Reflection on self awareness and personal growth

The purpose of this essay is for the trainee Counsellor to critically reflect upon, and evaluate, a recorded counselling session which took place on Thursday 2nd April 2009. Within this essay, the trainee Counsellor will evaluate their use of advanced counselling skills and assess the value and usefulness of these skills. In particular, the trainee Counsellor will critically evaluate their own way of being by closely examining their application of the six conditions which are essential to therapeutic change and will focus on:

“…the three attitudes or conditions that a person-centred therapist needs to provide for the client are congruence, empathy, and unconditional positive regard. These attitudes are not presented as a hierarchy. Indeed they are viewed best as a trinity – inseparable, essential and mutually independent.”

An evaluation and reflection of the trainee Counsellor’s performance will be enhanced by use of the person-centred rating scales. Mearns & Thorne (2007) when writing about the rating scales posit that:

“Discussing these ratings, and the other possible responses the trainee counsellor might have made, could help to expand the trainee’s repertoire of ways of communicating [her] empathy.”

(Mearns & Thorne, 2007, p.71)

Another way in which the trainee Counsellor has evaluated the way they worked in this session is by closely examining the DVD with the observer who was present during the session and who asked the trainee Counsellor pertinent questions regarding the session. This procedure is known as Interpersonal Process Recall (IPR) (Merry, 2006, p.146). Finally, the trainee Counsellor will refer to feedback notes from the observer order to critically evaluate their way of working with the client.

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The client in this session is a 36 year old married woman who has two children. This session is the trainee Counsellor’s second session with this client, although the trainee Counsellor is aware that the client has seen another therapist previously, nothing of these other sessions has been divulged by the client. In the first session prior to the client talking about her reasons for wanting to see a therapist, the trainee Counsellor and client worked collaboratively through the contract. This was done with sensitivity as the trainee Counsellor was very aware that he was the first male Counsellor seen by the client and she had already disclosed her anxiety and nervousness about this fact. During the first session, the client talked about a number of different issues, but continually returned to focus on her feelings about a man who had been harassing her both physically and sexually. The client also expressed doubts about her own lack of self-belief and her compulsive organisational and controlling nature which she felt dominated her life. The trainee Counsellor considered how the client was moving along the Seven Stages Model (Merry, 2006, p.59) and that the client was positioned somewhere between stages 3 and 4, although possibly closer to stage 4 as during the first session the client demonstrated some internal confusion about her feelings and there was a tendency for her to express things in terms of ‘black & white’, she was however, also able to convey some profound and more meaningful feelings. Merry (2006) describes stages 3 & 4 as:

“Clients who first seek therapy are often at this stage and need to be fully accepted as they present themselves before moving deeper into Stage 4. Stage 4 – In this stage, clients begin to describe deeper feelings, usually those that happened in the past.”

(Merry, 2002, p60)

At the beginning of the second session the trainee Counsellor checked, by working collaboratively with the client [C1, C3, C5], about the contract in order to confirm with the client that she was happy with and understood everything discussed in the first session. The client confirmed [CL6] that she was fine to continue. The trainee Counsellor then proceeded to set the boundaries [C1, C7] for the counselling session. Boundaries are an extremely important element of the therapeutic process as they make the client aware of what the trainee Counsellor is offering them. The trainee Counsellor, by being open about the type of counselling they offer, by setting time limitations and by reassuring the client, clearly sets the scene for a healthy, professional and mutually beneficial relationship. Mearns & Thorne (2007) when discussing boundaries suggest that:

“It is important both at this early stage and as counselling proceeds that the counsellor monitors continually what [she] is prepared to offer to the client, and what lies outside the boundaries of [her] commitment.”

(Mearns & Thorne, 2007, p.53)

The trainee Counsellor, when discussing the boundaries and when checking with the client about the previous session and the client’s understanding displayed a deep level of Unconditional Positive Regard (UPR) [rating 4.0] [C1, C7].

