Counselling and Psychotherapy - Essay Example

Introduction Counselling is a of action, structured in a sequence of steps, that is intended to assist individuals cope (deal with or become accustomed to) better amid debilitating conditions they may be facing. Counselling and psychotherapy is exercised in a multiplicity of manners that are determined by the presenting problems of the clientele, theoretical point of reference of the therapist and other factors. Child counselling in a family setting (which will be constantly referred to in this case study) is the therapeutic and psychotherapeutic support offered to children and their parents in a bid to help them to attend to and triumph over developmental obstacles, psychological impediments and traumatic ordeals thereby endorsing buoyancy, augmenting self-insight and establishing self-belief. Long-term psychiatric repercussions of trauma in childhood The long-term repercussions of childhood trauma which can result from neglect and abuse affects the person’s interactive skills, psychological well being and bodily vigour and can be incapacitating years after the traumatic event. Persons who went through a traumatic ordeal in their childhood especially abuse and or abandonment, are at an elevated risk of developing multi personality disorders in the course of their life mostly those with depressive connotations such as Paranoid Personality Disorder (PPD) , Borderline Personality Disorder (BPD) and Schizoid Personality Disorder (SPD). As the child gets older, the consequential results of the trauma experienced can as a matter of fact, elevate and become more complicated to treat. Feerick and Snow (2005, p 410) stipulated that basing their argument on the study done by Raczek in 1992, persons who have experienced trauma in their childhood are more likely to develop personality disorders than those who didn’t. This was the same predicament that Khadija was going through. She suffered a great deal of trauma after her eczema and abandonment by her father and she constantly feels that because she is different, she has to do something to get the attention of her peers and points of authority as well. I feel that Nadia the counsellor did not do enough to counter with the feelings that Khadija was going through due to the simple reason that Nadia had been in the same predicament years back she should have used self disclosure and a certain degree of confrontation to tackle the case of racial difference that was facing both Khadija and her mother. Instead Nadia’s reaction to the situation had a sympathetic innuendo rather than empathetic and this to an extent clouded her professional capability for a while. When a child faces a traumatic experience, their response to the situation is always fight or flight. This is why such children display either of the extremes of self esteem. Arata et al, (2005) held that these children manifest a high propensity to display a lower self esteem that is lower than that of children their age, and are at an elevated risk of manifesting phobias and incapacitating anxiety. For example Khadija was always making statements claiming that that she was unattractive and that she loathed her body and regularly wanted to maintain close proximity to her mother due to her low self esteem and this all started after her eczema and her father’s departure when she was three. In handling this aspect of the case Nadia does exceptionally well, particularly because she lets Khadija channel her emotions and feelings about her parents through her drawings. Nadia is able to learn that though her Khadija’s dad hadn’t been always there for her she still held on to the good memories of him but her mother’s case, the feelings that she portrayed through her drawing weren’t very impressive. Another long-term psychiatric repercussion of childhood trauma is an incapacitation of their social functioning proficiencies. As they become of age, these youthful individuals seek artificial methods of coping with their malfunctioned social skills such as using cigarettes, alcohol and other types of drugs (Mulvihill, 2005, p. 120). This is perfectly displayed by Khadija’s mother Carol, who had been in the same predicament as her daughter and the repercussions of her traumatic experience in childhood led to a malfunction of her social skills a condition she decided to deal with by alcohol consumption and always staying on the phone to avoid facing the problems she had with her children. Other repercussions worth mentioning may include but aren’t limited to Post Traumatic Stress Disorder (PTSD), eating disorders, substance abuse, irrational fears, multiple personality disorders, panic disorders, petulant bowel disorder, arthritis, and autoimmune messes” and these repercussion were brought forward by (Mulvihill, 2005). Unfortunately Nadia the counsellor didn’t seem concerned to ask if these symptoms had manifested themselves in Khadija’s case. Process and how work has evolved over time A process is a methodical sequence of events or an incessant action, procedure, or sequence of changes happening in a distinct mode intended aching a specific objective. Counselling of clients also happens in a process, the counselling process can happen in a multiplicity of