Counselling Case Study 1985

From my training journal of 1995. 

The approach I use with all my clients is Rogerian / person centred approach, where my clients congruency provides its own focus and momentum, and I accompany the client on that journey in the sessions. In the way I work, each session is complete, and I don’t refer to previous issues. The approach involves reflecting the current client’s feelings. This has been shown to increase emotional tolerance levels, and provide access for catharsis, reflecting thoughts and meanings which may provide insight, and having a nonjudgemental attitude - I may not always be accepting of what they do but I look at my own projections and deal with these in my own therapy and supervision sessions, and I try to remember that we are all in the process of becoming, and I value my clients bravery and potentials. By being congruent where I feel it is appropriate, I may state my thoughts and feelings, which allows the client to see the ‘real’ me and hence transferences are not so likely to occur. If a transference happens, it happens, and I do not interpret it or amplify it. If a client is unhappy with a session, if they tell me before they leave, I return their fee. 

 

This case study features a female client who came by recommendation from a lady I have been seeing for nine weeks in my home and had come to me by way of personal recommendation. My response was that she could give her friend my telephone number and that I would agree to see her for an initial interview to see if we were suitable for each other. The client rang me and I made an appointment. She arrived on time. My oppression was that she looked casual but appropriately dressed, her hair was groomed and she looked attractive was a little overweight for her height. She had a middle Eastern European accent, was intelligent and educated. I told her something about me and asked if I could drop down a few notes and that what she told me was strictly confidential. I should call her Maria. She is 46, married, when I asked how how this was for her, she said she couldn’t cope and that she had counselling in the past with her partner, but it hasn’t helped because he was not interested. I asked if she wanted something just for herself now and she responded affirmatively. I said that I detected that she had an accent and she described her close and large family in the Middle East, the death of both parents three years ago, her mother dying of cancer and a suspicion that her father killed himself by not taking his insulin soon after. Acknowledge this by saying this must be a very difficult time indeed for you and she described the problem that she has at present, that the eldest brothers wife wants some inheritance from the sale of her parents flat in her hometown, but another brother is a schizophrenic and needs to live in the house and that she doesn’t want him to lose his home she is the youngest so I said something along the lines of not only is she dealing with the loss of both parents but also difficult relationships within her close family. I asked if she had children and she has four children I will call Linda 13 Stephen 11 Brandon and Donald seven when I asked if she had any problems with the children, she said the children are really good children but that it was her, that she couldn’t cope. She has to work and permanently feels exhausted. She was shouting at the children at the weekend and her husband went over to the window and closed it saying the lady down the road doesn’t wanna hear you, and and the thought ran through my mind that her distress is not beingAnd that she may have to bury her bereavement and get on with the needs of the family but I thought it may sound judgement about her husband so I said something like so he made a joke but it’s not a joke is it she paused and I think she didn’t know what to say and went on to talk about the things that desperately need to be done in the house and that the toilet is broken and she is embarrassed when people come but they can’t afford to have everything done at the moment.

 And that she may have to bury her bereavement and get on with the needs of the family but I thought it may sound judge mental about her husband so I said something like so he made a joke but it’s not a joke is it she paused and I think she didn’t know what to say and went on to talk about the things that desperately need to be done in the house and that the toilet is broken and she is embarrassed when people come but they can’t afford to have everything done at the moment.

I asked about her job, she works as a relief science assistant I didn’t know what this was but she works in a school arranging things for the science classes. I asked if she enjoyed her work and she says that she enjoyed seeing people but that there are changes at the moment, and one woman is racist and because of this woman popular models from his popularity she also has influence, I respond to this makes you feel insecure? And she said she desperately needs a job. I responded “and this makes you feel insecure? And she said she desperately needs the job.

