Psychology: A Person-Centred Counselling Case - Coursework Example

On initial contact Kelly seemed very nervous; she avoided eye contact and spoke very quietly. Kelly was dressed casually. She was of medium height with a large build and long brown hair. She wore a little makeup and had glasses on. Her voice was soft and she struggled to make eye contact. She appeared very shy and friendly but lacking in confidence. I thought this because of the lack of eye contact and her nervousness which presented in her keep pushing her glasses back on her nose and her wringing her hands as If she were trying to comfort herself. Her body language was closed and she had her arms crossed over her chest. At this moment, I thought that Kelly needed to be heard and accepted as she presented as being not comfortable to be there and nervous as to what to expect. I felt it was important to offer her Rogers core conditions of unconditional positive regard, congruence and empathy, as I wanted to her to feel comfortable and safe to explore her reason for being there, and also allow herself to be heard. Kelly made it very clear that she felt her main reason for coming to counselling was due to the death of her son, just over 6 months ago when he was stillborn. She was able to explore with me some of her feelings around the loss of her son explained that she was holding a lot of guilt as to whether she could have done something different and the impact it was having on her other child. I assessed Kelly as needing to fulfil a role in life and how she had to be excellent at this and being good enough was not enough for her and I had the feeling that she possibly had a driver of Be Perfect as she appeared to want to be the perfect parent and wife and the death of her son had rocked that because in her world, she had been unable to keep him safe.. When I asked Kelly why she had requested counselling now, she explained that she knew she had to move on and didn’t feel able to do this without being able to talk about her thoughts and feelings with someone who wasn’t going to judge her. I thought that this was very insightful as it showed a level of maturity in what she was experiencing.We talked about the various boundaries in our work, including time keeping and arrangements for absenteeism. These included a twenty four hour notice of a cancelled session by either her or me. We agreed that if she was late by more than 15 minutes the session would be cancelled and I explained the issue of confidentiality and outlined the possible breaches. Kelly attended eight sessions and her time keeping was good, however her attendance was sporadic as she was moving house at the time of our sessions and she DNA’s once. Kelly shared with me the lead up to the birth, her excitement and joy at becoming a mother again. All was well when she went into labour and when she went to the hospital, she was told baby was fine and to come back again when contractions were closer together. When she returned to the hospital 5 hours later, the baby had died. I was very aware that when she was describing hearing this news that she her speech slowed right down and I could see that it was physically painful to share as she clutched her hand to her chest. When I reflected this to her, I was aware that she glossed over this and removed her hand. At this moment in time, I was very aware of my own internal reaction of shock and what this must have been like to receive this news and I found myself feeling very sad and tearful. At this point I showed real empathy towards Kelly as I shared how difficult that must have been for her and how sad it made me feel and it was at this point, that I felt we first connected as she lifted her head to make eye contact and let out a tiny half smile. As I made my notes after the first session, I considered where she was in terms of Roger’s Seven Stages. She was somewhere in-between stage 2 and stage 3. She seemed slightly reluctant about talking about of something’s. There was a look of hesitation on her face and she would often wrinkle her eye brows as if she wanted to look confidant in what she was doing or saying. However, I became aware of the fact that even though Kelly was quite aware of her need to overcome the tragedy she was unable to do so by herself which was having a negative impact on her mind since she was already holding herself responsible for the stillbirth and now she was feeling more ashamed that she was unable to take care of her young daughter as well. I felt there a need to understand her parental side as well. I assumed she was a very loving person because every time she talked of not being able to take care of her “darling” her “pumpkin” and the sudden change of expression between love, pity and shame. Subsequently, we discussed her relation with her own parents. She spoke normally at first just giving me the details that they lived in Kent and were divorced. On being asked to ponder over the relationship she had with her parents I could not help but notice a slight hesitation when she said that seldom had contact with her mother but a slight sporadic contact with her father. I derived that her mother’s withdrawal from Kelly’s life could have made Kelly a loving mother who wanted to be a “perfect” mother, a “perfect” wife and live a perfect life, perhaps something that she did not get as a child. Kelly wanted to “be there” for her children which were reflection of what she herself needed for sometime as well. Her parental care was a result of her belief that parents were responsible for the joy or the sorrow in their child’s life and this was something that was having a impact on how she was feeling about the stillbirth i.e. she was blaming herself for it, often saying that she “went wrong somewhere” and “I get to live on not him”. DEVELOPING AND BUILDING A RELATIONSHIP In the next sessions, I wanted Kelly to go back and think about the “dark days”. She was horrified at first and was rather afraid to do so which clearly showed that it was hurtful but she softly agreed to it because there were feelings that I knew she had suppressed when her dead child lay cold beside her, feelings that she did not even share with her husband or friends. She showed trusts in me and perhaps knew that this time thinking about the loss would somehow hurt her less. We decided that more than 1 session would be needed to revisit and overcome the tragedy time. Kelly’s