Marian is a 37 year old female who appears to be from a middle class background. Marian is currently married (for 17 years) and she and her husband have two daughters aged 9 years and 11 years. I conducted a phone assessment with Marian two weeks earli...

mother was the type of person that she had to be the center of attention. (Co: hmm). She, in my mind I believe she was a hypochondriac. So, you know, I’d come home from school and think, Oh my God, she’s in bed again. She’s sick again and I was resentful, resented her terribly. Ahh, but she didn’t work when I was young. My father, my step-father, um, he was twenty years older, he was on a war pension so um, they didn’t do anything during the day. They didn’t do anything with us. They always had, you know, fitting in with things in the back of the family, things like that, drinking, drinking, drinking. Now my step father didn’t do it to excess, you know, she would drink ten times more than him (Co: right). And, um, he had it as a social thing, um he put her on a pedestal, you know, she could do no wrong in his eyes (Co: right) so how ever much she wanted to drink was just fine by him. (Co right). But it got to the stage where, um I would be going around the house and all of a sudden, you know, I’d, I’d, I would be doing the house work and behind her bed was a bottle of scotch, you know, with a glass, (Co: hmm), things like that and I would think well, what is this doing here (Co: hmm), what and, if I questioned her, leave it alone, don’t you touch that, don’t you touch that, that’s mine or, um, she would get up in the morning and I would say to her, you know, can I make you a cup of coffee mum?, and she’d say to me, no, I’ve already got one but she’d sit with that and she’d have her hand over the top of the coffee cup and she would very slowly, you know, without anybody looking (Co: yeah), she would be sipping that cup, cup of coffee and it wasn’t until I was probably a teenager that I thought, that’s not coffee in there, what (Co: yeah) is it? What are you drinking (Co: yeah). Um..Continuation response/s and where I think the Active Listening stage began.The majority of the continuation responses used (i.e., hmm) allowed Marian to keep on talking and also let her know that I was listening to what she was saying.Counselor So there was never any honesty there.Reflection of content presented in a closed question formatI was paraphrasing what Marian had said earlier about her mother’s drinking habits and presented it in as a closed question for confirmation from Marian that I was hearing what she was telling me. Client Never, never any honesty (Co: no). No, there wasn’t. She was always an aggravated drunk as well. When I feel as though, when I drank, um, I became happy, you know (Co: oh right). I would try to, to, laugh and be the happy one and dance and, you know, be everybody’s friend. I’d tell every body I loved them (Co: yeah). But my mother was an aggressive drunk she would, um, she would provoke fights and then if it didn’t go her way she would, she would yell and scream (Co: hmm) and pass out on the floor and then we would have to carry her to bed.Continuation responsesThe minimal responses were varied and allowed the conversation to flow uninterrupted. Counselor So a very unpredictable environment for little children.Reflection of content presented in a closed question format. I wanted to reflect back to Marian what I thought it would be like to grow up in her home. Client Ooh, absolutely, absolutely, yeah (Co: yeah). Um, I always got the impression that my mother had children for the wrong reasons. Um, she didn’t have them to love and cherish and care for them, they weren’t an important part of her life and to be there to help her out (Co: right), to do things for her, to wash, cook, clean, iron, you know, um, things that we had to do for her were, were demeaning and, um, she never physically abused us but mentally it was shocking (Co: yeah). It was shocking and I can only see that now (Co :hmm). At the time I resented her thinking, oh gosh you know you’re just, you’re not the type of mother I wanted (Co: yeah) and, um, so I, I did, I resented her for many years and, um, when it came to the stage where I had, you know, grown up and got married and everything like that, I knew what an alcoholic was. (Co: hmm) and, there was no doubt in my mind that she was (Co: yeah). Um, I believed then that I was a social drinker and I’m never going to turn out like her (Co: yeah). I’m never ever going to be like her because I despised what she was (Co: yeah), I really did and I, I really, it, it, I know hate is a very bad, it’s a very negative word and, it’s a very harsh word but I hated what she was doing. (Co: Hmm). I really did. So you would think that I would, I would shy away from that, something shocking but I didn’t, I didn’t and I, I don’t know whether that comes to, back to my feeling of being inadequate (Co: yeah) or, um, not a strong person, um, you know the way alcohol would make me feel when I drank it (Co: yeah). I, I would feel on top of the world, it would give me a confidence that I believed that I never had (Co: right), you know, that I could of, I could talk to anybody on any level whatsoever (Co: hmm) without being shy or, um, when I talked I felt confident (Co: hmm), you know, I could speak articulate where, when I’m slurring my words I didn’t know what it was but I believed in my mind (Co; yeah) that, you know, I could talk to the prime minister (Co: yeah) and shake his hand (Co: yeah) and he could go away feeling good about the conversation. Um, but it sort of, um, my mother died about six years ago, um, at the age of 56 (Co: OK) and it was an absolute inhumane death she had, um, she actually did of heart failure (Co: hmm) that was formed due to, um, the years of abuse and the last couple of years, um, my step-father was put into a nursing home, he had, um, alzeheimer’s and amongst other things so she could not care for him (Co: hmm), she could not care for herself, (inaudible) you know rather than care for him, so she was basically left on her own then, um, to survive (Co: right) and she coped shockingly (Co: yeah). Um, I lived in Queensland and she lived in Melbourne but, um, we had basically cut ties with her at that stage because, um, you know, we, we could see what she was doing was getting deeper and deeper and deeper, you know, she went, when I was a teenager (Co: hmm) certainly she drank but, you know, she could get up and walk around she come sit, have dinner at the table and things like that (Co: yeah) but just, you know, a couple of years before her death it was, it was the most pathetic thing that I have ever seen, you know, often I would go down there to visit or anything like that, um, she could not take herself to the toilet (Co: right) and, you know, I would be scrubbing the floors, I would have to wash her and, you know, change her beds and things like that (Co: hmm). I’d have to feed her, you know, physically put the fork in her mouth and it was, as I said, the most pathetic sight that I have ever, ever seen.Continuation responsesCounselor So, the child actually became the mother of the mother. Reflection of content I wanted to reflect back to Marian, in an empathic way, the picture I had of the impact that prolonged drinking had had on her mother and how the roles had reversed between her and her mother.Client Yes, yeah. Well that’s right and she was childlike you know (Co: yeah), um, the look on her face, things like that was, was just, I don’t know whether I felt sorry for her or, or what it was (Co: hmm) but you know I cried (Co: yeah), I really did, I thought this is just, it’s awful that, you know, a person that has got to this stage without realizing that something (Co: hmm) has got so bad and they can’t do anything about it (Co: hmm), um, she got so bad that she, she could not go out and buy food, you know relatives and things like that (Co: hmm), they would take her keycard, go down, and buy food and things like that. Counselor Very dependent on other people Reflection of contentI wanted to let Marian know that I was actively listening to her and so I paraphrased how I had interpreted her description of her mother. Client Other people, yep, um, and she would tell me, and I would say to her, you can’t drive mum, how are you getting your alcohol (Co: hmm). And she would say to me, well phone up the taxi company there is a guy down there I know very well, he comes once a day or comes once a week and stocks me up (Co: yeah), I give him my keycard, of all things (Co: yeah). He drives down to the liquor shop, stocks her up, buys a case of scotch or whatever like that, takes out his fee, goodness knows what else he is taking out, and then comes back with it (Co: yeah), and I think, why, why would a taxi driver knowing that she’s in (Co: hmm) the state that she is, why would he let himself do this (Co: hmm) and then, um, you know, um, as I said she’s just been gone for 6 years now, um, I was the one that had to go down and organize the funeral because she had nobody, absolutely nobody, um, with the people that were there to so call help her were not helping her, they were, they were using her, um, my mum died a very, a fairly wealthy  woman (Co: oh right) so of course going, having free access to her bank account and things like that, why would they not help her (Co: yeah), of course not, why would they not help her but they pretended to be good friends and, and they weren’t (Co: yeah) but, but she, she  believed  that, you know, she had all the best friends, but they weren’t (Co: hmm), they weren’t so, um, of course when it came time for, for her funeral nobody wanted to know anything about it, nothing at all. My first and only funeral that I have ever been to in my life and I had to organize it. So we, it all went very well but I was, we had an open coffin (inaudible) and I’m standing in front of that coffin and I cried and I cried and I cried. Now I can honestly say that I, I did not love my mother (Co: hmm), I did not. I cried for me, I cried for her, and I cried for something that we never had (Co: hmm)Continuation responsesClient I cried for the fact that (Co: for the loss) I never had a mother, the loss, the, the sheer waste (Co: hmm) of a life (Co: yeah). So went home, wonderful husband, beautiful children, I’ve got a wonderful job and I’ve got a lot of friends and I did, I went down the same track. Um….. Reflection of feelingI felt that, although I was talking over Marian, it was important to let her know that I was aware of her pain.Counselor And this, more so after your mother had passed away.Open-ended questionI wanted to know if Marion’s mother’s death was a contributing factor towards her drinking more alcohol. It is possible that Marian may require some form of grief and loss counseling. Client Yes, yes probably, um, I guess it was progressive it didn’t just sort of happen over night or (Co: hmm) anything like that, it was progressive, um, my sister and I would be drinking buddies. She’s not an alcoholic due to circumstances in her life now but, say 5 years ago or, you know, say, or around about that time, um, (Co: hmm) we were both, you know, merrily on our way to being as bad as she was (Co: hmm) but we would encourage each other. I would love going down there, you know, because she was, she was, she was egging me on (Co: hmm) whereas when I was with my husband, Marian don’t you think you’ve had enough? No, (Co: yeah) no, and then it got to the stage where I knew that David did not like my drinking (Co: yeah). He, he would go quiet (Co: right), OK, he wouldn’t talk to me and I knew that he was upset (Co hmm) so that he would always bottle things up. He’s not, he’s not a very confrontational man (Co: right), he would bottle things up so I would get sort of agro with him, come on, come on, have another drink with me, well I don’t want anymore, oh but I do, fine you go and have another drink then (Co: hmm) and I could hear the tone of his voice (Co: voice), he’s not happy with me (Co: yeah). I think that, that’s the stage I was going down to my sister’s a lot then (Co: oh right) because she was happy to give me another one (Co: yeah) and another one, and another