Case_Study

I am a trainee counsellor and I have worked in a case study as part of my training. My case study is about counselling a fellow student over a period of about 8 weeks; for a total of six sessions, the sessions have taken place in a spare classroom. I used the room in the best possible way I could by moving aside the extra chairs, and positioning the remaining ones in the SOLER position which allowed me to show participation with my client, this is done by positioning the chairs at an angle of 90 degrees. Furthermore I made sure all mobile were on silent. In the room with us there were two observers and I position their chairs in a way that would not create a distraction for my client as this could make her feel uncomfortable and hinder the therapeutic relationship. Creating a warm and safe physical environment is an essential stepping-stone to building a strong therapeutic alliance with the client. I made sure that the door was looked to prevent other people from walking in to the room as this would create a breach of confidentiality and as result would affect the communication between me and the client. Trust is something that has to be earned by the counsellor, developing the skills of active listening, sensitive responding, reflecting feelings can help to minimize disruption to communication, is important to show empathy geniuses and demonstrate that you are fully present for the client. My client is a single mother and she takes full responsibility for her two boys. She is coming from Muslim background and strong religious believes. After the birth of her second child, she experienced some problems with her husband, shortly after the marriage broke down. This has caused a loss of social connections with family and friends. This loss has also created some personal conflict, currently she is studying part time to become a counsellor and when she is not studying her time is taken by her role as a mother. In reference to a book I have read, Elisabeth Kubler- Ross 1969, she introduces the five stages of grief, she explains that people in a moment of tragedy or while dealing with death, would encounter denial, anger, bargaining, depression and at the end acceptance. I believe that my client is in between experiencing anger and depression. She has lost her husband and large part of her social life she is grieving for the life she has lost, and furthermore she is not accepting her situation. Before I started my counselling session with my client I went through the basic clauses of a contract where I discussed the length of the session which was 30 minutes. I explained that the agreement to work on the issues presented by her in no way guarantees a cure. I made clear that everything we were discussing was confidential and I asked for authorisation for recording the session. I explained that confidentiality will be maintained in all but the most exceptional circumstances; if I felt that if she was to harm herself or anyone around her. Most standard of confidentiality applied in professional contexts are based on the Common Law concept of confidentiality where the duty to keep confidence is measured against the concept of Grater good. I explained to my client that I am a trainee counsellor and that my knowledge is limited to the training I have received so far, I felt that I had to make sure that my client was aware that if I was not able to help her with a particular issue I would have asked the help of my supervisor. In addition a case of Counter transference could arise, these refers to the projecting of a counsellor's experiences, values and repressed emotions that are awakened by identification with the client's experiences, feelings and situation that affect the dynamics of a counselling relationship, this once again highlights the importance of supervision for the counsellor, since is only through supervision that this can be identify and dealt with. I explained my client that punctuality was important and that any lateness would have made impossible for the session to take place. I explained that I did not allow any swear word or rudeness. I think that is very important to establish and review the boundaries, as this reflects to the client an air of professionalism and approachability. I clarify that in the room we had two observers who were taking notes of my performance and I asked if she felt comfortable with it. I explained that the reason why I had two observers in the room is important because it allows me to receive feedback and positive criticism, as a trainee counsellor this is very important as it can allow me to brainstorm with my observer/supervisor and give me the opportunity to offload any concern or doubts that I have about the session just occurred. I enlighten that it was important for both of us to feel comfortable and if she wanted to ask me anything before we started. I went on by asking as well if she had any expectations or if she had any goals that she wanted to achieve. At this point I asked my client if she was happy with what I said and I asked her if she was happy to proceed. I started the session by using an open question which was: “To start with, what would you like to get out of this session'” The client replied: “I need some answers, not necessarily from you. I need to clear my mind.” I used an open question to encourage the client to explore her feelings and issues. I chose to open the session in this way, as this would allow the client to choose what she wanted to talk about; as this was our initial meeting and I wanted to build slowly a reassuring and trusting relationship. I choose to use Carl Roger approach best known as Person-Centred Approach, the base for this theory is a more and equal relationship with the client, to help the client to reach a state of a weakening and self help. To do this, the therapist would help the client to voice her feelings without suggesting how a person might want to make changes but by actively listening and then by reflecting back what they have expressed and subsequently guide them to understand their emotions and actions for themselves. Personal development in this case can be achieved