremely reluctant to participate in care for the baby, expressing fear of the baby’s small size and fretful nature.  Carla was thus responsible for all of the baby’s physical needs.  I also established that John’s mother Doris had been an ongoing source of stress for Carla since she became pregnant with their first child.  Doris was very opinionated, and frequently sat Carla down for talks on child-rearing. 

Carla had begun to develop confidence in her own mothering abilities recently as her daughter continued to have good health and average development.  However, the difficulties of caring for a baby with more challenging needs had convinced Carla that she was too incompetent to care for her new son.  Neither John nor Doris was providing situational support for her in her role as the mother of a premature infant.

♦ #3 - Interventions
In addition to four tasks for mothers of a premature infant and assessing the family, a third consideration I had regarding therapeutic crisis intervention for Carla and John was the interventions.  I set as the three principal goals for the crisis intervention helping Carla and John explore their feelings about the premature birth, the couple’s changed communication pattern, and the lack of support John was providing. 

Technique: "Carbonated Thoughts" Visualization
As an immediate intervention to help Carla gather coping mechanisms, I instructed her in passive muscle relaxation, and also suggested the ‘Carbonated Thoughts’ Visualization technique to complement the physical relaxation technique she was learning.  After walking Carla through progressive relaxation, I guided her through the visualization. 

I stated, "Imagine a glass of carbonated water with lots and lots of bubbles. See the bubbles float to the surface and burst.  As the bubbles burst, let go of any thoughts bouncing around your mind along with them.  As you continued watching the carbonated water, see the bubbles slowly declining in frequency, getting fewer and fewer, slowly, very slowly, until the water becomes very clear and calm.  As the bubbles burst and disappear, continue seeing your thoughts flow from your mind, gradually and slowly becoming less and less, and feel your mind becoming calmer and clearer, coming to a place of complete rest in quiet peacefulness.  See yourself drifting into a deep, calming relaxation as you continue to breathe very slowly." 

I provided Carla with a tape of this visualization, as well as progressive relaxation and relaxation breathing exercises, for her to take home.

During the first few weeks, John was able to fully explain to Carla the insecurities concerning handling such a small baby that were behind his reticence to provide physical care.  Carla expressed similar anxiety.  I reassured Carla that she was doing well, and selected several books to provide to Carla and John concerning caring for a premature infant so that they would be able to discover together the reality of the situation. 

♦ #4 - Anticipatory Planning
A fourth consideration I had regarding therapeutic crisis intervention for Carla and Jim involved anticipatory planning.  As John became more confident handling their son, I encouraged him to share the responsibility of caring for the baby in the evenings, so that Carla could get more physical rest.  This emotional support helped Carla to relax, and she began sleeping better.  I also recommended that the couple resume social interactions with each other as soon as possible, emphasizing that the baby boy would do fine in the care of a competent sitter for a few hours. 

Finally, I emphasized that the couple should make a concerted effort to spend alone time with their two year old daughter.  Out of necessity most of the Carla and John’s attention had been spent on the new infant.  However, I reminded the couple that this was a stressful time for their daughter, too, and she would need to feel included.

Think of your Carla and John.  What strategies would you suggest in handling the crisis precipitated by the birth of their premature infant?

In this section, we have discussed four concepts regarding therapeutic crisis intervention in the case of a premature birth.  These four concepts are four tasks for the mother of a premature infant, assessing the family, interventions, and anticipatory planning.

In the next section, we will discuss four concepts regarding therapeutic crisis intervention following divorce.  These four concepts are, tasks of engagement, subphases where a crisis is most common, risk factors for divorce, and a case study of an intervention with a client in crisis precipitated by divorce.

QUESTION 11
What were three techniques recommended for Carla as immediate reinforcements for her array of coping strategies? To select and enter your answer go to Answer Booklet.


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