The four counselling sessions documented within this case - Sample Essay
She remarked afterwards that it had helped to talk as she felt her general state had improved. She then shook my hand and kissed me on the cheek – a gesture that I have reflected on alone and within the MSc group supervision. Initially my feeling was of unease and a concern that her affection had arisen from her misconception therapy and my role. I felt a mild level of fear, that a previously unidentified feeling of ’emotional protection’, had been removed. What it means to be a ‘counsellor’ is evolving within my self-concept at a rapid pace, constantly refining through a seemingly steep learning curve of education and experience.
I believe that the person-centred relationship gives the counsellor room to identify their own way of being with individual clients, and therefore do not feel that the gesture raised ethical considerations. I do not need or want to raise that boundary again, my fear is focused on the next session and my tolerance for working with a degree of uncertainty. I am unlikely to discuss with the client what it meant for her, though this is not a decision set in stone. I feel now that the gesture encompassed a number of feelings and processes operating at many levels within the relationship: 1.
A moment of intimacy emanating from my willingness to be with her in feelings of hopelessness. The gesture marked a profound sense of sharing and commitment. 2. The client has a history of disturbed relationships and weak self-acceptance, to be understood and accepted has been a unique experience for her and a powerful instrument in challenging her feeling of ‘contamination’ and self-rejection. This gesture was a mark of her fledging belief that she is good enough to receive and show affection. 3. Her aim of therapy is to increase her ability to willing show affection to those she cares about and who care about her.
We had left the session with the client stating her desire to hug her husband; she wanted to see me in two weeks to allow time to achieve her objective. Her gesture was a mark of beginning this process. I believe this is more my issue than the client’s, and highlights a process where I begin to assess how much of myself I am able to bring to the relationship. At present, the client is taking nourishment from me, but is slowly replacing that with her own self-acceptance as her locus of evaluation is moving away from external sources. Within the sessions, the client has shown the capacity for processing new insight.
An example of this would be her statement in session two that her father’s belief that ‘boys were trouble’, was obviously right, because of the resulting traumatic experience when she defied him. My reflection generalised her core statement, ‘A = B, no grey areas’. She appeared uncomfortable with the degree of truth in this statement and we remained silent. Eventually she responded by identifying a grey area; that if the boy had been of her husband’s calibre, she may have positive memories of the experience. Through empathy, I have begun to understand the client’s personal language of using humour to defend her vulnerability.
This understanding has helped me to see the person behind the behaviour, and I am not deflected by her flippancy. As an example, the client laughingly stated, that I must feel ‘down in the doom and gloom’ following our sessions. I was aware that if I had not been in her frame of reference, I might have colluded through smiling or sharing the joke. However, I felt that underneath her flippant remark was a need to feel that I was resilient enough to cope with her emotion. This checking may have originated from the conditional support afforded by her husband, who she feels limits the emotion the client can unburden at any one time.
My response emphasised that we were both committed to the therapeutic relationship and that my emotional resilience would be taken care of within supervision and my own therapy. This flippancy was more apparent in the earlier sessions, and it is questionable whether the client would believe in the efficacy of our relationship if I had failed to respond to the deeper message DIFFICULTIES IN THE WORK During the first three sessions, the client questioned how talking about her problems would help, and I asked her to suggest how she thought it may help.
She used her insight to appreciate the potential link between her adolescent experiences and the here-and-now, but I sensed her frustration and discomfort, despite knowing that she is motivated to be in therapy. My understanding of these feelings centres on her pain and discomfort when discussing her experiences, and the question phrases her need for reassurance that this pain is somehow bringing her nearer her therapeutic goal. However, despite this understanding of her discomfort, I was aware of a momentary feeling of pressure due to this reiteration of earlier questions that I felt had been both explained and understood.
I focused on our initial contract that we were both responsible for developing and maintaining a therapeutic climate, and that the client’s role was not a passive one. Her question voiced a tacit assumption she had brought with her to the therapy setting about therapy and therapists, and I became cast in the role of expert. I was aware of a feeling of disappointment that we had not reached the level of understanding of the nature of our relationship that I had perceived. I was uneasy with this, but during supervision became aware that noting her anxiety had brought me a little closer to understanding her view of herself.
The notion of being a facilitator is attractive to me, as it does not demand I behave as an expert – which I do not feel I am. I am aware that I need to pay attention to the communication of implied questions, as my intonation seemed to suggest a conclusion, which usually resulted in the closure of exploration. I discussed my perception of ‘an effective counsellor’ within the broad support of group supervision, and how this connects with the transitory anxiety of breaking new professional ground. By listening to their challenges and not hiding behind defensive
ways of communicating, I am confident that my fears of inadequacy are not of a level which is distracting and hence, counter-productive. I am aware that in the early years of counselling practice, it is normal to focus on ‘doing a good job’ with a conscientious adherence to core principles. Therefore, in order to minimise pre-session anxiety I have implemented three strategies: 1. Utilising time-management by booking fifteen-minute breaks between clients. 2. Using supervision as an opportunity for feedback and development.
The individual supervision at the surgery has, to date, concentrated mainly on client content. In future sessions I intend to raise process and relationship issues. 3. Objectively assessing what harm I could realistically do to the client’s situation. This was reaffirmed in session four when, for the first time, the client acknowledged the lack of honest communication with her husband. Having identified her needs, she felt to approach him now would be too much and wanted to return to it in future sessions. I realised that in a relationship of emerging mutuality, clients will exert their own power and pace.
I am also aware of the liability of operating from my own theories of human behaviour i. e. that intra-marriage communication must be improved before a satisfying sexual side can co-exist. REVIEW The case study herewith has presented an opportunity for an evaluation of self and of psychotherapeutic practice using person-centred philosophy. Within the text, I have discussed personal and therapeutic strengths, plus areas that may benefit from development. In relation to the client I have focused on, I am aware of the therapeutic advantages of working with a committed client.
A challenge for the future will be to maintain unconditional positive regard in the face of hostility, conflicting values or a client seemingly discrediting person-centred hypotheses by moving away from personal growth. I am aware of the need to accept one’s own conditionality, whilst working to understand an individual’s valuable experience of their own world.
REFERENCES Mearns, D and Thorne, B (1990) Person-Centred Counselling in Action. London:Sage Lietaer, G (1984) Unconditional Positive Regard: A Controversial Basic Attitude in Client-centred Therapy as cited in D. Mearns and B. Thorne Person-Centred Counselling in Action. London:Sage.