essay 2 december 29th

    

How I Work Within My Placement

1.     How I work within an ethical framework

2.     Codes of conduct at my placement

3.     What service level am I working at?

4.     Legislation or legal issues I have encountered?

5.     How I feel about my setting and my role

The most striking thing in my placement is the short-term nature of the sessions. They end quickly. For that reason I have found that in every session I need to remind the client where we are, so that they have a reminder of the time left. This can be crucial in terms of not opening them up with any work we cannot deal with in the time available. Also it is very important in this particular setting to be mindful of the additional resources that clients have in and around the university and Plymouth in general. For example I have reminded clients to be registered with a GP and then this opens up access to local mental health services such as Options.

I only have to look back at the first client I ended with in this placement to know that the relationship can develop very quickly between client and counselor and can create a sense of loss in the client very quickly, when we came to end. One client “O”, saw me for six sessions and in these sessions he shared with me some extremely intimate details of things he was struggling to contend with. I was able to begin to offer him acceptance and non-judgment. I feel that this relationship became very important for him and he was very sad when we had to bring it to an end. In fact as was I, given we had begun to make a difference for him. I offered him a follow up in order to check in with him at a later date. For me the role is really about meeting mostly young adults in this hugely vulnerable time, moving away from him and embarking on their first freedoms. I see my role as a support and a safety net for them to try to understand what on earth is happening to them. I feel that its barely enough, six sessions.

6.     Therapeutic boundaries I set and maintain with my clients

When I am seeing my clients at the university for the very first time, I know that they have already had an induction from a senior member of the team, however I have yet to meet them. When meet a client I am clear about what my role is. I state openly that I am there to listen, to offer a non-judgmental space and to help them to try to understand themselves and what is going on for them. I do my best to unpack the person-centered approach in non-jargonistic terms such as those because it is crucial for the client to know what it is I offer, but also and equally important, what I cannot. I do make clear that I am not a source of advice as I suggest that our time together can be spent understanding and making sense of things, so that things become clearer, hopefully.

What I have found so far is that students, being largely of a certain age group, can be quite hopeful of guidance. In some senses so far they look to me as the expert, which is something I deliberately have reminded them subtly that I am not. I am easy going about how seeking advice can often seem like a good idea, so this enables the clients to feel ok about testing that out. But I am pleased that on reflection this is something I have never strayed into doing.

7.     How I use supervision and contract reviews to ensure I remain focused on my clients

At my placement in the University I receive both one to one supervision as well as group supervision. I use supervision to bring what is going on for me, what has come up and to voice what I have done or said in terms of practice, to check this all out. I feel that I am able to get my learning needs met as I feel very able to bring anything to these sessions. I learn from the supervisor as well as am able to take something from the other counselors in supervision.

It is a completely brand new situation with every client and so the role of going to supervision to affirm what I am doing or learn what else I could have done for future reference is vital. I am fortunate to have supervision at the end of the working day, and group supervision to attend at the beginning of a working day.

In terms of staying client focused the supervision is vital as I can check out my interventions, to ensure that are supportive for the client. Last time for example I was able to share that I had felt that I had ventured into an almost rescuing role, which may have made the client sense that his distress was not ok to feel. I needed to check this out and was reassured to some extent that what I had said was compassionate, but at the same time perhaps it would be better for the client for him to have sat with his sadness.

I always check out what a client want to use the session for, with a very brief summary of what we have achieved so far. I feel that reviewing the purpose of our meetings is especially important when using such time limited sessions, as I have a maximum of six sessions with each client. With a client this week I reminded him that they brought anxiety and sadness when they first came, that we had begun to explore where this might be originating from but that they had mentioned being bullied in school last week. Did they want to use our session for something new or to review what we have looked at or explore what had come up for them in the last session? It has to be the client’s session by design and by choice.

8.     How I evaluate the effectiveness of my work

The most obvious way to evaluate my effectiveness is through my contact with clients. That they return is somewhat encouraging at my stage of development and I am certainly pleased that this is the case, to date. Another form of evaluation is that I tend to get a sense from some of my clients that we are making progress. I can review where we have come from and what we have achieved and between my sense of what is going on, and the clients words often, their lies a qualitative feedback on effectiveness, or lack of. Beyond knowing that I am being boundaried, applying the core conditions and treating my clients with respect, there is a confidence growing in me that this will be effective.

