Counselling Case Study Essay

Critically evaluate, your taped session within the context of a live case study, your professional practice and use of supervision.

INTRODUCTION

The rationale of this case study is for the Counsellor in training to closely examine a client’s process throughout their counselling sessions. This process will be aided by the in-depth analysis and review of a taped client session, elements of which will support the assessment. Evaluation of the client’s development and progression provided opportunity for the trainee Counsellor to consider their own growth and development within the client/Counsellor relationship and highlighted areas where private and group supervision was considered necessary and important and was used effectively to support their work with the client.

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The person-centred approach (PCA) to counselling, which is the therapeutic model used by the trainee Counsellor in this case study, is a non-directive, non-judgemental talking therapy which helps to promote growth and development in the client. When discussing the PCA, Bozarth (1998) suggests that:

The natural growth process of the individual is promoted when the therapist can be a certain way by embodying certain attitudinal qualities. The therapist strives to be congruent, to experience unconditional positive regard and empathic understanding towards the client. (Bozarth, 1998, p.8)

To provide a vignette, the client, Diana, is 64 years old, has been married to her husband John for over 40 years and has no children. Diana relocated from Matlock in Derbyshire to Mablethorpe, Lincolnshire in March 2009 and has been struggling with the transition, as well as her ongoing issues, since then. To date, Diana has attended 26 counselling sessions all of which, with the exception of 2, have taken place in the same room, in the same placement, the Boatshed in Mablethorpe, Lincolnshire. Sessions took place on either a Tuesday morning or a Wednesday afternoon. The Boatshed, so named because it was formerly the home to the town’s lifeboat service, is a community based Multi-Use Centre which provides counselling, Citizen’s Advice, social services, internet access and support and advice to those who need it. All services provided by the Boatshed are currently free to its users. The counselling room within the placement is private, secure and comfortable and most importantly, clients do not have to report to reception and can enter the counselling room without being observed.

In the placement’s infancy one or two issues were encountered with regards to building access and made conducting any counselling sessions impossible. This particular issue was resolved by speaking to the placement mentor and obtaining keys and alarm codes, thus eliminating future access problems.

During the initial meeting, which allowed for client assessment, Diana disclosed that she had some limited experience of counselling, a total of three 30 minute sessions, when she was referred to a Community Psychiatric Nurse (CPN) by her former doctor in Matlock, whom she approached with anxiety about her personal circumstances at home, as well as her concerns about her self-confidence and emotional state. Diana gave a concise précis of her medical and mental history and presented the issues which concerned her most, and which she wanted help with, which included: feelings of depression; anxiety; occasional panic attacks; low self-esteem and a lack of self-confidence. Throughout the duration of her counselling sessions the client/Counsellor relationship has matured and grown to a deep level of mutual respect and trust. Mearns & Thorne (2007) posit that these:

…moments of relational depth may be experienced as intimacy and the more continuing form of relational depth will develop to create an experience of mutuality.

(Mearns & Thorne, 2007, p.190)

It is these profound and deep levels of relational depth and mutuality which will be evaluated and highlighted with examples from the taped session later in this essay. There will also be an assessment, underpinned with theory, of elements identified in both the client’s and Counsellor’s process when working together.

((615))

EVALUATION OF TAPED SESSION

Diana has used her counselling sessions to examine her personal and interpersonal relationships with her husband, close friends, her brother, her parents and her grand-mother in some depth. Diana’s work has helped her to identify a number of “… values and injunctions …” (Tolan, 2003, p.4), which she referred to as “ways I am supposed to act and feel, people tell me how I should behave, my grand-mother told me that girls are meant to be seen but not heard”. Diana adopted introjected conditions of worth, such as feeling ungrateful [CL 119, 187] primarily from her father and grand-mother. In sessions 1 and 2 Diana talks openly about her low self-esteem and to paraphrase Mearns & Thorne (2007), Diana feels as if she is so weak and frail that she could easily be broken. (Mearns & Thorne, 2007, p.11) [C205, C207, C209] During those moments when the client was particularly distressed and scared it was difficult for the student Counsellor not to fall back on their rescuing nature.

