0.1. Counselling have been using the case study methods for various purposes such as documenting, evaluating and disseminating new approaches to therapy; contributing to public understanding of counselling; the development of theory; drawing attention to critical issues and areas of practice; extending and enhancing the interpretability of large-scale outcome studies; and training (McLeod, 2010). For the current case study, I have chosen a somewhat challenging case, which has contributed a lot to my practical and theoretical learning. This case study is divided into following sections: Case context, the client, the therapeutic process, evaluation of change, and conclusion.
1. Case Context
1.1. I have been working with this client at the
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All the client’s quotes from HAT are given in Appendix-2.
Beginning phase (Sessions 1 – 4)
3.2. I have divided this phase into first 4 sessions because it is in the 4th session that the client seemed to develop trust and move on in the therapy. As suggested by Mearns and Thorne (2013) that the ‘beginning’ phase of the counselling process involves the client developing sufficient trust in the counsellor and the relationship to start exploring the previously feared edges of his awareness.
Client’s Process
3.3. In the first 3 sessions, Tom spoke about various things including his problem of hoarding and different aspects of his self-concept. In the first session, he spoke about his self-concept of a Narcissist in a retrospective manner that during his teenage years he used to think that he is perfect and there is no one like him. According to Tom, his actual self is a Narcissist whereas his ideal self would be someone who can accept people unconditionally. This incongruence was so important to him that he mentioned it as the most helpful aspect of this session (Qoute-1). This also indicated towards his struggle to accept himself. In these sessions, Tom also spoke about his different configurations which include a self who wants to control other people’s behaviours and is jealous of happy and beautiful people. There was another self who is charming and eloquent and helps him socialise with people hiding this
For the purpose of this paper, this writer, will use the APA Task force on Evidence-Based Practices (2006, p. 273), definition, beginning with the foundation and expanding it to mental health, defined evidence-based practice as “the integration of the best available research with clinical expertise in the context of patient characteristics, culture and preferences” (Norcross, Hogan, & Koocher, 2008). According to Dr. Norcross, counseling is a dynamic process, with many moving parts, and the clinical experience is the integration of parts (pillars), the actual work in progress, which creates an opportunity for the best clinical outcomes and improved quality of life (Laureate Education Producer, n.d.).
The British Association for Counselling and Psychotherapy (BACP) define counselling, along with psychotherapy, as being “umbrella terms that cover a range of talking therapies” (BACP, 2012: 1). In addition, counselling is provided by practitioners who “work with people over a short or long term to help them bring about effective change or enhance their wellbeing” (BACP, 2012: 1). Those who practice counselling in a professional manner undergo intensive training and personal development, the latter of which has been “defined in terms of self-awareness and change” (Wheeler, 1996: 75). These changes, according to Johns, “influence the
In my opinion the beginning of the counselling session is one of the most important stage of the process, the client will be very nervous and will not fully trust the process they are about to embark on, their unknown journey they will be nervous. The Client may hold back what they are feeling until they have gained the trust of the counsellor, and know they are safe and in a confidential environment.
In this reflective essay I will provide an analysis of the counselling session I conducted and recorded. This will include a summary of the session. I will also describe the micro and advanced counselling skills utalised, as well as a critical evaluation of their effectiveness. A discussion of my application of these skills, as well as areas of possible improvement will supported by reference to relevant literature.
A counselling relationship is likened to being on a journey - a beginning, middle and end (Smallwood, 2013). During the beginning phase the client develops sufficient trust in the counsellor and the relationship ‘to explore the previously feared edges of his awareness’ (Mearns and Thorne, 1988, p.126).
The second phase consists of a process where the client and counselor share their belief system and try to come up with a plan to recovery. The third phase actually decides on a plan of recovery. The fourth phase consists of the client owning up to their responsibility and being held accountable for the plan of recovery.