one and I, I felt good down there (Co: yeah), you know, um, and she felt good too (Co: hmm), you know if we ran out we would both have to go down and get some more  (Co: hmm), you know, even if it was 9 o’clock at night (Co: yeah) whereas my husband would say, “for god’s sake Marian, you are not going out at 9 o’clock at night to go and buy more alcohol” (Co: hmm). That’s when it got to the stage probably, you know, three or four years ago that David stopped drinking, he used to be a social drinker. David stopped drinking and, um, because if he stopped drinking he knew that I would feel embarrassed or you know apprehensive about drinking on my own (Co: hmm) and, um, it didn’t worry me to begin with (Co: hmm). Then as time went on I thought, it bothers me, you know, it bothers me (Co: yeah) that I was wanting to have a drink but he didn’t want one (Co: right). I would deliberately go and, and buy a bottle of champagne or something like that and pop it in the kitchen and ‘I would say to him, have a glass of champagne, and I’d say well I’ve already opened the bottle (Co: yeah) and he would have one glass of wine and I would have the rest (Co: Oh right). So, so you know, I just thought there was a method behind my madness, that I could, I could get around him in any situation (Co: hmm). Christmas time and things like that, you know, um, gifts of, of, you know, alcohol and things like that which is always in abundance, you know, especially with the job that I am in (Co: ah right). It’s very easy for somebody to, to give you a gift of a bottle of wine to say thank-you (Co: yeah) for, you know, things over the years, um, I thought it’s great, fantastic, well I can’t let it go off (Co: yeah), I can’t, I have to use it, they would get upset if I didn’t enjoy what they had given me so there was always an excuse.Continuation responsesThe continuation responses enhanced the flow of the conversation because I was letting Marian know I was hearing what she was saying. Counselor Well, you managed to always come up with an excuseReflection of content and mild confrontationI wanted to get Marian to acknowledge that she was responsible for making the excuses. Client Yes, well yes and I believed that they were legitimate and liable excuses (Co: hmm) and I always thought that, you know, I, I could, I could fool anybody, especially my husband (Co: hmm). I could fool anybody, you know, going to parties and things like that (Co: hmm). I would always make sure that I took my glass in the kitchen to fill up (Co: right) and then drink the whole glass and then come out with a glass of water (Co: oh right, yeah). But again over the years he, he, he knew (Co: yeah). He, he’s’s not a silly man and I got to the stage where my mother was, well not, not quite as bad as what she was at the end (Co: hmm) but I started hiding it (Co: right) Ok, that’s Ok, I can’t drink in front of him because I feel bad (Co: hmm) and I feel humiliated but I still want to drink (Co: hmm), still want to. So until he came home at night I freely drank openly (Co: right), until he came home at night (Co: hmm). I’d always phone him up and say, well, what time are you home so I can organize dinner, so I’d always have my eye on the clock (Co: right). He’s going to be home at 7 o’clock so I’ll make sure that I go and hide it at a quarter to 7 (Co: hmm), always, you know, have something, a fresh breath mint or something (Co: hmm) like so he can’t smell it on me, but silly me, he knows (Co: hmm). It was me that was silly because I always thought I was the bright person and you’re the fool because I’m getting everything around you (Co: yeah), but I was the fool (Co: yeah), I was the fool. And it had, it got to the stage where I would hide these casts of wine and I’ve got so many hiding places over my home, so many. I always thought that I was really good at finding, you know, unusual places but then it started that my husband would find my hiding places and leave me little notes on the bladder (Co: laughing) I thought no, not another one that he’s found geez (Co: laughing). I even started hiding them in the boot of the car (Co: yeah), no, he found them (Co: yeah) and I think that he use to go around looking (Co: yeah), certainly he would of (Co: hmm) but not as, not to hurt me (Co: hmm), but to try and help me.Continuation responsesI wanted to acknowledge what Marian was identifying as important points in her drinking behaviour.Counselor To bring to your attention that…….Open-ended questionI wanted to say, to bring to your attention that he was aware of what was going on, but Marian cut me off.Client But I didn’t see that (Co: hmm). I always thought that, fine go ahead, pick on me again (Co: hmm), you know, give me another lecture (Co: hmm) give me another lecture, you know, I’m not as bad as you think, I can stop whenever I want to (Co: yeah). Well stop then, I don’t want to (Co: yeah). And we started arguing, I would always try and make light of it, well at least I’m not as bad as my mother (Co: hmm), you know, um, I don’t believe that I’m drunk yet (Co: yeah), I only drink at night, I only drink the one type of alcohol, I don’t mix, I don’t, you know, I don’t drink hard liquor. There was always some sort of comeback (Co: hmm) but I thought…Counselor Well while you were perhaps rationalizing, it’s ok for me to do it (Cl: yes) because I’m not doing (Cl: yes that’s right) yep, yeah.  Reflection of contentI wanted to see if Marian was aware that she had been rationalizing in order to keep drinking. I didn’t get time to finish what I wanted to say as Marian started talking.  