by coming to terms with episodes or problems that have marked in a negative way her life. When you sit with a client, the first challenge is to listen as openly as possible, without expectation or judgment. We need to remember that this person is not us. No matter how similar they may seem, they came through a substantially different set of formative experiences. Race, class, gender, culture, region, specific family history, specific personal history, all has their influences. You will hear them better, and they will feel safer to speak, if you can set your theories aside and just listen. As the session progressed the client said: “I feel that there is something playing on my mind.” I used a probing question by replying: “Would you like to elaborate' The reason that I used this probing question was to allow the client to expand on his initial response, and elaborate on her feelings. I feel that by doing this, the client may have felt accepted by me which may help to create trust and equality in the helping relationship. The client said: “Basically I am very upset with my husband, every time we speak on the phone we argue and after I get a very bad migraine, I replied using the skill of paraphrasing by saying: So every time you have a conversation with your husband you end up in an argument and after you develop a migraine. The reason I used this skill was to clarify the content of what the client was telling me. The effect this can have on a client is that is being actively listened too. At this point I felt my client was in a very high emotional state. Her tone of voice was choked and she changed the position of her arms from being lying over her legs to a closed position over her chest as if she was protecting herself. I responded to her emotional state by asking if she needed a glass of water, for a moment my client retreated in her on world and she stopped talking. I managed the silence by just sitting with her, I waited quite a while and finally she looked at me and she said that she was ok. My client was wondering from one thought to another and I decided to use a closed question to frame the context of the situation, and then used the skill of focussing to establish the client’s issue, as I felt that she was being vague about her problems. I feel that in this situation, the skill of focussing allowed the client to make sense of what she was truly feeling. Very quickly we came to the end of our first session, a sense of relieve came over me, I was overwhelmed. As the weeks went by, I learned to understand my client to a deeper level, her body language became like a non verbal way of communication. Still part of me felt that I needed to push her just little more. During one particular session I decided to choose to use the Gestalt approach, more specifically the Empathy chair technique, when the client expresses a conflict with another person, the client is directed to talk to this person who is imagined to be sitting in an empty chair. This helps the client to experience and understand the feeling more fully. Thus, it stimulates thinking, and highlight emotions and attitudes. So I asked my client if she wanted to try something different and she happily agree; so after repositioning our chairs plus another, I asked her to imagine her husband sitting opposite to her and I asked her to tell him what she was thinking and felling. For a moment my client looked at me, after she stared at the empty chair and started to poor out words full of emotions, her voice was deep and her all body shrank in the chair, her eyes full of tears. When her voice stopped, I felt that this approach was too strong for my client as once again her body language was very defensive and her emotional state was very high and so I decided to retreat from this approach by asking an open question: “How do you feel now'” my client replied by saying: “I am not sure”. On reflection I have realised that to use on Gestalt approach on my client was probably not the best choice as I feel that was to direct for her, I feel that this approach can corner a client and possibly damage the therapeutic relationship. Gestalt therapy seems to be particularly beneficial for people who are rather 'buttoned up' when it comes to their emotions. This technique can give rise to emotional scenes, and the previously buried emotions need to be handled carefully, emotions can become too strong to manage for the client, I feel that this therapy approach needs to be use very carefully. I finally decided to go back to a more soft approach and I stuck to it all the way through my last session. As we reached the end of the last session I made sure my client was aware that we were coming to an end of our therapeutic relationship. I made a brief summary of what we just discussed and I asked her if there was anything else she wanted to say or discuss with me. It is important to be sure that the client is aware of the time boundary and furthermore to refresh what has been said. This can allow the client to reflect about what has come out and bring home some ideas to reflect upon. I was aware that at the end of each session I felt a great sense of concern for my client and I was wishing that I could have spent more time with her so I could have possibly given more support; I can see why it is important to establish from the start the duration of the sessions and I know as well that for me was important to clarify with my client if she was feeling that the counselling sessions had helped her. It is important to make the client aware that everything comes to an end and this can allow the client to be aware of time boundaries and make it easier to let go of the therapeutic relationship. On a more personal note, when David my tutor told me to go back to basics and use the three core conditions with the skills I have learned, and kept it simple I was frustrated as I wanted to explore other models and challenge myself, but after experiencing with my client the Gestalt approach, I realised that Carl Rogers Therapeutic Approach of Person-Centred Counselling provides a climate where is possible to experience growth and therapeutic change.