Description of a Cinical Case from the Practice of Counseling in Psychotherapy - Essay Example

Counseling Session for the Client Introduction Counselling and psychotherapy help individuals seeking help to conquer the mental issue(s)/problem(s)/concern(s). Relationship hitches, relationship break-up, anxiety, and many other possible causes may result to psychological problems. Psychology, interpreted as the study of human behaviour, deals with man’s developmental pattern of progress. Aspects of heredity and environmental influences determine the kind of person he eventually will become. In so far as psychology attempts to explain the personal aspects of development and adjustment, it can be regarded as the study of personality. To the layman, personality often means no more than as identifying description of a characteristics possessed by an associate that either attracts or repels. To some psychologists, an individual’s personality reflects the functioning in his behaviour of deeply hidden forces within himself that defy any attempts to discover or to identify. An individual of any age is faced with problems that have psychological implications. From early childhood through old age, everyone experiences situations involving one or more specific form of relationship. Her abilities, motives, and mode of thinking may be inadequate for success-achieving behaviour unless he is helped to gain a better understanding of all the factors inherent in the situation. The need to improve the process of counselling continues to take its shape. This process of therapy was proposes by Beck (1995). To do this, the broad story of the client as well as the explanation of the client’s issue/problem are established, which include elements to identify the information, chief complaint, history of present illness, psychological condition examinations, psychiatric history, medical background, personal and social history, and applicable diagnoses. Case write-up and audiotape will document the actual therapy session. The counsellor’s functions are to discover the basic principles of good adjustment and then to help people apply these principles in every phase of human relationships so that they become well-adjusted, constructive members of their various groups. A further responsibility of a counsellor is to recognize the overt symptoms of maladjustment, trace its causes, and utilize such methods as may seem appropriate to effect an improved adjustment. General History and Description In this case study, there are numerous client’s issues as reflected in this case study. These issues are holding her back to move forward. Just recently, a stable position of being the Head Nurse in the hospital has become available since the former one retired. Although she is highly recommended by other superiors, she has reservations about applying for the vacant position. “What if I failed?”, she often asked her best friend Patrice. No matter how Patrice comforted and encouraged her in their daily conversation to go ahead and take the plunge, Miss X believes she cannot apply since she does not want to upset herself nor her family if she will not be successful. Most often than not, she has reservations even on little decisions that she makes. She is afraid to try even if her family try to comfort her most of the time. “I am afraid of not succeeding after trying.”, “How many times will I tell you that I hate rejection.”, and many other issues. “Most of them in the workplace find me boring.” Statements such as this were given by Miss X during her conversations. These are also the common things she tells her Mom when she confronted her. Despite what happened to her premarital affair, her siblings and parents stay behind her for comfort and support. When asked about her reactions about these kind of acceptance and support she gets from her immediate family, she just shed tears and said that she realized how they stayed beside her but she is doubtful if they are sincere on what they say about her. It is hard for Miss Y to decide on things. She has a number of fears. She puts weight on what the others might think of her. She gives more importance on others than herself. When she speaks of her accomplishments, she just ended the conversation with so many questions about what she feels. She is even amaze of how she did those things. Based on her reactions on simple circumstances in her life, she manifests abnormalities in terms of behaviour towards simple decision-making in her career path. She takes things negatively even if it is an advantage or beneficial on her part. Miss Y lacks self-confidence and self-worth. She doesn’t expect others to like or respect her decisions. She is pessimistic and foresee things in and she thinks that other would go against her no matter how good is her intention. She is always in doubt of the little good things that other say about her. She is uncomfortable receiving praises and compliments from colleagues. Information She comes from an ordinary family of three siblings where she is the middle daughter of a father who is a mechanic and a mother who is a teacher. She grew up in a pleasant home and peaceful environment although she encountered the normal conflict of a typical teenager who had a premarital affair and a daughter, Nicole, out of wed-luck. Nicole is a normal and loving kid. She is very keen on comforting her mommy through her wits and candidness. She is a studious and diligent student also. That