In terms of quantative data, I use the CORE 10 forms. They are relatively quick and unobstructive to every session. They cover some elements of risk and harm, which I certainly focus on, but also they ask the client to score their anxiety and mood. By referring to this after it has been handed to me I can suggest to the client that they are making progress perhaps, and ask if that’s how they see it. But on its own the CORE 10 score is rather a blunt tool of course. It must be used with a measure of knowing that a snapshot score could be momentary or not really accurate of the bigger picture, hence why I always ask if that’s what it really feels like to the client.

Further to this I talk about my clients in my regular supervision and group supervision sessions at the university. Its very interesting to hear others in the associate counselor team’s feedback on my presentation of the client, their issues and what others think would be ways forward. From this time I can make some assumptions as to the effectiveness by inference as often the feedback will be supportive and highlight a sense of agreement as well as growth.

9.     Evaluative tools which are used in my placement to assess outcomes

In the University we use the Core 10 forms at every session. These give a snapshot of how the client has been feeling over the past week. It ask for various emotional scales for anxiety, sadness and quality of sleep for example, as well as assessing risk of harm to self as disclosed, and when the ten questions are added together it gives an overall score out of forty. I find it useful for several reasons. 

The core 10 gives the client a moment to think about what they are bringing to the session, what they are feeling going into the session and I use it to ground them somewhat. While they are using it I myself have that moment to pause and bring myself back into the space I feel I need to now listen to them, as I will have just been to fetch them from a waiting room and walked them through the building. Then we can look at the results together.

A client who has scored significantly on one of the ten questions makes me feel that we should at least offer this up and jointly take note. Scoring highly for sadness or anxiety would mean that I definitely am minded to hand this to the client to see if this is something they want to bring to the session. In terms of the data stream, a change from week to week of ten points or more is something I might also note with the client, as this is considered statistically significant. Also any score above twenty-five is entering the moderate to severe realms of psychological well being. This would mean that the client is rating himself or herself as not doing well, which in itself is significant. While I’ve yet to work with clients for long enough to collect enough data to measure outcomes, this would also be a useful tool to mark if the input of counselling was making any significant changes, by this measure.

References

·               Lees-Oakes, R. (2011) Person Centered Therapy. Available at: https://www.youtube.com/watch?v=6ySUml2Cxmc (Accessed 8 March 2016).

·               Lees-Oakes, R. (2016) Critique of Carl Rogers, Counselling Tutor [Podcast]. 4 March 2016. Available at: http://www.counsellingtutor.com/category/podcast/ (Accessed 9 March 2016).

·               Mearns, D & Thorne, B. (2007) Person Centered Counselling in Action 3^rd Ed. Sage. London.

·               Rogers, C. (1961) On becoming a person: A therapists view of psychotherapy. Amazon.com [Kindle]. Available at: http://www.amazon.co.uk/gp/product/B005DKRFLO?keywords=carl%20rogers%20on%20becoming%20a%20person&qid=1457516697&ref_=sr_1_1_twi_kin_2&sr=8-1 (Accessed 12 January 2016).

Learning Journal 50

50 journals!

This week in my placement I saw 2 clients for the final time. They both were very different sessions in so much as one was quite underwhelming and the guy pretty much wanted to shake hands at the end and go. The other was a little more connected, a little more important and a little more like it was something we would both miss. Clients are different. Looking back these 2 sessions went entirely to a predictable ending script. Both ending left me wondering about what it is that I had achieved, if anything, and how to respond in my self to the feedback that the clients had left.

The first ending was quite matter of fact. I tried out something that Tony the tutor had touched upon in a previous session in college, that we should acknowledge the ending, so I tried this out. I feel that I made more of it than it really was for this particular person. That we would never ever meet again in this space and time was perhaps an overshoot for this semi-alpha male who really had come to the end of my usefulness anyway. That I didn’t use immediacy was the problem I feel, looking back, and say just this.

When working with this client, throughout, I had a large amount of personal resonation with his issues. R, the client, had arrived with presenting issues around his biological father coming back into his life and over the six sessions we had compartmentalised that and he had moved on. We had begun instead to unpick the person. This is something that I am starting to do a lot with clients. I wonder if it is a habit, a leaning or a bias in my practice?

Anyway, in exploring the person and his traits it transpired that R was quite the outsider. He lacked trust for others and struggled with social situation, especially large groups. While this is all perfectly understandable from a personality perspective perhaps he went much further and I began to find it uncomfortably like my own experiences.

R described having a very analyitical mind, constantly evaluating others in a cost benefit methodology. This I know as extremely wasteful and tiring and resource heavy, making social interactions very draining as I recognised his description of not really understanding the point of many encounters. He tired of nights out and made excuses not to attend. He liked his own space to just be. For him to be in large groups was tiring and undesirable. That’s me too I screamed, inside! I know! I know that! But I couldn’t say anything quite so direct. I felt that would be needy of me and create some sort of weird dynamic. I am here to listen and to reflect in a way that helps R make sense of himself, not to be partners in crime.