At [CL8] the client begins to talk about a man who is heavily impacting on her life at the moment. The trainee Counsellor [C9] reflects the client’s words back to her, but paraphrased and in a manner which questions the client’s feelings. At [CL10] the client is interrupted by a loud noise from an adjoining room and the trainee Counsellor, because of the psychological connection with the client and his level of congruence [rating 5.0] responds with a degree of immediacy [C11] which is positively acknowledged by the client. At [CL12] the client expresses anger and frustration at herself. The trainee Counsellor [C13] is at this point offering the client UPR [rating 4.0] and a deep level of empathy [rating 4.5 – 5.0] and acknowledges the client’s anger by reflecting and challenging the client’s feelings about being trapped [C15] and angry. The client [CL14] agrees with the reflection and at [CL16] questions herself about what it is that she is actually angry and frustrated about. The trainee Counsellor remembers key details about the client which were disclosed in the first session and following the client’s comments at [CL16] makes some gentle and refined queries [C19, C23, C25]. These challenges are accepted by the client, positively and with real emotion. The strength of the response identifies the level of relational depth that the trainee Counsellor and client have formed. At this point [C25, C27, C29] the Counsellor’s empathy [rating 5.0], congruence [rating 5.0] and UPR [rating 5.0] are clearly visible to the client and such a deep level of mutuality is present that previously unrecognised feelings which were just outside of the client’s consciousness become visible and the client achieves a moment of comprehension and awareness [CL30]. Rogers (2004) describes this as:

“…the letting of material come into awareness, without any attempt to own it as part of the self, or to relate it to other material held in consciousness.”

(Rogers, 2004, p.78)

There is a visible shift in the client at this point and the trainee Counsellor, because of the level of his empathy [rating 4.5] is aware of the internal confusion and struggle that the client is undergoing. [C29, C31]

At [C33] by expressing his confusion to the client, the trainee Counsellor displayed a deep level of congruence [rating 5.0] and this openness and genuine attitude assisted the client who moved on to explore her own feelings and reactions to what she had said at [CL30, CL32]. The trainee Counsellor [C35, C37, C39] reflects some of the client’s thoughts back to her. During this period of interaction, the trainee Counsellor takes the opportunity to make some gentle challenges which cause the client to question her thought process. At [CL50] the client questions the trainee Counsellor, and it appears as if she is looking for some kind of affirmation that what she is saying makes sense. The trainee Counsellor [C51] makes it clear to the client that what she has said makes perfect sense to him, and this could easily be construed as some form of collusion, however in this case it is more of a corroboration to demonstrate the trainee Counsellor’s empathic understanding [rating 4.5 – 5.0] and as a form of encouragement to the client to continue. The interactions at [CL50, C51] clearly display the trainee Counsellor and the client sharing the same frame of reference, being in the same place at the same time. Worsley (2002) suggests that:

“The greater the spontaneous-type content of the frame of reference, the more proper it is to call any therapist response process-orientated, because the therapist will be engaging empathically with the whole organism who is the client, and not just the reflexive, conscious elements.”

(Worsley, 2002, p.40)

The trainee Counsellor, at interactions [C53, C81, C92] makes use of challenges which could be construed as directive questions, however, with the use of IPR and a deeper analysis of the recorded session, it is apparent that the trainee Counsellor was not directing the client, but was using thought-provoking words to stimulate the client’s process. The trainee Counsellor used his UPR [rating 5.0] and empathy [rating 4.5 – 5.0] to identify with the client’s goals whilst at the same time valuing and respecting the client at the deepest level and at the same time being his own person, being congruent [rating 4.0 – 5.0] and honest with his own feelings so that the client is aware that she is valued and prized and that the trainee Counsellor is not hiding anything of himself from her.

At interactions [C81, C98] the trainee Counsellor takes the opportunity to query the client’s incongruence and the client’s responses [CL82, CL83, CL85, CL99] clearly suggest that she was not being truly honest with herself. Rogers hypothesises that if the client:

“…becomes more self-aware, more self-acceptant, less defensive and more open, [he] finds that [he] is at last free to change and grow in the directions natural to the human organism.”

