Counselling Case Study
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Counselling Case Study The following intervention analysis will utilise a planned verbal interaction, which occurred as part of ongoing care, during a 15-week placement on a Psychiatric Acute ward catering for Women aged 18-65. The client's informed consent was gained verbally, to use this conversation within my assignment. The client will be referred to as Carol. These measures are in accordance with the UKCC (1998) guidelines regarding consent and confidentiality. A client centred approach is to be employed as an aid to critical analysis of the intervention. It will firstly give a rationale for why this particular intervention was chosen and for the theoretical approach utilised. Biographical details of the client including events leading up to this point, previous conversations and incidents which are relevant to the chosen intervention, can be found in Appendix A. It will outline what a client centred approach involves. Firstly by defining its beliefs and essential core conditions, then by calling on the more practical micro-skills involved. The interaction will be analysed as each of these core conditions and skills are stated, thus helping in illustrating the helpful and not so helpful aspects of the interaction. Throughout the analysis, I will reflect upon how the intervention could have been more effective offering alternatives, which could have been more client-centred. Rationale The interaction, which is the focus of this study, is a prime example, in which I feel the need to offer a solution, in order to solve the problem, as I saw it. It was obvious to me that I did not have all the answers. This left me wondering whether a more 'realistic' approach would help. My practice up to this point has always been more directives and prescriptive, so logically I searched for an alternative, as my current practice was not having the desired effect. Therefore I chose to utilise a client centred approach and selected this particular intervention because I hoped firstly, to make sense of it and secondly, it could be inspiring to use a client led approach, as the prescriptive methods widely used in hospitals today (Morrison & Burnard 1990)
Maybe it would have been more productive to focus on carols feelings, through reflection and recognition of her nonverbal cues. In 7, 11, and 17 I could have used this same technique to elicit further information. For example in 7 I should have said, "you said it was all right, you seem unsure" I would hope that she would respond to this by elaborating on what she means. This, as well as being reflective is also an empathy building statement. 3. Empathy building Burnard (1997) states that empathy building consists of making statements that show an understanding of the client's feelings. They should reflect what is implied as well as what is said overtly. Effectively this is an ability to read between the lines, allowing the client to disclose further as they see you understand them more. As seen above in 7 I could have been seen to be more empathic by noticing that although she implied it was okay, her non-verbal signals indicated otherwise. To notice this is a start but not enough, you need to state it within the conversation so that both parties are aware and the issue can be dealt with. To recognize this incongruence in a client can only help me, to recognize it in myself in the future. There was one point at which I attempted to be empathic. In 30 from her behavior I recognized her frustration with the situation, this seemed to appease Carol and consequently allowed us to continue. I feel that it would have been even more beneficial to have just said, "I sense your frustration, yet I'm confused at what it's with" again I see this statement as an aid to further exploration. Further illustration of my inability to build empathy is evident in 6 I lead the conversation to what I think is the root of the problem. If I am to be truly client centered here I would have to have faith in the fact that carol can lead herself to the root of her problem.
I thought we were getting somewhere today. CLIENT: (Carol continues to walk to the door) (30) NURSE: You're obviously frustrated Carol, I can understand that, but walking away from it can't help, can it? CLIENT: (Carol says nothing but stops near the door and turns towards me) (31) NURSE: (There is a silence, which lasts for about 30 seconds) Please come back and at least set a time and date for the next meeting. CLIENT: (Carol returns to her original seat, she remains silent for about 30 seconds) Nothing is helping. (32) NURSE: (I remain silent, while maintaining good eye contact) the anxiety management pack I gave you, has it been useful or not? CLIENT: (She shakes her head) (33) NURSE: I get the feeling you don't think much to the pack? CLIENT: I don't understand it. It goes on about physical things. I don't want to know that I just want a list of thing's that will cure it (34) NURSE: Should we go through it together again, would that help? CLIENT: I don't know (She is dismissive in her tone of voice) (35) NURSE: Well, why don't you think about it and get back to me. I am more than happy to try alternatives. CLIENT: Yeah okay (36) NURSE: Do you have any ideas about what might help? CLIENT: Don't know (37) NURSE: There are other self-help packs around which you may find better, would you like me to get one of those for you? CLIENT: I don't really want to talk about it at the moment. (38) NURSE: Okay (I hold my hand up as to suggest that it is okay) shall we leave it there for now? CLIENT: Yeah (39) NURSE: Why don't you think about what we've talked about today, try to look at the positives, think about whether we should try a different approach and we can talk about it the next time we meet. CLIENT: There you go again talk, talk, talk, and talk. (Carol makes a gesture with her hand as if it were talking) (40) NURSE: I think maybe we should leave it there.
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