is why she was able to enter colleges with good grades and extracurricular activities that further hone her as a teenager. Miss Y met his husband, a Medical Representative, father of Nicole in the hospital. However, after several years, it ended with a ruined relationship. But despite this unfortunate situation, her parents openly accepted her fate. Her elder brother offered support to Miss Y and her daughter financially. Her youngest brother, although not financially advantaged, gives his love and moral support. He is always around for Miss Y. Miss Y rarely spent much time with her daughter during weekdays for she works hard to give her daughter good education and a bright future. Now, Nicole is in College staying in the Girls Dormitory where she visits her once a week to give her regular allowance. She also takes time paving visit to her mother in their ancestral house in their hometown. She does this voluntarily just after her father died. Miss Y is a graduate of Bachelor of Science in Nursing. She performs in school as an average student. Being a certified Nurse in a prestigious hospital in Chicago, she performs her job without complain although this has been her first job and the first institution that she serves. Miss Y is now thirty nine (39) years old and is a loyal person considering the fact that she has been working for the same hospital for twelve years. She does not get easily tired of doing the same thing. It seems that it matters not to her if she is holding the same position for several years. She does not get tired of being on the same hospital for more than a decade. Chief Complaint When the stable position of being the Head Nurse in the hospital has become available, she has reservations about applying for the vacant position, as she does not want to upset herself and her family if she is not successful. This illustrates that she has reservations on some things. She is afraid to try. She is afraid of not succeeding after trying. She hates rejection especially from her loved ones and workmates. She thinks that majority in the workplace find her boring. This is because she does not go out with them during free time. She faces her daily routines at home and in the office with a very low self-esteem. History of Present Complaint (Psychiatric / Personal / Social / Medical) She knows deep down that she can do the job as she stood in for the former Head Nurse many times when he has been on leave. Despite understanding that she has the capacity, something seems holding her back. She cannot easily decide on applying for the position. She cannot quite put his fingers on it. It is taking her sometime to come up with the decision. She thinks that all the people in the hospital see her as a bit boring. She associates being boring with never going out with colleagues for a walk or drink after work on a Friday. This is just in the mind. Actually, she does not know for certain that all the people in that hospital see her as a bit boring. This will be hard to know. Her reasons for not going out on a walk or drink are justifiable. She does not go because that is the day she visits her daughter in her Collage Dormitory. Likewise, she thinks that her daughter would never understand if she changed the day. She also feels that her daughter would pick on her even more than usual because of this. Maybe, it is possible that her rebellious daughter will not understand her decision of changing her visiting time or will have more reasons to pick on her. But there is also the possibility that her daughter will welcome the idea of her visiting in another day. She has not yet tried to change the day that she is to visit her. So, she would not know her actual reaction on the matter. It is possible that her feeling of her daughter picking on her is not valid. She would love to go out with his workmates on another night but fears that if she asks, they will say no. She has some fears of being rejected. She fears of getting negative response or reactions. However, there is no complete absoluteness that if she asks her workmates to go out they would decline. She cannot be certain that if she approaches her workmates, they would give negative response or reactions. She has never tried, so how can she be certain? She would love the new job because then her mother would see her as more successful besides being nagged on some matters! Likewise, she thinks that maybe, if she gets to be a Head Nurse, her mother gives her more respect. Miss Y has pre-conceived notion on a number of things. She thinks that if she does one thing, it will lead to that pre-conceived notion. She has a sort of boyfriend now whom she would like to marry but feels that she does not have much attention to offer him at present. Anyway, she would not say yes to the proposal for marriage by her boyfriend because she thinks she is not worthy as her daughter’s biological father would often tell her! The feeling that she does not have much to offer has no solid basis. Even if it is possible that the same instance happened in the past does not guarantee that what happened in the past would happen again. It cannot be said for certain that she does not have much to offer at present. It is for her boyfriend to assess. Her boyfriend has not said anything about her inadequacy to be his lifetime partner. There is no certainty as to what will be the response of her boyfriend since there was never an instance that Miss Y disappoints him in any case