(Rogers, 2004, p.64)

There is a point in the counselling session [CL109] where the trainee Counsellor senses a shift and a visible change in the client. The client starts to question her own behaviour and self, and in doing so realises how important some of the issues discussed in the session are to her. Rogers (1980) suggests that:

“To perceive a new aspect of oneself is the first step toward changing the concept of oneself. The new element is, in an understanding atmosphere, owned and assimilated into a now altered self-concept.”

(Rogers, 1980, p.155)

The trainee Counsellor, through several interactions [C112 to C134] briefly sums up the session so far, recapping the salient points of the session. This is done collaboratively with the client, continually checking that the client is in agreement with what the trainee Counsellor is reviewing. By working in this manner, the trainee Counsellor is adhering to the ethical principles recommended by the BACP and is ensuring that he is working in an anti-oppressive way. Within this review of the counselling session, the trainee Counsellor considered different parts of the client’s self. Mearns & Thorne (2007) refer to these different parts as ‘configurations of self’ and suggest that:

“…a configuration is a developed ‘self-within-a-self’ that can contain a wide array of elements – a set of thoughts, feelings and behaviours that together represent an important dimension of the person’s existence.”

(Mearns & Thorne, 2007, p.34)

An analysis of the client’s various dimensions gave the trainee Counsellor the opportunity [C124, C126, C134, C136] to sensitively challenge those different parts which in turn triggered a reflective process in the client. The relational depth between the trainee Counsellor and client at this point was extremely good with both client and trainee Counsellor aware of their own feelings and expressing the genuine and authentic person to each other. Nothing was hidden and there was a real connectedness between both people in the counselling session. If both the trainee Counsellor and the client “…can be genuine in the relationship, the more helpful it will be.” (Rogers, 2004, p.33)

The trainee Counsellor is a student member of the British Association for Counselling & Psychotherapy (BACP), and as such is fully aware of the importance of adhering to the elements within the BACP’s Ethical Framework for Good Practice in Counselling & Psychotherapy (BACP, 2007) which discuss the provision of maintaining a good standard of practice and care (BACP, 2007, p.5). The trainee Counsellor fully believes that:

“Regularly monitoring and reviewing one’s work is essential to maintaining good practice. It is important to be open to, and conscientious in considering, feedback from colleagues, appraisals and assessments.”

(BACP, 2007, p.5)

IPR of the session reinforced the trainee Counsellor’s original observations and feelings about the client as the session drew to a close. It was apparent that from interactions [CL150 – CL156] that the client was in a deep state of process. The trainee Counsellor’s level of empathy [rating 5.0] and the relationship which had developed between client and trainee Counsellor was such that at interaction [C157] the trainee Counsellor made the decision to end the counselling session a couple of minutes early. This was checked with the client to ensure that she was happy to do this, and the expression on her face confirmed that the trainee Counsellor’s choice was the correct one. The client had, at this point, moved on and was clearly trying to figure out what was going on in her head. Rogers (2004) outlines a client’s process by suggesting that:

“Clients seem to move toward more openly being a process, a fluidity, a changing. They are not disturbed to find that they are not the same from day to day, that they do not always hold the same feelings toward a given experience or person, that they are not always consistent.”

(Rogers, 2004, p.171)

The client’s progress in this session was, for the trainee Counsellor, quite a revelation. The trainee Counsellor by focusing, using a ‘felt sense’ (Mearns & Thorne, 2007, p.79) [C29] touches on the client’s unknown feelings and attends with deep empathy [rating 4.5 – 5.0] congruence [rating 4.5] and UPR [rating 4.5 – 5.0] to the client. It was the trainee Counsellor’s first real experience of witnessing a client’s self-realisation [CL30] to something that was at the edge of their awareness but which they had previously ignored or dismissed. A change came over the client [CL30] and their honesty and openness became much more expressive. At this moment the relationship between the trainee Counsellor and client became much closer.