manners that are determined by the scope, problems of the client, theoretical inclination of the therapist among others. The principles that guide counselling for adults are similar only that more caution is taken when dealing with children as they are fragile and they may develop a dependency syndrome on the counsellor. When handling Carol’s and Khadija case, Nadia was bound by the counselling codes of ethics include primary responsibility; the counsellor respecting the patient’s dignity and making efforts to promote the welfare of her patients, avoiding harm and imposing values are paramount. Therefore treatment plan device by the counsellor and the patient should have the primary goal of bettering the life of the patient. Moreover the counsellor should under no circumstance adopt treatment plans that might harm the patient. Notwithstanding the counsellor should also make sure that their personal values don’t get in the way of handling the patient. He or she should always remember that counselling is aimed at helping patients develop problem solving skills thus patients should play the biggest part in coming up with treatment plans. Working within one’s limitations is crucial, thus referrals should always be made if the counsellor deems it necessary rather than abandoning the patient in essence twelve therapy interviews may not be enough for Khadija and her mother. Moreover Nadia and Jane were supposed to refer Carol and Khadija case if they found that their personal values were interfering with the handling of the case or if they were not able to provide the proper cognitive behavioural therapy (CBT) which would be handy in handling trauma and abandonment issues that the patients were both experiencing. The social, cultural and ethnic backgrounds of Khadija in treatment In previous research it has been established thus a number of factors that may influence the relationship between patient and the counsellor. Some of these factors may include: counsellor’s gender difference, (such as Adams, McNeil, & Dubsick, 2004; Haviland et al., 1983), sexual orientation (Kurdelak et al., 1989), bodily disability (e.g., Feldman et al., 2005), religious affiliations (such as Belaire & Young, 2000; Simon & Gerber, 1990) and ethnic distinctiveness (such as Atkinson, 1983; Atkinson et al., 1984). However, in the midst of all these, the factor that continues to paralyse most patient counsellor relationships is the ethnic distinctiveness or racial difference between the two parties. The subject matter of difference and cultural identity was strongly intrinsic all through Khadija’s case. Khadija and her mother, who were of mixed ethnicities, seemed to have a better affiliation to their English culture rather than any other. These conditions sparked complexities and conflicts related to growing up as dual ethnic children in both cases. To worsen Khadija’s case even further, the fathers side (African Caribbean) of her ethnic heritage had been recognized every time a negative facet of her life was realised. This was portrayed in her grandmother’s ethnic bigotry, her peer’s ethnic rejection and ultimately her father’s abandonment and rejection of her. The sad thing is that they were all happening simultaneously. For scores of individuals from racial and cultural minority groupings, bigotry and bias is part of life experiences. A study done in the UK (Virdee, 1995) accounted that the way these individuals lived was restrained by the fright of being ethnically discriminated. The last two decades have witnessed a an increase in the literature that tries to comprehend the previous circumstances and impacts of ethnic discrimination to individuals (Allison, 1998; Crocker et al., 1998; Ruggiero & Taylor, 1997; Schmitt et al., 2002; Sellers & Shelton, 2003). Exposure to bigotry and discrimination will severely impinge on the psychological health of its victims (Erikson, 1956) and this is exactly the case for Khadija. The problems that she was going through were cored to her feelings of difference in terms of her eczema and skin colour. There is a plethora aspects of Nadia life that are replicating themselves when working with Khadija and carol in the matrix. She could relate to Khadija because she as a child went under the same ordeal of discrimination on the basis of colour. She could also relate to carol because like carol, her marriage also defied the ethnic restrictions. These posed a great dilemma for Nadia regarding her own personal values; race, gender and personal history thus clouding her ethical decision making. As for the supervisor Jane, there was no one she could related within terms of ethnic background but she was bound by the professional code of ethics to remain objective while handling the case. Carol’s ethnic relationships with her parents and husband were the root cause of the family’s current predicament her ethnic husband abandoned them and her relationship with her mother was dysfunctional. Transference phenomena: its impact, meaning and potency in relation to professional practice. The meaning of transference changed time and time again. To Freud (1912/1933), transference transpires when a client places over unconscious youth fantasies about a guardian or parent on to a therapist. However, even