Counselling Supervision - Case Study Example

Running Head: COUNSELLING SUPERVISION Counselling Supervision [ Writer’s Name] [ Institution’s Name] Counselling Supervision Introduction This piece of writing is a critical review of my counselling experience with Sandra is a seventeen-year-old lady , Sally is an attractive, witty, very intelligent 23 year old and was Tim Harris is a seventeen-year-old Caucasian with a history of alcohol and cannabis use. I will give a clear overview of my personal experience as well as my supervisors experience by describing my counselling sessions. I will also point out my weaknesses and strengths. From the analysis of my session I will give an overview of what I learnt and how it coincides with my courses. The counselling sessions were held at the local Chinese association in Singapore the goals of this association is to the development of psychology as a science and as a profession in Singapore Personal experience I had had just started practising I did not have a huge clientele , however I had two patients Sandra is a seventeen-year-old lady , Sally is an attractive, witty, very intelligent 23 year old and was Tim Harris is a seventeen-year-old Caucasian with a history of alcohol and cannabis us Meaningful experience: My most meaningful experience was Tim Harris is a seventeen-year-old Caucasian with a history of alcohol and cannabis use. His probation officer is referring him to treatment because he was carrying a razor blade at his high school and he was suspected of homicidal ideation It was the most meaningful experience because he needed exteme supportive therapy and this made me realize that he had trust on me . What made it more meaningful was that the combination of therapies I used helped to cure Tim and bring him back to life. supportive counselling helped to ease the pain, anger, and assisted to address the feelings of hopelessness that Tim felt. Secondarily, cognitive therapy was used to change the pessimistic ideas, unrealistic expectations, and overly critical self-evaluations that create the depression and sustain it (Kevin etal 2003). Cognitive therapy can help a depressed person recognize which life problems are critical, and which are minor (Sharon 2003). It also can teach them how to learn to accept the life problems that cannot be changed (Sharf 2007). In addition, problem-solving therapy was utilized to help change the areas of the Tim's life that were creating significant stress, and contributing to the depression the most difficult experience My most difficult experience was the case of Sandra is a seventeen-year-old lady and she came to counselling because she was suffering from panic attack and depression. Sandra feels that she is going through depression and panic attack this scares her and was tiring her best to be free from all this. Sandra felt very restless. She had visited a general physician numerous times. she started going to the physician after she gave birth to lovely baby in June. She exhibits symptoms of depression , however antidepressants are useless for her including fluoxetine and citalopram, and these were given to her by the physician . She did not go anywhere , she stayed behind closed door and kept no contact with her school friends. Sandra’ baby’s father is 30 years old , but he is very supportive. The age difference is quite obvious. It was her patient who sent her to a therapist for treating her panic disorders. . what made the case more complicated was that Sandra's parents had a divorce when she was very small .because of this he never got to know who her father was , he live with her grandparents . However Sandra I good friends with her mother, she shares al her secrets with her. Sandra’s grand mother was against the idea of her getting pregnant and living with a 30 year old the case confused me so much that I forgot to ask her if her grandmother didn’t like the idea of her living with a Indian man or was it because she thought Sandra had a whole life ahead of her . Both Sandra and her partner have no self income there are of support income. Her depression increased after she gave birth to her baby. Another thing which made the case difficult for me was that Sandra wanted baby but she described her life as being a mess. The fact that she wanted baby and afterwards feeling depressed made the case difficult . She said when she found out she was pregnant she was counting the days to her delivery , but her postnatal depression had turned into panic attacks after the birth of the baby. It was even more difficult because the client was not indifferent to her own condition. She felt frightened, she thought it would affect her social life and impair her daily functioning. What was more difficult was giving her hope that she would be fine without going through surgery. Her mother had to as she also went through panic attacks. I was confuse as to which therapy to give her so I started of with person-centred listening and acknowledging I would ask her question or two in the middle I also discussed something with her . I told her that it was normal that she felt depressed after having a baby , but then the biggest blunder of all the sessions ended in vain I could not find out exactly why she was going through these panic attacks It was the most difficult experience which I went through during the counselling of this patient was when I attempted to investigate the past history of the panic attacks however Sandra