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.
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) had not helped. Another contributing factor were, staff attitudes toward the client. These were mostly negative. One member of staff said, " Good luck with her, you will soon find out, she's beyond help". This influenced my perception of Carol, making me negative before the fact, which served to make the task of being client centred more complicated, consequently making me more determined to understand this accepting 'way of being' described by Rogers (1989).
What is a client centred approach?
Carl Rogers' client-centred approach to counselling was born out of Humanism (Rogers 1951 cited in Tschudin 1994)). Thorne (1990) states that Carl Rogers believed that what mattered, was the kind of relationship he offered to his client, nothing more, and nothing less. His approach, views the client as the expert. That is to say that, only they can really know what is good and bad for them. It stresses individuality, offers the client the opportunity to take control of their own life. The client centred-approach believes therefore, that the client is capable of finding their own way through their problems believing that in, everyone there is a potential for personal growth and change. Carol has been in the services for 20 years, only serving to deepen the layers of defences she has put in place to protect herself from harm, thus burying this ability to grow. He also holds strong belief in that counselling is not a way of modifying behaviour (Burnard 1999). The question remains how do we create the correct environment? Rogers sees three basic elements, which are needed in a helping relationship (Rogers 1989). These are his core conditions.
Congruency seems to be something that is gradually achieved. Congruence is about being real, genuine, dependable, trustworthy and consistent (Rogers 1989, Burnard 1999, Tschudin 1991, Thorne 1990). Rogers (1989) would advise that whatever feelings or attitudes I may be experiencing, I must try to be fully aware of them, in order to be congruent. He also states, that there is much research, which supports the concept that the congruency of the counselor is beneficial in creating a therapeutic relationship. In interactions 28 & 29 I was feeling frustrated and angry with Mrs. X. I recognized this at the time and expressed it through, reacting to her behavior, not by trying to understand the underlying feelings that were making her behave this way. Tschudin (1994) suggests that when feeling annoyance with another and not acknowledging or recognizing it, then the client will begin to see your verbal and non-verbal communication are not in harmony. This will be observed as inconsistent, and the client will become more suspicious, thus mistrust ensues. Rogers (1989) calls this 'transparency', or in my own words 'see through'. This is what it is to be incongruent. Maybe in 28 & 29 I could have been more honest with Mrs. X and said " I am feeling frustrated and angry because you are willing to walk away, without explanation". On reflection, my frustration was already established prior to the interaction, due to the content and outcome of other interventions, along with staff attitudes towards my attempts to help. I did not address these issues. Therefore I allowed myself to be incongruent. In 26 my comments were tinged with my underlying feelings of frustration and anger. I was beginning to become transparent. Maybe it was this factor, which played a part in making Mrs. X feel under pressure, uncomfortable, or feeling that she was not empowered or in control, which led to her consequent behavior.
This is the ability to understand the client's current situation from their point of view (Tschudin 1994). This requires the counselor to be not only able to listen effectively and gain an accurate perception of their world, but to also be able to communicate this to the client (Reynolds & Scott 1999). Rogers (1989) suggests that to understand it, the reader should view it as walking around another person's world, while communicating some understanding of it, of which the client may only be dimly aware. In 5 I missed the cues, which indicated her need to talk about her current feelings. If I had of been listening I would have recognized this and focused on those feelings instead of challenging her to search for a cause of these symptoms. If we had explored her feelings together, maybe the cause could have been found in her own way, and at her own pace. Again in 11 & 12 I missed what appear to be cues. She repeats the phrase 'at times' twice. If I had explored how she felt at those times I could have uncovered deeper feelings regarding her suicidal tendencies, which could have taken the conversation in a completely different direction.