Client And a way of waking up the next morning and still being able to have a smile on me face (Co: hmm), to go back to the liquor barn and get more (Co: yeah) Counselor And not feel guilty perhaps (Cl: yeah) yeahClosed questionI wanted to find out if Marian was aware the her rationalizing was a way of her minimizing her guilt.Client And another thing was that the drinking of the alcohol, although at night time I got to, there was always one point that I could never remember where I either fell asleep or I became, not unconscious, but it got to the stage where I could not remember anything (Co: hmm). You ask me a question next morning about what happened the night before and I could not remember for the life of me.Counselor That must have been pretty scary once you got to that point.Reflection of feeling I was trying to be empathic but at the same time I wanted to see if I was right in how I thought Marian might have been feeling. Client It was (Co: yeah), it was, where David would be telling me something, : aah look I’ve got a dinner meeting on next Wednesday” and then on that Wednesday morning I’d say to him, well what do you want for dinner tonight, well I told you I’ve got a meeting on, oh yes, yes sorry I forgot (Co: hmm) whereas I didn’t forget, I just, I had no idea (Co: yeah), absolutely no idea. But for me also there was no deterrent of waking up with a hangover because for some reason I never ever got a hangover (Co: right), I always woke up refreshed even, I’m not very good sleeper (Co: hmm), I always toss and turn and I, I’m up and down and up and down. I have never been a good sleeper so I don’t get a refreshing night’s sleep so you would think that I would wake up lethargic (Co: hmm) with a headache or, you know, bloodshot eyes but I wouldn’t, I’d wake up fine.Counselor No physical senses…Closed questionI wanted to make sure that I had heard Marian correctly. Client No physical at all (Co: hmm). And that’s why I thought to myself, this is great. I can feel good when I want to feel good (Co: hmm) and then in the morning I’d wake up refreshed (Co: hmm), don’t feel as though I’ve had anything, never woke up with bloodshot eyes like a lot of people do (Co: yeah) that look as though they’ve had a night on the drink (Co: hmm). Go to work, take the children to school, no problems at all ready to start another day and have more drinking that night.Counselor So you’ve got no physical symptoms, you’ve got a loving husband OK (Cl: I do), he’s there for you all the time (Cl: that’s right). Ok, then it must be very difficult for you to actually say, hey, I need to do something about this.Summarizing with a closed questionI wanted to point out a couple of relevant points that has been raised previously. The closed question was to get Marian to acknowledge to me why she kept on drinking. Client Yes it was, it was because I just kept on making excuses (Co: hmm), you know, um, any excuse would do and David, as I said to you, was a non-confrontational man (Co: yeah). He, he would always try to keep the peace. And, he would know that if he said something to me I would always be on the defensive (Co: yeah) and not so much that it always went into an argument (Co: hmm) but it always got heated and we’d end up going to bed angry at each other (Co: right). My husband and I very rarely fight (Co: right) but over the last few months or even the last year or so (Co: hmm) we’ve been fighting more (Co: hmm), obviously it’s because of my drinking (Co: hmm). So he would keep quiet, he would sit in front of the television, I’d be sound asleep on the lounge and he’d just let me go (Co: yeah), he would know (Co: hmm). And then he got to the stage where he didn’t even bother to wake me up because he’d have to shake hell out of me to try and wake me up to get me to bed (Co: yeah) and in the end he just thought, ah stay there, stay there, sleep on the lounge (Co: hmm). Middle of the night 3 o’clock in the morning I’d wake up and take off up to bed, but I would be sober at that stage (Co: yeah) and there’s been so many times when I thought, I could go and have another drink now (Co: hmm) but then I’d think to myself, Oh damn it I’ve hidden it in the bedroom so I can’t go and get it.Continuation responsesMarian appeared to be disclosing everything so I continued with the minimal responses so as not to interrupt the flow of conversation.Counselor So how did you feel waking up in the morning at 3 o’clock on the lounge? Open-ended questionI wanted to get Marian out of her head and into her feelings. I wanted to know what Marian was feeling.Client I would think to myself, damn it, damn it, I’ve fallen asleep, I’ve tried my hardest to stay awake, have wonderful conversation with my husband after he’s come home from work, have a lovely dinner with him and everything (Co: yeah) like that and I’ve bloody well fallen asleep. Anger, ashamed, and, and why Marion why. Counselor At the fact that you’ve fallen asleep Marion or at the fact that you’d been drinking?  Open-ended questionI don’t know why I really asked Marian this question because Marian had already told me earlier. I think this was one of those times when I wasn’t fully with my client. Client The fact that I’d been drinking and fallen asleep (Co: OK). I mean lots of people fall asleep on the lounge (Co: hmm), you know, if their tired or watching television (Co: hmm) or something like that but I knew that it wasn’t just because I was tired, it was the alcohol, it was the alcohol (Co: hmm), I had no doubt in my mind. But, and I would think to myself the next morning, OK, brand new fresh day I’m not going to go into that liquor barn today (Co: hmm), I’m not going to do it. My mind was so positive (Co: hmm) and then by a certain time of the day I’d have to go. I even, I’d drive into, to that liquor barn and I’d think Marian, stop it, turn this car around but, you know how you’ve got the little devil on one side and this little angel on the other (Co: yeah), this little devil was stopping that little angel (Co: in from stopping that little angel). Well, I, I don’t know what it was but I felt as though I was being pulled (Co: yeah), I was being pulled in all different directions and every single time I would choose the wrong thing. I would choose the wrong thing. Um, it got to the stage where friends and family around were putting pressure on David. David you have got to do something (Co: hmm) she cannot continue like this. Two children, something’s going to happen that she is going to regret for the rest of her life (Co: yeah). They didn’t feel as though it was their place to (inaudible)  me, they’d yell and scream at me (Co: hmm) but