was not successful in finding out why it started. This made me feel like complete failure I felt I had let the client down. As I was using the client centred therapy I faced a lot of difficulties like that it led to the dependence between client and counsellor. There is a greater chance of developing a relationship that is too comfortable. I as therapist utilizing this theory I would have a greater chance of crossing ethical boundaries with their clients. This led the client to ignore a lot of different aspects which my have led to the reason behind her panic attacks. Apart from this I was forcing on the conscious rather than unconscious thoughts as it was a requirement of the therapeutic method I was using. I should have realized that some time panic attacks have deep rooted reasons behind it which are usually buried in a Person’s unconscious (Gladding 2006). This was the main reason why I faced difficulty in finding out the root cause of the client’s attacks. What I should have done differently As mentioned above I may have use the wrong counselling therapy as Sandra was not able to pin down a situation that might be causing her onset of panic attacks. Apart from this I should have asked the client if her Grandmum objected to her pregnancy because of her involvement with an Asian man or before she (Sandra) was rather too young to start a family. This may have helped me in financing out is lack in family support had led her to be depressed The only reason why person centred therapy was used because The techniques of the theory are those of a 'real-life' relationship (Dryden & Sarah 2003). Client and therapist are 'real' towards each other and foster a trust between them (Trotzer 2006). Listening, acceptance, and empathy are all important aspects of this theory as well as any relationship. The assessment associated with this theory seems pretty typical and necessary to provide a background and basis for therapy (Trickett 1996). But person centred therapy can not help those suffer from panic attack as they need a complete change in behaviour, thus I realized I should have used Cognitive behavioural therapy (Sugarman & Addie 1996). Further I realized that since, personal reactions, thoughts, and expectations play a significant role in the etiology and maintenance of many mental health and sociological problems, these cannot be addressed by pure behavior therapy, but with the Cognitive Behavior Therapy (CBT) model evolved by Clark, Beck, & Alford (1999) (Dryden&. Feltham 1992). The main goal of CBT is to help individuals and families cope with their problems by changing their maladaptive thinking and behavior patterns and improve their moods (Blackburn et al, 1981). Intervention is driven by working hypotheses (formulations) developed jointly by patient, his/her family and therapist from the assessment information (Feltham 1999). Change is brought about by a variety of possible interventions, including the practice of new behaviors, analysis of faulty thinking patterns, and learning more adaptive and rational self-talk skills. (Hawton, Salkovskis, Kirk, and Clark, 1989). A probable reason why CBT works with depressed patients is that depression interacts with both cognitive and motivational processes (Feltham 1997). This is well evidenced in experimental analogue research with healthy and depressed individuals. Individuals with depression show deficits on a range of cognitive tests (Brown, Scott, Bench, 1994) with the pattern of dysfunction having many of the characteristics associated with fronto-subcortical impairment (Harold etal 2004). Reischies and Neu (2000) found that depressed individuals displayed mild cognitive impairments in comparison with matched controls, particularly in the areas of "adverbial" memory, psychomotor speed and verbal fluency. Further in these patients there appears to be considerable variation in the recovery of cognitive function with remission of the depressive episode (Patri 2007). Supervisor’s Experience The Most Difficult Case In my entire experience for me the most difficult case was the of Sally. she is an good-looking, humorous, very intellectual 23 year old lady, what made the case difficult for me was that her father physically abused, and went through a lot of severe physical fights among her parents then they divorced when she was only eight years old 8. The intensity of the emotion hidden in the client made the case a confusing one as sally at present extremely depressed. She looks for something which may separate from her surroundings, something to lessen the pain. Patients like this are always difficult to handle. , something which make her presence felt to the people around her. Her complicated feeling mad eth case more difficult as she felt She felt as if something was missing in her life , perhaps it’s a void which she felt could not be filled in any way. Her feeling of her childhood seem to be eating way on her , her past would not let her express her true feeling thus making this patient quite difficult to handle. She often feels very depressed, even suicidal, for reasons that she does not understand, and just hours later she will have severe outbursts of anger, sometimes very violent. Once when sally’s anger was at it’s hight she picked up a crystal centre plate and threw at her sister . She needed 5 stitches. What made the case even more difficult was that I had no support from the family as Even though her mother had been very controlling