maybe. This is indicated to the question? “Have you ever disappointed your boyfriend?” Miss Y replied, “No”. She comes across a gentle man who is very aware of the feelings of others. But still, she is afraid of what her boyfriend, her mother, her daughter or others might think of her. She, too, is aware of the feelings of others. Being aware of the feelings of others is a positive attitude. However, being cautious of the feelings of others should not come to the point of being afraid of what the other people might think. Mental Status Observations/Applicable Diagnoses The use of nondirective interview will be done to Miss Y to widen the counsellor’s perception of the client. Then diagnosis will be conducted taking into consideration the appropriate clients counselling strategy. Self-Appraising Strategy will be used to give treatment to Miss Y. This strategy can serve as an important means of support in order to help the client. It is imperative to use the strategy(ies) appropriately. Professional and ethical conduct demands that the strategies be explained to the clients. To treat a client, there is a need to first diagnose her. Based on the issues enumerated above, there are several other issues that need to be addressed. The client has difficulty in sustaining her decision to apply for the vacant position because she is afraid of not getting accepted. We should ascertain first the client’s own hidden agenda. After identifying her Hidden Agenda, help her to recognize them, accept and work through them. Looking at the different problems mentioned above, list the possible Hidden Agenda behind these problems: Problem Hidden Agenda Miss Y has reservations on applying for the available position of being the Head Nurse. Miss Y does not want to upset herself and others if she does not get successful in landing the job. Something seems holding Miss Y back. Miss Y is afraid of rejection. Miss Y cannot quite put her finger on applying for the Head Nurse position. Miss Y has a fear or sets of fears. Miss Y thinks that all the people in the office see her as a bit boring. She feels inadequate, such as not being able to go with her workmates for a walk or drink after work on a Friday. Her mother would never understand if she changed the day she visits his mother in her residence Miss Y fears of not being understood. Her rebellious daughter out of wed luck would pick on her even more than usual if she changed the day she visits her. Miss Y fears of being picked on even more than usual. She would love to go out with her workmates on another night but fears that if she asks, they will say no. Miss Y fears rejection. She would love being a Head Nurse because then her mother would see her as more successful rather than being an unwed mother. Miss Y long for recognition. She would love being the Head Nurse because then her rude daughter may give her more respect. Miss Y long for respect. She would like to marry her boyfriend but feels she will not be a good wife, not having much to offer him. Miss Y feels inadequate. Miss Y feels that her boyfriend might say she is not worthy to be a lifetime partner. Miss Y fears rejection. Miss Y comes across as a gentle man who is very aware of the feelings of others, but Miss Y is still afraid that her boyfriend might think negative of her. Miss Y is anxious that other persons may have negative perception(s) of her. After identification of the client’s Hidden Agenda, we can now gauge if or if not the client is aware of these Hidden Agenda. The Nondirective Counselling can be used to provide permissive and acceptant counselling climate by the counsellor. There should have free expression of opinions, feelings, and attitudes by Miss Y. The counsellor should refrain from criticism, censure or direction, whatever may be the attitudes expressed by the client. Whoever acts as counsellor should consider that the counselee is capable of making his own decisions if she is given the opportunity of expressing her most subjective and negative feeling to someone. There should have minimum of talking on the part of the counsellor and perhaps sometimes an almost total absence of comment. Each of the foregoing problem-arousing relationships represents many influencing factors. It is the function of the counsellor to assist her to analyze these factors, recognize their relative significance, and pattern her behaviour in such a way as to solve the problem satisfactorily. If Miss Y is aware of these agenda, she will acknowledge them. After acknowledging, some questions about her situation will be asked to gather more information. Then gently and tactically ask what she is getting out of these. Specifically, Miss Y will be asked in a mild manner what she is getting from avoiding to upset herself or others if she is not successful, being afraid of rejection, having a fear or sets of fears, feeling inadequate, not being understood, being picked on even more than usual, fearing rejection, longing for recognition, longing for respect, being afraid of what other people might think of her. In order to turn out this process to success, good rapport will be built with the client. Miss Y may become resistant to the idea of having a Hidden Agenda and taking responsibility for it. Hence, there is a need to make her at ease. The probing and diagnosis will be carefully conducted to gather significant amount of information. Miss Y will be assisted to undergo the process slowly. This will prove to be