I always said to them, none of your business, none of your business. David finally plucked up the courage to, to speak to me, you know, to, to have it out with me and I looked at him and I thought, my god I didn’t know that that part of my husband existed (Co: yeah) and he really, um, was assertive with me, not, not to the stage where….Continuation responsesCounselor He was aggressive   Closed questionWhile I wanted to find out if David’s behaviour was in any way threatening, I think this may have been another time when I wasn’t fully with my client. Client No, no, oh not it was never physical or anything like that, Marian you have got to do something for God sake, for me, for the children, for your self.Counselor Pleading.Reflection of contentI wanted Marian to hear that I was aware of David’s desperation.Client And yes (Co: hmm) begging (Co: hmm) begging, begging (Co: yeah) and I’d look at him almost in shock horror, you know, wow, you do have a voice, you do (Co: hmm) have a (inaudible) voice under there (Co: right). David I’m so sorry, I really, really am, I’m so sorry I’ve hurt you, I really will try, I promise you I’ll try, I promise (Co: hmm). Well next day I’m down at that liquor barn when it opens (Co: right), I’m thinking again, why am I doing this. Well, I’ve been given a reprieve, you know, he’s, he’s not going to yell at me tonight (Co: yeah). If he’s had this out with me last night, so, he’s going to give me a little bit of time cause because every time I’d make the excuse, well I’m trying David, I really am but you know they’ve all said to me it’s going to take time, I’m going to have setbacks (Co: right). Well I think, this can be one of my setbacks tonight or tomorrow night, tomorrow night, tomorrow night. So it got to the stage where it would be once every say, 6 weeks to 2 months (Co: yeah) but he would then have another go at me (Co: Oh right). But during those 2 months I, I was having a wonderful time having my little drinking binges (Co: yeah) and then it would come up again (Co: yeah) and I’d sit there and I’d cry and I’d do all my bits and pieces. I was genuinely sorry, you know, (Co: hmm) when, when we would sit down and talk I would cry and I would think to myself, he, and I would say to him, you’re right David, I’ve got no excuses (Co: yeah) I’m, I’m not blaming you for this, I’m blaming me, this, this is wrong that I’m doing this (Co: hmm) and I would put it all back on me (Co: hmm) and then I would, I would give him a guilt trip (Co: hmm). I really am trying, I don’t know what to do and I don’t know where to go and please help me, where do I go, what do I do. We then, well booked, I oh well, I booked myself into a couple of AA meetings and then I got to the sarcasm stage where, my meetings were on at night because I worked during the day and then had the children as well, so my meetings were on at night and, um, we’d go at get myself ready. I didn’t say anything to David and then I’d come to him with the keys in my hand and he’d say to me “where are you going?”  Well where do you think I’m going, to one of these bloody AA meetings (Co: right). I’d walk out the door sarcastic and aggressive (Co: yeah) almost trying to put the guilt (Co: guilt) back on him (Co: yep). And um, so anyway we’d go to these AA meetings and oh, shaking every time I went. Never got aggressive when I was in the car, I was sort of calmed down once I got in to the car. I always had that cask of wine in the car (Co: right). Drinking on the way to the AA meeting. We’d sit down at these AA meetings and all I do was cry, I don’t know why, I just felt as though I didn’t get anything out of these meetings (Co: yeah), maybe because I was probably still drinking at the time (Co: possibly). Yeah., but then I would drive home still drinking on the way home, but then I would cry, genuinely cry (Co: hmm) because I’m looking at myself taking another drink of wine. I’d think, you’re getting to the pathetic stage of your mother (Co: hmm). We’d get home and then David would say to me, you know, being, you know, caring and wanting to know how did it go I don’t want to talk about it. And then next couple of days it went on and I would, oh he would say to me “are you going to your meeting tonight? “yes if you want me to,” and then he would say well don’t Marian, do it because you want to, I don’t want to, I hate that place and I don’t even want to go back and I want to drive of a cliff every time I’m in my car when I  drive to these AA meetings, please don’t make me go back. And again put the guilt trip back on him (Co: hmm). So alright then Marian you don’t have to go, we’ll find something else for you. Then another couple of weeks, another couple of months would go by and we wouldn’t go and look for anything and I would, I would just go on my merry way thinking, well, David said he was going to go help me (Co: hmm) he is going to go and help me so I’ll just wait until he finds something for me (Co: hmm). I just wait and I’ll continue (inaudible) way. So of course it got worse and worse and worse.Continuation responsesI wanted Marian to know that I was following her throughout her story.Counselor And no doubt every time David came up with somethingOpen-ended questionI wanted to find out if David was making any suggestions to Marian.Client He never came up with anything Counselor What, he never came up (Cl: no, no) with anything, and if he had of.Closed question with an open-ended questionI was checking Marian’s previous reply and then I wanted to know what she would do if he did make a suggestion.Client I would find some reason for rejecting it (Co: yes, exactly). Absolutely (Co: yeah) I guess things, um, (inaudible) you know, for the last, um, well quite bad (Co: hmm) over the last 18 months to 2 years I guess, and things just kept on going. My friends started to get aggressive, my sister started to be aggressive with me. We know that you’ve been drinking Marian, we know that you’ve been hiding it. Yeah so, I’m admitting to it, I’m not telling, I’m not lying to you, I’m admitting to it (Co: hmm) and then that’s when I would start getting aggressive