and disapproved of her involvement with boys and even many of her friends ,sally became very promiscuous. This began around the age of 17. It is very rare that sally is not in some sort of relationship with a man. She fears being alone. She makes sure that she has complete control over just about every relationship, first initiating them, and then ending them, not long after they begin. She loves, and gets some sort of a high, when her partners seemed puzzled, or even extremely upset, when she ends the relationships that she so willingly started. She enjoys being close to someone physically. She needs this. But she dreads being too emotionally involved. She immediately ends a relationship, once she begins to feel anything for the person. Sally recalls, or rather doesn't recall finding any of her promiscuous behaviour sexually satisfying, and that she actually feels safer using sex to "equalize" a relationship. Apart from that she though she could not be cured eventually, sally turned to drugs and alcohol, hoping it would help her to "forget" the complete and utter hopelessness she felt so often, and maybe give her some sense of who she is. This is only temporary. These relentless feelings always seem to plaque her. She feels as if she is going "crazy" and does not believe she will ever be able to recover Meaningful Experience The most meaningful experience was when I found out that sally When sally’s family became aware of her promiscuity, and sudden periods of severe depression, they demanded she seek help, by attending therapy on a weekly basis. She did so, and soon she developed a very intense relationship with me . She often lashes out and yells at me when she is dissatisfied, accuses him of being incompetent and threatens to stop therapy, even though she is very dependant on him. Once I mentioned that if her behaviour continued, he would not be able to treat her anymore. She was devastated just at the possibility, and threatened to kill herself. She thinks that I and her family are planning something bad against her. She thought I was leaking information about her to her family and often accuses the therapist of breaking confidentiality. What I Should Have Done Differently I should have been more patient with Sally and should not have told her that I would not take her sessions anymore if she acted out like she does. I should have treated her with a form of cognitive behavioral therapy that, according to M. Linehan (1991), has been especially helpful with the treatment of borderline personality disorder is called dialectical behavioral therapy, or DBT. This approach is an action oriented, collaborative approach which teaches clients to explore, identify, analyze, and change dysfunctional patterns of thinking, feeling, and acting (Dewan, et al, 2004). This approach is considered a form of “brief therapy”, meaning it can be accomplished in a very short time frame, as opposed to long-term psychotherapy (Clarke 1989). Learning experience Being the therapist you have a role in helping your client. You want to include as little self-disclosure as possible, at all cost. You never want to put your input into the situation no matter how much your client past is the same as yours. You want your client to achieve self-awareness, honesty and a more effective personal relationship. You want this relationship to be with you and with other people in society, helping your client make friends and build his self conscious (Sharma 2007). After more and more sessions with your client and you begin to feel that the depression level of your client is decreasing, you can begin to have fewer sessions. You as the counsellor can start frequently use supportive interventions. Have a free association with your client (Corey 2008). Also, begin pointing out, explaining and teaching the client meanings of behaviour (Lees 1998). I stated earlier that if your good at counselling you can counsel anyone. Well if your good at counselling you can also use any theory when dealing with your client as well (Nigel & Borin 2003). Even though you don't want to combine any of the theories with one another, it can be done. There is never just one theory to help a client (Dryden 2002). You as the counsellor can use any theory of your choice, you just have to make it work. In order to do so you have to be good at what you do (Shaw& Dobson 1998). Lets take Behavior Therapy for example. The client doesn't realize the difference between right and wrong, it was never taught to him by his lousy parents (Buchanan &. Hughes 2000). Counselling Competency Counselling competency can be measured by means of three elements goal, task and bond (Mcleod 2003 p480). Goal: The goal in case was to provide the patient with the best kind therapy properly so that he/ she can function properly in their daily life. I was successful in doing so in one case where as in the other two cases I did recommend the right therapy. Task: The task in each case was different; the task in Sandra’s case was to find out what caused the panic disorders where as the task in sally’s case was be patient enough with her so that her borderline personality could be treated. The task in Tim’s case was to lessen his alcohol and cannabis use Bond: In al three cases I had a strong bond with the clients. All three clients trusted me . however I spoiled the bond I had with sally by telling her I might not be able to carry on the session with her if she does not fix her