Freud who is the proponent changed the definition a couple of times. Greenson (1965) stipulated that it is the familiarity of feelings, mind-sets, fantasies, and defence mechanisms in the direction of an individual in the present that are unsuitable to the individual and are a recurrence, a dislocation of responses starting off in regard to noteworthy people in their youthful days. Essentially, transference is important because it allows the patient’s problems to be experienced, rather than conversing about in a shallow way. Transference makes the patient’s problems more blatant so that the patient can labour through the emotions and feelings that are being promoted and eventually formulate new neural relations. Therefore transference was witnessed in Khadija’s case when she was drawing a picture of her father taking her and her brother to see a Fulham football match. The counsellor gets to know that Khadija still has a soft spot for her father even after abandoning her. In the transference it is also clear that she loves her brother but that isn’t the case with the mother. Exploration of the counsellor’s emotional responses to Khadija Empathy: this was mainly because Nadia herself went through the same ordeal as her client and this sometimes made her tread dangerously between the boundary of sympathy and empathy. This was realised when Nadia developed a sense of wanting to defend Khadija to a point where she even started questioning what the school was doing about Khadija’s case. Nadias thoughts were paralysed throughout the therapy though: She was able to put herself in the shoes of her patient particularly because she had once been in a similar predicament. Allowing silence: in multiple occasions during the sessions with Khadija, Nadia gave her ample time to process and carry on with her narration of events. This was aimed at letting her client contain the emotions that might have been triggered during her narration. Exploration: when Khadija was drawing picture of her family members Nadia wanted her to say why she didn’t include her in the picture she even went further to ask her to draw her mother. Seeking clarification for change of behaviour: on the second session with Khadija, Nadia noted that she was more enthused than the previous interview and she inquired to know why and Khadija informed her that it was because the previous interview was their first time but now she had gotten used to it. Praise: after Khadija finished drawing her picture Nadia complimented it saying that it was very good and very colourful.’ The compliment was meant to recognize Khadija’s talent and make her happy that she was good at something and indeed the intention was realized because Khadija became extremely happy and displayed a big smile. I personally think that Nadia should have also used appropriate self disclosure to help Khadija see that she is not the only one who has undergone the ordeal and to help her see that there is light at the end of the tunnel. If she saw that Nadia made it through the ordeal and became a fully functional individual it would have been easier for Khadija to deal with her discrimination problems. Role of supervision and the counsellor’s capacity to use the supervisory relationship during this case work Supervision in education programs is an important factor in student learning and experience. Coll and Eames (2000) stated that the function of the placement coordinator is supreme in endorsing greater involvement in and contentment with industrial based learning. The main objective of these programs is to link the theory-practice dynamic (Collier and McManus, 2005; Dumas, 2002). Many students aren’t aware that what they learn in class is of value (Morse 2006) and this is what necessitates these programs. Jane’s role was to assess Nadia’s ability to apply theoretical knowledge in the field work, follow her progress, offer guidance and assistance where she needed and to work with her in order to correct any mistakes they may make during their placements. This made their relationship vital for the progress of Nadia Learning outcomes What could Nadia do to improve her personal and professional competencies as a means to ensure Continued Professional Development (CPD)? She could go for personal therapy as it is a positive way in which a therapist can augment their comprehension of individual motivating factors that help or encumber progression as counsellors (Padesky, 1996).  So as to be able to control her personal values from interfering with her professional competence, she could start doing regular exercises and meditation, get enough sleep and rest, and learn how to counter her bias or irrational beliefs. These would also go an extra mile in helping her deal with burn-out. She could also increase her flexibility so as to improve her aptitude to work with multiple kinds of clients under inimitable conditions. Networking could also help Nadia progress professionally via learning and expanding industry connections that could help with matters like collaboration, referrals and supervision. Volunteering at charities would also be efficient in helping Nadia discover more about functioning in the counselling sector. 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