so, what do you want me to do, you know, what’s it to you, this is me, it’s not you so don’t worry about it (Co: yeah), I’ll, I’ll handle it in my own good time. Well I guess it came to a head in January this year when I was pulled up for the first time ever for DUI. Well blow me dead, I thought, I can’t believe this (Co: hmm) like, it was (Co: it was a shock), it knocked me for six it did (Co: yeah) it really did, I had to  go to the police station, I had to be tape   recorded and things like that. I had to be breathalyzed several times and then I’m still over the limit, and I thought, oh my God, their going to throw me in jail (Co: hmm). No it wasn’t a case of their going to throw me in jail though the constable said to me, but you do have to appear in court and I thought, oh no, oh no, what am I going to do, and I didn’t tell David, I never told him. Um, the court hearing came up and I took myself, I, I got some time off work and everything like that, I took myself to court and oh, I was, I was so frightened, I really was so frightened. Well apparently they had to adjourn because I didn’t have the proper paperwork, affidavit and things like that. I had to apply for a work license, no problems, I’ll apply for a work license that way nobody has to know and I can continue on my merry way (Co: hmm). No, I had to have an affidavit from my boss at work to state why I needed a work license, why I had to have a work license for my livelihood. And then I thought, oh my God, I have to go and tell my boss that I was picked up during working hours in the middle of the day for, DUI. How do I explain that (Co: hmm). So, um, I, I had to, the hearing was a few weeks down the track and I left it for as long as I possibly could, you know, I would wake up in the middle of the night sweating, crying because I was, oh so worried and so nervous that.Continuation responsesThe minimal responses in this section were to show Marian I was aware of her continual rationalizing and further along I reflected back to Marian how she may have been feeling after she was pulled over for DUI.Counselor ScaredReflection of feelingI wanted Marian to know that I understood how she might have been feeling.Client Oh, scared out of my mind (Co :hmm). What am I going to say, how am I going to explain this. Plucked up the courage to go and see my boss, made up the excuse that, gone to lunch with some friends, didn’t realize that I’d had too much, got picked up on the way back (Co: hmm). She was very good about it. OK Marian, it could happen to anybody but you do understand that this could be grounds for immediate dismissal. Yes Lynette, I’m so sorry, it won’t happen again now that I’m aware of what my limitations are (Co: yeah) it won’t happen again. Thinking in my mind, Marian I cannot believe you are getting away with this. Maybe this is some sign, somebody’s giving you another reprieve. Give yourself a break Marian and stop (Co: hmm), otherwise the next time it could be jail, so she signs this affidavit for me and I thought, gone to court the second time and they had given me this work license, gone and, another thing was, and I shouldn’t be saying this because I will get into heaps of trouble, wasn’t allowed to drive my car from the station to the transport department to get my license changed, have to catch a cab. Alright then, yes, yes your majesty, I will go and get a cab. Um, your worship, I’ll get a cab and go and get my license changed now. As soon as I walked out the door I got back in my car and went, drove to the transport department (sigh). All these things I did, I, I can’t believe that I’ve done them I can’t believe that I’m sitting here saying all the things that I’ve done. So anyway, I’ve got this work license no problems. All of the time David never knew anything (Co: hmm), $300 fine, paid the $300 fine. Didn’t well, well that was at that stage but, um I said to, to the clerk, clerk of the court, is this the only paperwork that I will get. Yes this is the only paper work you will get. I’m normally very strict with checking the mail when I go home so there, if there’s anything like my, if I got a Mastercard statement that’s got something about a liquor barn on it (Co: ah right) that goes straight in the bin (Co: OK), burn it whatever, so Counselor Very secretive about it, yeah (Cl: yeah)Reflection of contentI was letting Marian know that I was aware of her behaviour. Client Very secretive about everything (Co: yeah) or, um, um, certain, like credit card..Counselor Things that would incriminate youReflection of contentI wanted Marian to know that I was aware of the extent that she would go to, to hide her drinking. Client That’s right (Co: yeah), I got them being sent to work now (Co: right). David will never know (Co: yes), he’ll never know. So anyway, I’m believing that everything was fine, um, the courts, they sent just a duplicate in the mail (Co: ah right). David went and got the mail this, that afternoon and he said to me “what are you getting from the magistrates court Marion”. Oh, the blood just drained from my face. I thought, oh no, how am I going to get around this one, how am I going to ….oh it’s just something for work, just something for work, cause I’m in and out of court with my business (Co: ah right), um, I thought, just something for work, and I picked it up and just went down the bedroom and shoved it in my bag and I knew he’s not going to leave it like that. Came out and tried to change the conversation, you know, got involved with the children and everything like that, the children went and had a shower and everything and David said “what was it Marian”, and I said, oh, it’s nothing, nothing you have to worry about. Marian, what was it. I thought, well he’s going to hound me, he’s not going (Co: hmm) to let up until I tell him. Took a deep breath, I said alright, I got picked up for drink driving. Well, the color just drained from his face (Co: yeah) and he said “Marian”, he was angry, I could see he was angry, I could see he was angry (Co: hmm) and I felt his pain (Co: yeah) and I felt, felt really, really bad, and I, I, he’s, he’s, if