face reflected someone’s who was brave and wanted to move on but did not know how. She was soft spoken and often hesitant to speak about things but with a little assurance and understanding Kelly was able to hold on to her strength and talk about the “dark times” that she was so afraid of. We talked about how she had stopped going to her daughter’s crèche where everybody would be asking her about her second baby and showing pity. She was afraid to face the questions and the looks on their faces. She had begun to make herself busy with work so that she would not have to drop or pick-up her daughter from the crèche. She talked about her elder sister and from her words it was evident that she loved her. Kelly’s elder sister was her pillar of strength in a way and has always helped her. I recalled that some young children used their siblings as a secure base in stressful situations (Whiteman et al, 2011). Next she talked about her family and friends who were very close to her. Kelly was a jovial and friendly in nature but since the past 6months she engrossed herself in her work and was reluctant to face her family and friends. Here again, I noticed that she had that belief of having to be a perfect mother and that the death of her son was somewhere her responsibility. We next discussed her marriage. Her husband supported her but Kelly had been trying to avoid her husband for example she would come late for dinner, go early for work or even sleep on the couch. She was afraid to talk for stretched hours with him because she felt so guilty that she had “done that to him.” We discussed her relationship with the daughter she loved so much and as soon as she talked about her daughter tears filled her eyes and a look of helplessness which showed she wanted to be there for her but something was holding her back. Her daughter was three and had not even learnt her alphabets but she knew that her “brother was in heaven”. Kelly felt responsible for introducing something as harsh as “death” to her daughter so early in life. Personally, Kelly had not seen much death in her own lifetime so far. Her parents and relatives were old but and so she had never had to attend the funeral of a loved one. She cried that it was because of her that her daughter had seen the fact of life when she did not even know how to spell “death”. In supervision, we noticed how Kelly was feeling guilty and ashamed and that, my acceptance and unbiased understanding and assurance was helping her imbibe the fact. It was at this point that we highlighted the fact that she was depending on me and that we have developed an understanding which would help her overcome her drawbacks of the moment and move on. BUILDING ON THE RELATIONSHIP DEVELOPED AND DEEPING UNDERSTANDING Having accumulated information and gotten to know Kelly much better it was time to think about the theoretical frameworks from where I obtain sound knowledge and understanding about Kelly’s case as well. I noticed that if Kubler-Ross’s model could be stretched to Kelly’s grieving circumstance which is an extreme case, she would be on stage 4 of the cycle where she is depressed. She has crossed the first few stages. Kubler-Ross (1969) stated that grief cycle had 5 stages where “depression” was the fourth stage. Kelly had accepted the fact that her son was dead and she unable to lead on a happy life without him in it. She somehow felt guilty that she had done absolutely nothing to save his precious life. I had often wondered why Kelly has always been blaming herself for everything that happened to her children –the still birth and not being a good mother to her daughter. Bowlby’s Attachment theory states that primary caregivers help a child to grow and develop positive interaction capabilities with others. This primarily happens around the age 3-7 years. However, it seems Kelly had been detached from her own mother at an early age owing to which her capability of developing the “internal working model” had been hampered the result s of which resurfaced after the stillbirth of her son since a person’s interaction with others around her is guided by expectations, incidents and memories laid in the internal working model (Bretherton & Munholland,1999,p89). The attachment theory of Bowlby’s also has implications that Kelly has become attached to her foetus and that the death had shocked her and shook her life (Bowlby, 1969).The stillbirth annihilated all dreams and expectations that Kelly has had. The overall pattern of response that Kelly has been showing over her child’s death was rational and the pattern is different from the grieving process seen when one loses a spouse (Klaus & Kennel,1976).One thing that had struck me most was when she had explained how in the winter days, when it had been snowing heavily outside while her son lay cold, she tried to make him warmer as if the news of his death had not sunk in or she had hope of some kind of miracle to occur. Having carried the child for the entire gestational period she had had developed an attachment to him. RECOLLECTION OF THE TRAGEDY We used sessions four, five, six and part of seven to explore the deeper feelings that Kelly was experiencing at the time. During the sessions I could not help but notice that Kelly looked less hesitant and her words were clearer. She looked into my eyes as she spoke. She told me that she knew I understood her and she felt reassured during the sessions. I asked her if she was ready to re-live the moments that have so long inflicted nothing but pain and guilt and she went ahead saying that she wanted to accept and come into terms with her loss and she wanted to be able to be there for her daughter. Kelly, started with her pregnancy days, the fact when she was happy and everything around her seemed perfect. Her friends and relatives were excited about her second pregnancy. Kelly recalled how she read out poems to her the baby in her womb and how her daughter kissed “mommy’s big tummy” with love. During the later stages her husband had bought a small cradle for the baby and filled the top shelf in the hall with new toys for the baby. Her expression changed drastically from a smile to that of horror. She gave birth to a stillborn-her son. She was being unable to accept the fact that the life she had been carrying for so long, nurturing it and being attached to it was no more. Pollock et al (1999) had shown an established relation between