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The four counselling sessions documented within this case study originate from an in-house GP referral in January 1999, for a client with psychosexual difficulties.

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Introduction

CLIENT CASE STUDY MSc COUNSELLING PSYCHOLOGY YEAR ONE Student no: 9503992 Due date: 24th March 1999 Word count: 3245 The case study will be presented within the following structure: * INTRODUCTION * DEVELOPMENT OF THE THERAPY i) Key content issues ii) Therapeutic process iii) Difficulties in the work * REVIEW * REFERENCES INTRODUCTION The four counselling sessions documented within this case study originate from an in-house GP referral in January 1999, for a client with psychosexual difficulties. The client had identified her problem as a lifelong failure to achieve orgasm, but felt this physiological problem may have a cognitive aetiology. In the interests of receiving the client with an open mind, I did not read her medical history and, after consideration, chose not refer to specialist literature on psychosexual issues as I felt such knowledge would not be predictive of the client's experience. I was aware of my 'trainee' anxiety and was wary that if I encountered any confusion with the client's behaviour, I may grasp onto an inaccurate interpretation from specialist literature. The sessions commenced in February and took place over four weeks at the counselling unit within the surgery. The client did not want to be audio-taped and I began by setting out the contract; an initial structure of six-eight sessions and then review. (Trust policy allows for flexibility on number of sessions.) The confidentiality excluded only suicidal ideation or threatened harm to another individual. Introducing client-centred counselling, I explained the emphasis would be on a relationship of shared power and control, rather than my use of therapeutic techniques or interpretation. The client's aim for therapy was to want and enjoy sexual intercourse with her husband, as throughout the marriage she had sporadically consented to have sex without expectation of enjoyment. Her aim marked the beginning of a shift from an external to internal locus of evaluation, as since adolescence she had not trusted her organismic self. ...read more.

Middle

I believed that the client's experiencing of warmth and unconditional regard was the most important ingredient for the fostering of trust between us, and that my communication of positive regard lessened her feelings of alienation; from self and others. Lietaer (1984) uses the term counter-conditioning to describe the process of the counsellor's unconditional positive regard breaking down the link between meeting conditions of worth and being valued. In session four, the client had described the level of emotional support she received from her husband, and through reflection, became aware that his patience and warmth felt time-limited and conditional. It became apparent that our relationship was the first time she had been freely given the time and space to feel truly understood, and was consequently able to articulate her feelings to her satisfaction. Through reflection on my feelings, I was aware of a non-possessive warmth and respect, plus an initial desire to protect. My group supervisor questioned how such feelings might impede/facilitate the process, which I needed some time to consider. I feel my ability to communicate warmth and acceptance to be a personal strength, and believe it facilitated the client's feeling of being valued. However, a potential negative implication of feeling protective, would be to 'hold the client back' through the desire to shield from potential failure or painful experience. I would be concerned if my response to the client was of pity, sadness and a desire to rescue her from her immediate experience. The desire to protect has lessened as the client's appearance of anxiety has reduced. In session four, the client was as low as I had ever witnessed her, experiencing nihilism with regard to her family and job. She did not return to any of the material we had focused on in previous sessions, instead talking about the difficulties with her family and job. On reflection, this could be indicative of her need to gain further strength before moving forward. ...read more.

Conclusion

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. ...read more.

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