During her third session Diana spoke about her younger brother who died some years ago from alcohol abuse and self-neglect. Diana expressed feelings of guilt, shame and regret and felt that she had not done enough to help her brother. Kübler-Ross (2007) describes Diana’s feelings perfectly, suggesting that

“when a loved one dies, we are often left with many regrets about all those things we wish we had said, all those things we wish we had done.” (Kübler-Ross, 2007, p.38)

THE COUNSELLOR

Critically Evaluate your taped session within the context of a live case study, your professional practice and use of supervision

I. 1 – context of real life case examples recognising diversity and the complexity of human situations

II. 2 – good standards of practice and care and an understanding of the importance of supervision groups as outline in the BACP Ethical Framework

A. professional practice

1. own competence

2. self care

3. private supervision

4. peer support

5. group supervision

6. need to work ethically

7. knowledge of referrals

III. 3 – Anti-Oppressive ways of working and ethical principles in relation to personal practice with live cases, confidentiality and the client’s capacity for self-determination

IV. 4 – Collect, critically analyse and evaluate information from real life case studies including professional issues

A. critically reflect on audio tape session

1. link PCC to practice

2. Client process

a. progression and change

b. depth of relationship with counsellor

c. client history and background

3. own counselling skills

4. why was this tape chosen

a. demonstrates clients growth

b. client exploring feelings

c. asking questions of self

d. still some incongruence

5. process and theory of what is happening in the session

6. 1st person? owning locus of evaluation?

7. 7 stages – identify where client is – why ?

8. are they in touch with their feelings?

9. how has the relationship with self changed?

10. relational depth – what is it?

Relational depth is the ‘unspoken relationship’ that develops between counsellor and client. Relational depth can be referred to as Edge of Awareness which is, according to Wilkins:

“…an empathic response to something (a thought, a feeling, a sensation, an intuition) which is just below the threshold of awareness. That is, when such a reflection is made, there will be an instant recognition on the part of the client “Yes, that’s it!”.” (Wilkins, 2003, p.111)

This edge of awareness is identified in Diana’s process at ((interaction ***)) where the relationship between client and counsellor is at such a level that it is almost as if their minds and thoughts are as one.

11. as a counsellor do I fully understand what is going on for client?

12. IPR – what did it reveal?

Interpersonal Process Recall (IPR) is a means by which a therapist can study the way in which they respond and connect not only with their client but within their own process. According to Allen (2004),

“IPR is based on the idea that at any moment in time we are receiving and storing a multitude of feelings, thoughts, sensations, images and bodily reactions, of which we are not normally aware and which we do not have time to process in the moment, but which subtly affect the way we behave, react and interact.”

(Allen, cited in Tudor & Worrall, 2004, p.154)

IPR in supervision = how can I be sure that I am allowing into awareness all that I need in order to look at and understand the process? = how can I help my client to strengthen her own internal locus of evaluation? = how can I help my client to develop an informed, alert and sure-footed ‘internal supervisor’ that she can believe and trust?

Initially I found the prospect of playing a taped session to my supervisor daunting and nerve-wracking. All 3 people involved, me, supervisor and client were aware of the reasons behind taped reviews. Transparency of purpose, method and safety for all 3 parties. Thoughts, hunches, pictures, images, memories which occurred at the time of original interaction but did not have time to process and stop there and then.

13. 7 stages

14. process and theory of what is happening in this session

15. clients body language

a. eye contact

During the initial meeting, Natalie spoke quietly and constantly broke eye contact, instead choosing to look around the room whilst still maintaining dialogue. Dozois & Dobson (2004) explain this by stating that:

Research has shown that depressed individuals make less eye contact; demonstrate slower speech; and exhibit fewer hand, head and body movements during conversation…

(Dozois & Dobson, 2004, p.274)

b. clothes

c. demeanour

d. way of sitting

e. any unconscious fidgeting etc?

f. has any of this changed over the course of the sessions?

V. 5 – Identify, synthesise and evaluate relevant primary research from real life case study and supporting secondary research from key thinkers within the field of counselling

VI. 6 – Produce reasoned arguments, justifying conclusions and recommendations in relation to real life case study and your own practice

VII. 7 – Reflect, evaluate and conceptualise own counselling competence when working with a live case study

VIII. 8 – Use a range of advanced counselling skills competently, effectively and with increased confidence

IX. 9 – Demonstrate understanding within supervision groups through the application of knowledge and skills

X. 10 – Work within a professional and ethical framework demonstrating recognition of the limitations of training and experience

XI. 11 – Demonstrate a commitment and acceptance toward regular supervision of counselling practice within the placement setting and supervision groups

XII. 13 – Demonstrate an ability to work independently producing evidence to demonstrate adherence to professional ways of working

XIII. 14 – Engage in interactive learning between classroom and practice learning settings

XIV. 15 – Communicate effectively with others within placement and supervision groups paying attention to the importance of unauthorised disclosure

For the purposes of this case study the trainee Counsellor has decided to focus on the client’s depressive tendencies and to demonstrate how, using counselling as a vehicle for change and with the help multi-agency support, the client has altered their mental state and their physical situation and changed the way they think about things.

In Natalie’s case there are a number of attributing factors including: the abusive relationship in which she was living; considering herself to be without a voice and unheard; her loss of identity (Glassman & Hadad, 2007, p.246) and being a mother to a new-born child in the abusive relationship.