attitude. Linking Practicum Experience to Courses in the Counselling Program My experience was directly linked to the courses of counselling, ho were I got confused in the Sandra case and used the wrong therapy. I should have analyzed the client’s history fist as I learnt in my courses. I feel that by my understanding of different communication/interpersonal skills, which are used in counselling, and theoretical 'helping' models, which I have found useful was the same as that which was mentioned in my courses Current Vision Of Counselling Role The counselling role is something very special for me as I can help people live a normal life by various therapies. I feel the people need to talk to somebody to vent out their emotions who could be better person then a counsellor (Anthony 1992). My current vision of counselling is that every one should be aware of the fact that counselling plays an important role in the lives people who are distressed. Counselling is medicine for the mind and soul (Egan 2002). if this vision is considered to the relationship of the practicum then it is more or less the same , the aim of counselling is to help people overcome what ever psychological problems they have , and my vision implements the same notion (Corey 2004). Conclusion My entire experience with clients was a healthy one. I learned lot and land found out my weaknesses. I found out how to handle difficult patient’s who have dark past . Apart from this I also learned that right kind of therapy can only be used if one concentrated on the history of the client . As that is the only appropriate way to give proper diagnosis. The bond between me and the clients made me feel that I was an extremely special person and that helping these clients felt good. I knew that the clients trusted me and I acted accordingly. All my courses though me and helped me lot through my experiences References Anthony Clare (1992).;In the Psychiatrist's Chair London: Heineman Blackburn, I. M., Bishop, S., Glen, I. M., et al (1981); The efficacy of cognitive therapy in depression: a treatment trial using cognitive therapy and pharmacotherapy, each alone and in combination. British Journal of Psychiatry, 139, 181-189. Brown, R., Scott, L., &Bench, C. (1994); Cognitive function in depression, its relationship to the presence and severity of intellectual decline. Psychological Medicine, 24, 829-847 Buchanan, L. and R. Hughes, eds. (2000); Experiences of Person-Centred Counselling Training. Ross-on-Wye: PCCS Books Clarke, K.M. (1989); 'Creation of Meaning: An Emotional Processing Task in Psychotherapy', Psychotherapy 26: 139-148. Corey Gerald (2004); Student Manual for Theory and Practice of Counseling and Psychotherapy Thomson Corey Gerald(2008); Theory and Practice of Counseling and Psychotherapy Cole Pub Co Dewan, Mantosh J., Steenbarger, Brett N., Greenberg, Roger P. (2004);The art and science of brief psychotherapies, a practitioner’s guide. Washington, DC: American Psychiatric Publishing. Dryden Windy & Sarah Opie (2003); Overcoming Depression London: Sheldon press. Dryden Windy (Ed.) (2002); Handbook of Individual Therapy (4th ed.). London: Sage Publications. Dryden, W. and C. Feltham (1992); Brief Counselling: A Practical Guide for Beginning Practitioners. Buckingham: Open University Press. Egan, G. (2002); The Skilled Helper: A Problem-Management and Opportunity-Development Approach to Helping, 7th Edition. Pacific Grove, California: Brooks/Cole Feltham Colin(1999); Understanding the Counselling Relationship. London: Sage Publishing Feltham, C. (1997); Time-Limited Counselling. London: Sage Gladding T. Samuel (2006);Counseling: A Comprehensive Profession Prentice Hall Harold L. Hackney, Sherry Cormier, L. Sherilyn Cormier, Sherilyn Cormier (2004); The Professional Counselor: A Process Guide to Helping Prentice Hall Kevin A. Fall, Andre Marquis, Janice Miner Holden (2003); Theoretical Models of Counseling and Psychotherapy Routledge Lees John (1998) ; Clinical Counselling in Context An Introduction Routledge Linehan, Marsh M., Comtois, Katherine Anne, Brown, Milton Z., et al. (2006); Two year randomized controlled trial and follow-up of dialectical behavioral therapy vs. therapy by experts for suicidal behaviors and borderline personality disorders. Archives of General Psychiatry, 63(7), 757-66. Mcleod John (2003); An Introduction to Counselling Open University Press; 3 edition p480 Nigel Benson & Borin van Loon (2003); Introducing Psychotherapy Cambridge: Icon Books. Patri, Vasantha R. (2007); Counselling Psychology , saujanya books Reischies, F. M., & Neu, P. (2000); Co morbidity of mild cognitive disorder and depression--a neuropsychological analysis. European Archives of Psychiatry and Clinical Neuroscience, 250, 186-193. Sharf S. Richard(2007); Theories of Psychotherapy and Counseling: Concepts and Cases Thomson Sharma, A.S.(2008); Counselling Psychology , saujanya books Sharon L. Johnson (2003); Therapist's Guide to Clinical Intervention: The 1-2-3's of Treatment Planning Academic Pr Shaw, B. and Dobson, K. (1988); Competency judgements in the training and evaluation of psychotherapists. Journal of Consulting and Clinical Psychology, 56, 666-72. Sugarman, P., Addie, G. (1996); Counselling has much to offer patients. BMJ 313: 1208-1208 Trickett Shirley (1996); Coping with Anxiety and Depression (revised ed.) London: Sheldon Press. Trotzer P. James (2006); Integrating Theory, Training, and Practice Routledge Read More