I asked if she had ever had any medical treatment in the past for any nervous conditions and she described tranquilisers and sleeping tablets over the years, but was not on medication at the moment. I asked why she has come for counselling now and she said that she’s very concerned about the children and the effect she is having on them. She also described that her face is very sensitive and all her skin is sore and that she feels rundown. I couldn’t totally grasp the problem about her face, it looked normal to me, but she described it in a complicated way and says she has she is on a special diet with no acidic foods now. I asked “how did all this begin?” and she said she didn’t know, and that she thought it was stress. I told her a bit about me that I held certificates in stress management, and that I was in my second year of training at the London Centre for Counselling & Therapy, that I have a supervisor. I explained I normally ask my clients if I can record the sessions and could make a copy available for her, and that my supervisor can see my progress, but she said that she didn’t want to be recorded. I told her my fee is £8 (which is what her friend is paying) and she agreed that this was okay and that our sessions would be 50 minutes. I suggested six sessions that could be extended if she found it helpful and she agreed to this and I asked her for a 24 hour cancellation notice. As there was nothing further she wanted to ask, we arranged another appointment for a week later. 

Because of the setting in which our counsel is my home, I’m aware we are not a neutral ground and this might inhibit my clients, as they can see my taste of furnishings and my personal effects. Transference is therefore less likely than in an analytical setting, though I was aware there may be transference from the previous counsellor, and that she may not be familiar with my PCA approach and what is offered by it.

 I sit about 3 feet away and I don’t touch clients which is my preference, but I could move to sit beside the  client as they sit on a settee but I have never done so. I provide tissues, a clock that they can see, and I unplug the telephone to minimise interruptions.

 I see my role as an empathic listener, to help clients to uncover and clarify their feelings, to help with insight in a non-interpretive way, to provide a place and space for them to express their thoughts, experiences, and grievances, to a person who will not judge them. I thought that Maria’s husbands comment that she was shouting at the children may state his need for privacy and that for Maria, I may be the person who acknowledges her needs. I did not thoroughly understand the problem of her skin that she referred to when asked why she came for counselling now, but it may have been her way of telling me that she feels sensitive and sore, and she thinks it’s obvious to those she meets. 

My concept of her was that she was quite a strong person, has a strong religious background, is conscious of her image, is caring and living in a country far from home, struggling with a job and four children in what may be an unsupportive marriage. There could be unresolved feelings about her parents death three years ago. 

I have been on a strictly Person Centred Course at the School for Independent Study so I try to be congruent, empathic and give unconditional positive regard. I felt as though I could do this with this client. Transference is not cultivated, and I try not to think interpretively.  My supervisor says there is no harm in looking at possible interpretations after the sessions. I try not to intellectualise with my own opinions, but remain within the clients frame of reference. 

Using PCA was a change for me from using techniques based on process cues as a counsellor which can be quite directive and confrontational. My own experience of analysis was Jungian before finding PCA so my counselling style was adapting and developing itself and is now naturally eclectic and intuitive in orientation. My supervisor and the CSCT course psycho dynamic in nature. My eclectic style does concern me as I would prefer more purist approach. I think the counselling sessions went well as she trusted me with personal information and was relaxed. I noticed avoidances to my contributions and a lot of feelings unexpressed as though she hides behind talking. Because I don’t have recordings and have only my notes made after the sessions, I may not have exact wording every time. I not included material that describes some serious aspects of her needs due to the confined length of the case study and I would have liked more space to present the matter more fully. Not all sessions are given.

Appointment 4 she was seeing a homeopath for her face. He put it on a special diet where she cannot eat certain foods, especially acidic fruit like oranges but can only eat bananas. She has given up seeing him due to the cost in order to see me but continues the diet. I made reference to her choice of a new way of looking at the situation now with me, that it sounds prohibitive and prescriptive. She said that she buys food for the family and buys biscuits that she hides in her room. My response was that she wanted something just for herself and she didn’t have to share.  She said she felt bad about herself. I said “if you want something just for yourself then you feel guilty”, and asked if this had parallels with her counselling sessions. She immediately described an incident that happened at Sainsbury’s, where she bought some packets of curcheese. I didn’t know what this was. She put all her goods on the trolley and there was one packet of left in the trolley after paying for the goods but she couldn’t be bothered to check whether she had paid for it or not. She said it was only about £2 at the most. She kept stressing that she couldn’t be bothered and I eventually repeated her words. I felt her sadness and just how tired she felt. I made reference to whether she stole the packet, and whether she felt that she was owed something. I knew about her difficult financial situation, and her parent’s financial asset that could be very useful to her at this time. I put together her situation, her feelings and how difficult life is for her. She left deep in thought but appreciated the session.