In clinical setting, the case formulation guides a therapist how to structure the sessions and by prioritising the client’s core problems, give rise to a plan and choice of intervention. Case formulation is an element of an empirical hypothesis testing approach to clinical work and has three main elements which are assessment, formulation and intervention. The process of case formulation starts with an unstructured ‘problem list’ (Persons, 1989), then proceeds to look for common themes which could suggest underlying beliefs, schemas and early life experiences. This supports CBT in standing up against criticisms made by psychodynamic theorists which states that CBT deals only with symptom reduction, having no underlying rationale (Persons et al., 1996).
Counseling and delivering services under the “best practice” should always be the goal of a practitioner. In a field such as counseling, where the lives of others are being impacted, making specific choices on how to deliver services, and making a choice to choose one form of therapy over another is pertinent to not only the successful rehabilitation of a client, but to also ensure the longevity of yourself as a practitioner and as a counselor. Practicing techniques or alternative forms of therapy which are based off of literature which is not evidenced-based can lead a practitioner to unethical practices which can eventually mean revocation of
When comparing and contrasting the differences in the three approaches, I will review the relationship between client and counsellor. I will attempt to discover how the relationship is formed and how it is maintained during the therapeutic process. Once this has been established, I will then look at how the changes occur in the therapeutic relationship and which techniques will be used. I will compare and contrast the approaches of Carl Rogers, Sigmund Freud and Albert Ellis. I will look at how their theories have impacted on the counselling processes in modern times and throughout history.
Counseling is a relatively young profession when compared to other mental health professions. In my brief personal and professional experience with the field, I have come to define counseling as a process of engagement between two people, both of whom are bound to change through a collaborative process that involves both the therapist and the client in co-constructing solutions to concerns.
Case conceptualization explains the nature of a client’s problem and how they develop such problem ( Hersen, & Porzelius, p.3, 2002) In counseling, assessment is viewed as a systematic gathering of information to address a client’s presenting concerns effectively. The assessment practice provides diagnostic formulation and counseling plans, and aids to identify assets that could help the client cope better with concern that they are current. Assessment is present as a guide for treatment and support in the “evaluation process. Although many methods can be employed to promote a thorough assessment, no one method should be used by itself” (Erford, 2010, p.269-270). Eventually, it is the counselor's job to gain adequate
Sanders, Frankland and Wilkins. (2009) Next Steps in Counselling Practice. 2nd Edition: Ross-on-Wye: PCCS Books Ltd
Cognitive apprenticeship allows one to problem solve and complete complex tasks successfully. The concept that I think has more value with, cognitive apprenticeship is scaffolding. Scaffolding is best for students because it offers student support so they can master their education. Allowing students to stay on task with their work. “In education, scaffolding refers to a variety of instructional techniques used to move students progressively toward stronger understanding and, ultimately, greater independence in the learning process” (Education Reform, 2015, para.1). This article also explains, “the term itself offers the relevant descriptive metaphor: teachers provide successive levels of temporary support that help students reach higher levels of comprehension and skill acquisition that they would not be able to achieve without assistance” (2015, para.1). When teachers support the student he or she feel encouraged. When the student feels more encouraged they are motivated to learning which allows them to achieve at a high rate academically.
The nursing profession is always evolving; therefore, nursing education should also evolve. The nursing profession has changed from a focus on bedside care to a focus on technology, and now a focus on excelling at care integrated with technology. This paper will identify current teaching strategies, and discuss the potential effects of the integration of new teaching strategies in my own classroom.
I would use discussion as an instructional method because it is a great interactive learning tool and facilitates listening, teamwork, confidence, critical thinking, critical listening and critical reading. Moreover, classroom discussions can help students sharpen their communication and speaking skills. Classroom discussion helps to dispel myths and preconceived prejudices about others and students tend to develop mutual respect for one and others. Above all, discussions foster better understanding as students share their “take” on the subject, additional knowledge is shared. Hence, discussions require keen listening skills. I would say from my personal experience, classroom discussions opened up my own understanding of many subjects and helped me to navigate toward “right” thinking.