you know David, he is the, the most gentle most kindest and wonderful person that I, I…Counselor Felt shameReflection of feelingI reflected back to Marian how she must have been feeling. Client I felt shame and I felt (Co: yeah), I felt the pain in his heart (Co: yeah), I really did and I, I felt really angry at myself and, and it, we actually sat down, he, he didn’t raise his voice that night or anything like that, he sat down and we, we had a really good conversation (Co: hmm) after the kids went to bed and, you know, he’s talking in a really nice tone and he just says, “Marian, what are we going to do” (Co: hmm). “You’ve got to do something. I said, I know David but just, I don’t know what to do, I don’t know where to go or what to do, and, um, again, you know, the, the next day came and the next day came and went and I must admit I wasn’t drinking every single day (Co: hmm) at that stage but then come say March when, you know, the guilt’s gone out of my head (Co: yeah), you know, I went through the guilt trips for about a month after the drink driving, but then I went back on my merry way again and started, you know, as much as I like thinking well, David hasn’t commented on the fact that I have been sober for the last 3 weeks (Co: hmm). If he’s not going to compliment me on being sober then why would I go back, you know, what’s the point, he’s not saying anything (Co: hmm), what’s the point, nobody knows the difference, but they did, they just didn’t say anything (Co: hmm). I got back into what I was doing again, I did, but, um, it came to a high point where, um, my best friend, my sister, and David all turned up at the doorstep one night, um, I was absolutely bombarded by all of them (Co: right). No sympathy, no nothing whereas I’ve been use to getting all those things. Marian, I know it’s hard for you, you know, you poor thing, you know, this must be so difficult for you and we will help you and we’ll find out more about it and everything like that, and (inaudible word/s), you go, you go (Co: hmm) find out about (Co: yeah) it and just leave me alone for the time being, but not this time. We want you to go do a program, we want you to go and see somebody. Well who, what, where, why. Well within 5 minutes they had the phone book out, you know, the Royal Brisbane Hospital everything (Co: yeah) like that and I’m thinking gosh, why do they make it look so easy, I could’ve done that (Co: hmm). But I didn’t want to (Co: no, well that’s   right), I didn’t want to (Co: yeah). So, the next morning, I, I can’t go, I got, I’ve got work on tomorrow, both the ladies who relieve go on holidays. Marian, get your priorities straight, it’s either your family or work, and I said, I cannot go, I cannot physically go anywhere at the moment. I can’t take even a day off. Well where are your priorities Marian. All the while David’s sitting in the background with eyes wide open like saucers not saying anything, with two girls, my sister and my best friend yelling and screaming and everything like that. Fine, I’ll just go and kill myself, OK fine, go do it, go do it, we’re sick and tired of you now, the girls don’t need this, David doesn’t need this, just go and do it (Co: they had it). Pull it off, put us all out of our misery, just go and do it. And I found myself standing there thinking, oh God, now what do I do. I don’t really want to go and kill myself but I want, I want the sympathy back again. Counselor So what, they were kinda calling your bluff.Closed question.I wanted to see if they were calling Marian’s bluff however what I should have said was ”you were trying to bluff them Marian”. Client Well yes, no, they were deadly serious, no, no, and then you know their (inaudible) ….David say something, say something cause I’m standing there in tears, looking at David.Counselor Come to your rescue Reflection of contentI wanted Marian to know that I was aware of what she wanted from David.Client That’s right, come and help me, you know, their, their bullying me, come and help me here David, you know, you’re suppose to be on my side, come and help me (Co: hmm) Marian had arrived at Logan House, a therapeutic community, 24 hours earlier, hence, there was the possibility of two presenting issues. The underlying concern was how well Marian was coping with being at Logan House, and was she going to stay. Although Marian appeared to be in the action stage of the ‘stages of change model’ (Prochaska, Norcross & DiClemente, 1994) I wanted to ascertain whether she had any ambivalence toward remaining at Logan House. I wanted to explore whether Marian may have engaged in any discounting regarding the severity of her problem. For example, I do have a problem with drugs however it is not bad enough to warrant me staying here. I also wanted to know whether Marian, a self-referral client who was free of any legal conditions, had made a commitment to the action stage or reverted back to the contemplation stage (e.g., I need to do something about my problem, but not at Logan House) or perhaps even the pre-contemplation (e.g., I don’t have a problem, especially compared to other people here). I noted during the first 5 minutes of the counseling session that Marian had experienced a broad range of affective states, had at one point since her arrival become ambivalent towards remaining at Logan House, and had used a decisional balance technique to reinforce her commitment to the action stage of change. At this point in the counseling session I did not feel that motivational strategies were necessary and may have been viewed by Marian as the counselor not reflecting active listening skills considering Marian had identified important personal incentives for remaining at Logan House and had already experienced some positive benefits after attending her first class. The second issue discussed in counseling related to Marian’s use of alcohol. I cannot recall feeling any ambivalence throughout the entire counseling session as I have counseled women previously and, in relation to Marian’s drug problem, I currently work in the drug and alcohol field. I was however uncomfortable