a mother and her unborn child. It is at this stage she visualizes her child and forms a deep bond with the baby. At first she was unable to accept it she tried to warm her cold sun when it snowed outside. Soon enough her family and friends started calling in with condolences and she was devastated. I asked her to tell me how she felt and she said she felt “everything”. She felt “angry” at God, at herself and at everyone around her, she wanted to go somewhere where she would not have to face anyone. She felt “guilty “when she looked at the cradle and the toys that her husband has so lovingly placed. She felt “afraid”, she would also harm her daughter in some way .Her expression showed each of these emotions as she re-visited them with me. She told me she would often feel that her husband would have an extra marital affair after this-after giving birth to a dead son, after failing to cope up etc. Even though she found no connection of her thoughts she was happy that she could finally tell me all of this. She cried out loud after this, holding my hand really tightly at first. She spoke in sobs that she wanted to save her child but she could do nothing. She wanted to overcome the grief but she was being unable to let go of the dreams she had seen with her son in them. She wanted to give nothing but happiness to her daughter and wanted to protect her from every negative feeling there was. As she sobbed and spoke her grip on my hand loosened and finally her sobs became sporadic and her tone sobered up eventually. I believe behind the close doors’ of the counselling room, Kelly was able to expose her real self to me. I saw that she was able to trust in me and find confidence in me when she revealed her darkest “fears” of her husband leaving her or her spoiling her daughter’s life in some way to me.I had chances of reassuring her with words or just touch of hand to let her know that I am there and that I understand her. In a way I knew that birth of babies and still births does increase the chances of breakups or divorces (Frain et al,1990) however I did not reflect this. In supervision we talked about guilt and attachment. She was attached to her son no wonder having spent so much time preparing for his welcome into the world. She told me that she knew she had nothing to do when it came to the tragedy yet somewhere she was guilty that she was getting to live while her son was no more. We discussed her “anxiety” about her relation with her husband. He loved her and loved a perfect family. She was afraid that she was not a “good wife” and that he would eventually lose interest or love her less and she would be divorced just like her own parents had been.This again opened her up to more fears of her daughter having to grow up with divorced parents. In Attachment terms, she was at present anxiously attached to her daughter since she knew she had introduced a harsh reality to her daughter at such small age and somewhere Kelly was afraid that she would somehow harm her daughter in some way or the other. It was as if she was responsible for all the things that have happened around her. I told her I would stay along her side and would always be there for her emotionally and that she could tell me anything she wanted to without slight hesitation. REFLECTION OF THE PROCESS AND PREPARATION FOR A BEGINNING The sessions had almost come to an end and my relation with Kelly was deep. Her eyes reflected her trust and assurance. Our relationship has offered her to come in terms with her loss and accept that there is nothing she could have done but there are things that now needed to be done. I was most astounded with her registering for counselling which showed that she knew of her problem and just needed guidance. This is in fact very helpful in counselling when the person himself/herself is aware of the fact that he/she needs some guidance and understanding to overcome certain issues in life. Kelly has been a diligent and cooperating person. She was in fact really helpful and I knew she wanted me to help her. Talking about herself problems, feelings and experiences it seemed Kelly had finally overcome the tragedy. I asked her what she expected from her on and she replied that she wanted to help her daughter become a strong and brave person. We also discussed whether or not she wanted a baby. I recalled that “ a large proportion of women who had had a still birth were later insistent on having no more children” (Bowlby,2008,p122). However to my amazement, Kelly said that she knew she was young and she was open to the idea of having a baby in the future and living the dream that she had seen. She said she knew the importance of having a sibling and she wanted her daughter to have one as well. In summary I can say that post-counselling Kelly has been able to accept her problems really well and has been able to open up. She knows that she needs to move on and help her family and friends move on as well. She understands that she has the power to “make everything better” from now on. As I made my ending notes I see that Kelly has made remarkable improvement. She was on stage 5 of Rogers Seven stages which were good. She trusted herself and was being able to make certain life changing decisions as well. As we parted she had a sense of satisfaction on her face and I was happy that the sessions had given her what she was looking for-guidance to peace. I felt her pain and her sorrow but I also knew she was a brave person herself and she had once again found herself. REFRENCES Bowlby,E.J.M (1969). Attachment. Attachment and Loss. . london: hogart. p10-25. Bowlby,E.J.M (2008). Loss - Sadness and Depression: Attachment and Loss. 3rd ed. london: random House. p122-130. Bretherton,I & Munholland,K.A (1999). nternal working models in attachment relationships: A construct revisited. new york: Guildford Press. 89-111. Frain et al. (1990). The Psychological Effects of a Stillbirth on Surviving Family Members. OMEGA--Journal of Death and Dying. 22 (2), 81 - 108. Kubler-Ross,E (1969). on death and dying. london: scribner. Klaus & Kennel. (1976). human critical period immediately after birth.Ethological Perspective. 1 (2), 1-10. Pollock et al. (1999). Maternal antenatal attachment style and potential fetal abuse. Child Abuse & Neglect. 23 (12), 1345–1357. whiteman et al. (2011). Theoretical Perspectives on Sibling Relationships. J Fam Theory Rev. 3 (2), 124–139. Read More