I wondered if R might too benefit from simply realigning his acceptance of himself as someone with a lot in common with those on the aspergers spectrum, albeit at a level that was very easily hidden. That too seemed like a step too far for me. To suggest or even use the terms seemed like a walk down diagnosis lane, and I know that’s a breach of the rules and my training and expertise.

I did wonder for a time about how I could possibly go with a client to places that both resonated with me and that in many senses I had not come to be at ease with myself. With R talking about such similar experiences of being an ‘outsider’ and on the periphery of his social group was an allied journey for me. However, dipping into Yalom’s work does much to ease my angst on this. He states that ‘to take someone further than a therapist has been’ was not really a worry. It is entirely ok to be a witness to changes that may be far beyond what the therapist has done. I feel that being entirely person-centred and going with them, it could be entirely safe for us to explore an understanding and level of self-awareness that I clearly do not feel I have. I would have admired

To go back to the ending with R I found him quite difficult. I was somewhat relieved to see the back of him actually as he didn’t really want to engage with me in the last session, it was a formality in some respects I felt. That made any special treatment of the ending quite false and overkill. He’s going to be ok I thought and good for him that he is having these contemplations now so that he can begin to come to terms with who he really is. This he must do in his own way, not mine.

Reflecting on how useful my interventions have been with R, I would have to say that the fact that we have six sessions as a maximum is something that drives a focus to the work. We have travelled between us through several issues and come to begin to explore him, as a person. The goal of the university counselling team is, rather particularly, to keep the cash cows grazing. That’s an underlying conflict to me,no matter how the staff re-present it. While I feel that by helping this client stay aware and in control by being listened to, this goal has been maintained. Is it a satisfactory process for me as a therapist, no. However, I have succeeded in my job of keeping the cash cow at Uni.

Another client, NV came to me some 5 sessions ago with the issue of anxiety over a speech impediment. She was having serious anxiety attacks when going into certain lecture rooms and was extremely worried about her impending presentations. We have spent 5 sessions getting to know her in more depth. I have been able to use that time very well with her I feel as yes, we’ve validated the anxiety and taken her feelings very seriously. She has been grateful to receive this authentic validation I feel. To evaluate how far we have come is tricky for me. We have not had the environment nor I the training that could actually help her speech impediment in any way. This is not really something that she came for anyway, just the anxiety. At times this has become higher and the very day before her last session this week she had another attack. In that sense I am not assisting with the management of her anxiety attacks. What I have been able to do is make her experience very real, not dimished and further, asked her about her. The person behind the anxiety, who is she?

I sensed that it has been extremely liberating to share space and time with me to talk about ho she feels, what she wants in life and her wider interests,. She is so much more to me than a girl with a stutter. I would like her to know this for herself. This is my goal for our sessions.

Another boy, OK has now finished with my sessions. He had shared with me and the counselling team how helpful he had found the sessions as I ‘got him’. He was able to open up about many issues in such a way that surprised me a great deal. He was another reason I had looked to Yalom’s book to reassure myself that I could support someone who was going through things that I doubt I would have the courage to share. If a client goes further than we have, is it safe to support them? Is it possible to support someone who is going through such emotional vulnerability in front of another person, when I myself am likely not ready for that exposure. Well, to evaluate ones practice by realising that such things have been achieved is a gratifying thing to do, but also something that needs to be taken with caution. This one went well. This client moved forward, felt heard, felt listened to and not judged. Ben, you’re doing it. But how come that client went well? What did I do that made those sessions ‘work’ for the client in this agency setting?

Surely there’s something about me in a University setting. It’s a very exciting place to work and I am enthused to support this client group. Also I have taken on board the 6 session limit and been mindful of the need to focus and mark the passing of sessions and the need to prepare a client for the ending. But it’s a little more than that. When I am with clients here I am very caring and interested and I have noticed I truly validate there experiences. I sense that in such a young client group that may have lacked external validation through much of their lives to this point, this attribute of mine must be a useful addition to see in a man.

Learning Journal 51

We had a skills session this week. I used it to focus on a criteria I still need to tick off, the 4.2.3. I had never really tried to hit this in a skills session before and it showed. The ‘what lies behind’ or ‘unspoken’ agendas seemed to be quite a challenge to get out in a 15 minute session, although it was possible.