My most difficult experience was the case of Sandra is a seventeen-year-old lady and she came to counseling because she was suffering from a panic attack and depression. Sandra feels that she is going through depression and panic attacks this scares her and was tiring her best to be free from all this. Sandra felt very restless. She had visited a general physician numerous times. she started going to the physician after she gave birth to a lovely baby in June. She exhibits symptoms of depression, however antidepressants are useless for her including fluoxetine and citalopram, and these were given to her by the physician.

She did not go anywhere, she stayed behind closed doors and kept no contact with her school friends. Sandra’s baby’s father is 30 years old, but he is very supportive. The age difference is quite obvious. It was her patient who sent her to a therapist for treating her panic disorders.what made the case more complicated was that Sandra's parents had a divorce when she was very small .because of this he never got to know who her father was, he lives with her grandparents. However Sandra I good friends with her mother, she shares all her secrets with her.

Sandra’s grandmother was against the idea of her getting pregnant and living with a 30-year-old the case confused me so much that I forgot to ask her if her grandmother didn’t like the idea of her living with an Indian man or was it because she thought Sandra had a whole life ahead of her. Both Sandra and her partner have no self-income there are of support income. Her depression increased after she gave birth to her baby.Another thing that made the case difficult for me was that Sandra wanted the baby but she described her life as being a mess.

The fact that she wanted the baby and afterward feeling depressed made the case difficult. She said when she found out she was pregnant she was counting the days to her delivery, but her postnatal depression had turned into panic attacks after the birth of the baby.It was even more difficult because the client was not indifferent to her own condition. She felt frightened, she thought it would affect her social life and impair her daily functioning. What was more difficult was giving her hope that she would be fine without going through surgery.

Her mother had to as she also went through panic attacks. I was confused as to which therapy to give her so I started with person-centered listening and acknowledging I would ask her a question or two in the middle I also discussed something with her. I told her that it was normal that she felt depressed after having a baby, but then the biggest blunder of all the sessions ended in vain I could not find out exactly why she was going through these panic attacks It was the most difficult experience which I went through during the counseling of this patient was when I attempted to investigate the history of the panic attacks however Sandra was not successful in finding out why it started.

This made me feel like a complete failure I felt I had let the client down. As I was using the client-centered therapy I faced a lot of difficulties like that it led to the dependence between client and counselor. There is a greater chance of developing a relationship that is too comfortable. I was a therapist utilizing this theory I would have a greater chance of crossing ethical boundaries with their clients. This led the client to ignore a lot of different aspects which may have led to the reason behind her panic attacks.

Apart from this, I was forcing on the conscious rather than unconscious thoughts as it was a requirement of the therapeutic method I was using. I should have realized that sometimes panic attacks have deep-rooted reasons behind them which are usually buried in a Person’s unconscious (Gladding 2006). This was the main reason why I faced difficulty in finding out the root cause of the client’s attacks.

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