with the setting for the counseling session as it was basically a rectangle room with sliding glass doors so that we were both, to a certain degree, visible to other residents passing by, and there was no other furnishings in the room apart from the two chairs. The room had a somewhat sterile feel and the design of the chairs, which were positioned at a slight angle to each other 3-4 feet away, limited the chance to implement all the micro-skills posited by Egan (1994), especially the open posture and learning forward. I opted instead to mirror the clients body language, which was one leg crossed over the other. I found it difficult to summarise all the important points disclosed by Marian other than to use continuation responses as I was conscious of Marian acknowledging her own ambivalence, resistance, and rationalizations for her drinking. I think we went through the preamble, getting started, and active listening stages of a counseling session. I think that the development of the therapeutic relationship began earlier during Marian’s phone assessment for eligibility to the program. I began the session by inquiring as to how she was settling in at Logan House which may have been interpreted by Marian as a genuine concern for her well-being. My initial decision to start from where Marian had migrated from Scotland (page 4), although very directive, allowed Marian to be in control and begin at any point in her life. I noted that, although I felt comfortable providing the continuation responses, it was very difficult for me to respond to some of what Marian was saying because she seemed to be letting it all out. I was aware at times of hoping she would pause so I could have some input and when she did I was caught of guard and I struggled at times with some of my responses suggesting that I was not fully with the client. I did not notice any dissonance between Marian’s bodily behaviour, facial expressions, or voice-related behaviour and the content of her disclosure throughout the counseling session. In addition to employing micro-skills (e.g., active listening and attending skills) and counseling skilss (e.g., reflection of feeling and content, open-ended and closed questions) I feel I conveyed to Marian that I was present through my body language, facial expressions, and voice-related behaviour. (e.g., tone of voice, laughing). While empathic responses such as of reflection of feeling were minimal for the most part of this counseling session, I think that the counselors tone of voice, albeit it in the form of continuation responses, can also convey empathy to the client. I came to the conclusion that Marian was indeed in the action stage of her recovery. Marian had pointed out that she had a lot to lose (e.g., friends, family) because of her drinking however her concern for her health and her acknowledgement that she was an alcoholic indicated to me that she was taking action for Marian as well as significant other’s in her life. As Marian told her story I noted that, although she had been the reluctant, rebellious, and rationalizing precontemplator, she had passed through this stage into the contemplation stage. The drink driving incident and the anger and shame that Marian felt, due to the effect that alcohol was having on her relationship and her behaviour, were motivating factors for Marian moving from the contemplation stage to the action stage where she refrained from drinking for 3 weeks. Although Marian relapsed back into the contemplation stage and continued drinking, the confrontational tactics used by her husband, sister, and best friend were undoubtedly a significant factor towards Marian moving back into the action stage. The turning point for Marian was when she threatened to kill herself and although her sister and best friend challenged her, I believe it was David’s decision not to intervene that prompted Marian to finally realize that she needed to take action, and the decision was up to her. In closing, I feel it is just as important for the counselor to realize that his client is motivated as it is to employ motivational techniques when there is no evidence to suggest that motivational strategies need to be adopted. Marian acknowledged her ambivalence and resistance throughout the session. Furthermore, the resistance was especially noticeable in the final confrontation with her sister and best friend when she first argued that she was needed at work, and then when she threatened to kill herself. The only changes I would have made would have been to provide a better setting for the session, be less directive (e.g., from when she was two years old) when starting the session, and be more articulate with my reflection of feeling and reflection of content responses. References Egan, G. (1994). The skilled helper: a problem-management approach to helping (5th edn.). Pacific Grove, California: Brooks/Cole Bibliography Geldard, D. (1989). Basic personal counselling: a training manual for counsellors. New York: Prentice Hall. Jarvis, T., Tebbutt, J., & Mattick, R. (1995). Treatment approaches for alcohol and drug dependence: an introductory guide. New York: John Wiley & Sons. Nelson-Jones, R. (1983). Practical counseling skills. London: Holt, Rinehart & Winston. Chapter 4: The initial session and beginning skills (pp. 65-90). Nelson-Jones, R. (1982). The theory and practice of counseling psychology. London: Holt, Rinehart & Winston. Chapter 11: The fundamental counselling relationship (pp. 208-243). Pease, A. (1987). Body language: how to read others’ thoughts by their gestures. Avalon Beach, Australia: Camel Publishing Company. Price, J. & Young, R. (1996). The usefulness of treatment. In C. Wilkinson and B. Saunders (Eds.) Perspectives on addiction. Perth, Australia: William Montgomery. Prochaska, J., Norcross, J., & DiClemente, C. (1994). Changing for good: a revolutionary six-stage program for overcoming bad habits and moving your life positively forward. New York: Avon Books. Prochaska, J., & Velicer, W. (1997). The transtheoretical model of health behaviour. American Journal of Health Promotion, 12 (1), 38-48.