In my sessions with clients, in university and college practice sessions, I suspect that I have fallen into a comfort zone of relying on empathy and UPR. For me the relationship has been absolutely key, and really understanding the person has come first. Now I really feel that it is time to look beyond that.

I had a client who brought a lot of feelings such as frustration and fear and loss at his current predicament, finding work less enjoyable as the team ethic had been replaced by ruthlessness in the workplace. I was very able to follow the individual feelings and was very able to be with the client in his experience, but then to take counselling ‘to another level’; I feel that I need to be able to focus on the underlying feeling, which was hinted at. There were a few chances to catch something stronger, a fear in the client, and I missed the importance of this.

This disappoints me as I want to grow into being a better counsellor and I feel that I have many of the basics, but have stagnated somewhat of late. This concerns me a little as it very much typifies my experiences through life. To find myself achieving something fairly easily, but not know how to improve or apply effort, and so getting left behind.

Getting left behind I would say describes my experience growing up. I found all studies quite easy at first; all subjects and all activities come fairly easily to me at a basic level. There are very few things I cannot pick up quite quickly. This is not such a blessing.

Finding school or music lessons very easy as a child does not make for a good future. All it did was train me to not know how to apply effort. I have always struggled with endeavour and work, beyond a certain level. This really impacted me as going into ‘A’ level studies for example left me woefully prepared compared to many of my peers as I have never learned to ‘work’. As ever the mantra is being aware of this is half the battle, but it is something I carry with me in a regretful and slightly fearful sense even now.

I wonder if this is something that is beginning to happen too in counselling. Have I dropped the ball? Am I allowing being good at empathising and confident with people to be enough? Should I not now be looking at how I can improve? So in the skills session I want to be able to pin point the emotions that really matter to the client, and brush away the easier and more acceptable smokescreens that they bring. That being said, it was only a 15-minute session and much of that is client story. To give someone a chance to speak is fair enough I think, and to cut in with things in this initial session is quite challenging. Given time with the client I feel that I would get there, but of course, in the exam situation we will not have this.

I saw 4 clients this week and then had supervision.

One client I saw for the last time. NV had been a gift to me and remains special as she was my first university student client. She has a speech difficulty and is struggling with anxiety. I was perfect for her really as there was no hidden agenda, no secret task to uncover, just that, anxiety. She was grateful to have a person-centred therapist to hear how it was for her every week. I offered he that safe and non-judgemental space, and that was all. That part I’m good at. Not every client has a hidden agenda so I’m confused as to why the exam demands we enable clients to speak about hidden ones. Maybe some people do not have a hidden agenda.

The other three clients I met all for the first time. One was a client who had come to vent, as he clearly wants to leave his course. My role is to listen to that, that is all. Again I’m not needed to look for the hidden agenda here either. This is real life, not exams. People come with all sorts of different reasons for counselling, not just to speak about the unspoken.

Another client I met that day was a struggle for me. She was a client who seemed to present with both a very minor issue, so I was left feeling what is it you want from counselling, but also something else. She was highly nervous in being around me and sharing anything. This presented the second difficulty.

This client is beautiful, she is clever and successful, yet she has a physical problem right now and it is clearly having a massive impact on her. But yet she didn’t really want to tell me much more than that. I was left kinda wondering if I had created an environment whereby she could trust me enough. Should the work be to create that environment or talk about what it is in the room that is a barrier? I don’t know. I’m meeting her again next week. But secretly I hope she doesn’t show up, as I do not know what I can offer her. Unless exploring the environment so she can open up is the initial step, and then to perhaps see if she would like to share more about her worries and concerns. I think I have been guilty of not going deep enough into what she has described. The pain that she is going through as her knee ligaments are damaged is stopping her socialising, going out, shopping and dancing and exercising. This has massive knock-on effects, but this is rather stoic about this.

There may be something in her Polish nationality or Vietnamese background that doesn’t lend itself well to opening up, but then why come to counselling? Maybe we can explore that too.

I spoke about my career option in supervision this week. My supervisor couldn’t give me any clear advice, and that is starting to feel a theme in counselling. However as it turns out most of the jobs I hear talked about or the one I have seen advertised require 450 hours client time. Knowing full well counsellors will have to achieve that off their own bat, that assumes 450 voluntary hours I can only see. That’s a huge commitment, to a job that doesn’t pay well for that kind of investment. I am left feeling quite defeated by this. How can I justify to my children spending 2 more years of Saturdays giving my time up for free, to then be able to apply for, not get, apply for, work as a counsellor. Lola will be 7 years old by then.