efficient in the end. If Miss Y is not aware of her Hidden Agenda, more effort will be exerted to be gentler. Miss Y will be assisted to realize what the counsellor is doing to prevent therapeutic process. In order to eliminate this hindrance to development, the counsellor will ensure the client that the effects of the Hidden Agenda in action are in some way decreased so that they become less important than the main goal that Miss Y came for help with. The utilization of Projective Techniques may evaluate an individual’s total personality pattern rather than to discover the degree of possession of isolated traits. The counselee should be encouraged to express her feelings freely either verbally or in action. One approach fitted for Miss Y is the Thematic Apperception Test using twenty cards. Each of the 19th cards contains a picture and the twentieth is blank. She is expected to tell a story suggested by the picture at which she is looking. When she is given the blank card, she will be given a chance to imagine the picture she wants on it, describe and tell something about it. This technique will discover her dominant behaviour, drives and conflicts. A required outcome in the mind of Miss Y will be created. This will employ the power of the thought that is identified by the imagination. He counsellor will intentionally employ this to effect change. Psychologists agreed that the thoughts that our imagination focuses on become action. Hatred brought about by unpleasant past experiences will be dealt with and resolved. These hidden feelings of rejection and wounded child in her will finally be replaced with forgiveness and acceptance in due time. If Miss Y continues to think that she will be rejected, misunderstood, picked on even more than usual, upset herself or others if she is not successful, unrecognized, disrespected, think of or regarded negatively, then there is a big possibility that personality maladjustment will happen. The counsellor will address one issue at a time. There is a need to focus on one issue at a time so that Miss Y will be able to accept the idea and action will follow. The primary concern of the counsellor is human adjustment. Miss Y will be stimulated to action by forces within or outside herself. She experiences needs, wants, or interests, and seeks ways of fulfilling them. People and objects in her environment become motivators of the kind of behaviour which she exhibits. A person’s entire life consists of series of responses that are either satisfying or unsatisfying to herself and that earn either approval or disapproval from her associates or family members. In other words, as a person constantly is engaging in the process of adopting herself or adjusting to inner strivings or outer demands. It is important that the counsellor establishes rapport first in order to build positive relationships with Miss Y. It will be made clear to Miss Y that the outcomes that the counsellor wants to get. Miss Y has to be informed of these desired outcomes. It is essential that Miss Y understands. There is a need to solicit her approval on the desired outcomes. The processes that will be employed to her should be approved by her also. Once Miss Y has been paced successfully, then the counsellor can lead her to where the counsellor wants her. The counsellor’s aim is for the client to go on a different train of thought or concept that is beneficial to her situation. Conclusion Miss Y has symptoms of emotional and behavioural personality abnormalities. She is suffering from lack of self-esteem. It is possible that during her childhood, she was not supported emotionally by her parents or other people in authority. This case can be analysed and resolved through psychotherapy. There are a lot of things that Miss Y keeps to herself. Based on the videotape taken during the process of interview and gathering of information though her response and reactions in the Thematic Apperception Test, she possesses a low frustration tolerance compared to the responses of other persons who were given the same tests. These patients/clients manifested different responses and reactions. Each person has his/her own level of tolerance towards frustration and Miss Y has a very low level compared to others. The fact that Miss Y decided to attend the counselling and psychotherapy implies that Miss Y is actually identifying that she feels that she is suffering from an imbalance of thought. That is, she is seeking psychotherapy to change the thought process and acceptance of beneficial thoughts as valid and reliable. She has the positive attitude to change for the better and that is a good start to expect a positive response on her part. In this case, Miss Y is going to have to overcome her fears, anxieties and others. Then how she will deal with the issues will be tackled with this client. She has to overcome all these. Miss Y has to accept responsibility for maintaining the activities that support a Hidden Agenda. If she is not willing or ready to do this then there will be difficulty in achieving her goal(s). The client knows best. The client knows what hurts and where the pain lies and it is the client who, in the final analysis, will discover the way forward. The task of the counselor is to be a companion who can relate to the client in such a way that he or she can access his/her own wisdom and recover self-direction. References Beck, J. S. 1995. Cognitive Therapy. New York: The Guilford Press. Read More