Feedback from this session was received from a third party observer, who took notes to assist the trainee Counsellor in their evaluation of this session. The comments suggested that the trainee Counsellor’s congruence, empathy and use of UPR were obvious and perceived by the observer to be at a deep level. The observer suggested that on occasion, in her opinion, the client / trainee Counsellor relationship seemed almost friendly. From a learning and professional perspective and having reviewed the recording several times, the trainee Counsellor can see how some of the session might have been experienced from an observational point of view, but within the counselling relationship the two participants were experiencing each other and absorbed deeply in the counselling relationship. This is characterised by their ability to share a moment of levity [CL36, C37], followed by the client moving flawlessly back into her train of thought and process.

From the trainee Counsellor’s perspective, several key points were noticed. Firstly, there were a couple of areas [C19, C39] where the session could have gone in different directions. As a trainee, the choice of language, the correct use of handle-words and the on-the-spot decision making is difficult to practice as every client is unique and individual, and every client will bring a different range of issues to the session. Secondly, the trainee Counsellor considered their use of questions in the session. There is no doubt that there will be some criticism of the way in which the trainee Counsellor phrased some interactions to the client, but there is a firm belief that none of the questions were deliberately directive and the session flowed well, with the relationship between client and trainee Counsellor relaxed, natural and open. Finally, the trainee Counsellor was real and authentic and it is clear that the client experienced this realness in the relationship.

A major learning experience taken from this session is that of experience. There were three significant moments in the session, the first at interaction [CL30] where the client achieved self-realisation about the way she had been behaving, the second was at interactions [C61, CL62] where the client acknowledges her participation in what she refers to as a ‘game’ in which she chooses whether or not to play, and the third is at interaction [CL91] where the client starts to question the relationship she has with her husband with regards to her issue of control. As a learning outcome, these moments were invaluable as they provided the trainee Counsellor with experiences not previously encountered.

The trainee Counsellor, in evaluating this counselling session, has already discussed and evaluated three of the conditions from the six necessary for therapeutic change: the trainee counsellor’s empathic understanding of the client’s world; congruence on the part of the trainee Counsellor and the trainee Counsellor’s UPR towards the client. The remaining three conditions, although not mentioned specifically have also been present during this session. The first, that two people are in psychological contact, is demonstrated throughout the session by the dialogue that the client and trainee Counsellor maintained, thus forming a meaningful relationship. The second condition is that the client is in an anxious or vulnerable state, in other words is in a state of incongruence and this condition is openly displayed by the client throughout the session and no more so that at interaction [CL8] where the client admits to being stuck and confused. The third and final of the remaining six conditions is:

“The communication to the client of the counsellor’s empathic understanding and unconditional positive regard is to a minimal degree achieved.”

(Merry, 2006, p.49)

The trainee Counsellor, in evaluating this session, has visibly exhibited his UPR [rating 4.5 – 5.0] and empathic understanding [rating 4.5] of the client’s inner world [C61, C86] and in doing so helped to facilitate a safe and constructive environment for the client.

This was a significant session for the client as the trainee Counsellor believes there has been a major movement along the seven stages of process and that the client at times during the session made the transition into stage 5. There was obviously some vacillation between stage four and five and the trainee Counsellor, although identifying the shift in the client [CL30, CL109] made no attempt to move them onto stage five, but rather left the client to find their own path, knowing that she would move forward when it was right for her to do so.

The trainee Counsellor was himself, the client was herself. There were no facades, no hidden agendas, just two people experiencing a deep understanding of each other. Rogers (2004), when talking about this kind of relationship, posits:

“…acceptance of each fluctuating aspect of this other person makes it for [him] a relationship of warmth and safety, and the safety of being liked and prized as a person seems a highly important element in a helping relationship.”

(Rogers, 2004, p.34)

The relational depth achieved by the client and trainee Counsellor is clearly evident throughout many parts of the session. A particularly powerful moment is at interaction [CL109] where the client questions her own values and the client’s body language and the timbre of her voice expose her feelings. Mearns & Thorne (2007) suggest that:

“At times such as these, understanding between client and counsellor exists at many levels, as does acceptance. The outcome is a profound sense of sharing.”

(Mearns & Thorne, 2007, p.191)