Learning Journal 27

This week was largely about a preparatory session for the case study. I think I had course fatigue throughout the day and this spread into my working week also, a general need for a break right now. But also the week has been about my development in my placement role at Chy, as well as thinking about how I could stretch myself with another placement as the possibility of one at the University does appeal. Now I have accumulated 30 hours it’s a possibility for September and would save me a lot of travel time. I definitely would struggle to do both placements. What I struggling with this week is drugs and alcohol clients. All day every day drugs and alcohol clients. On placement and in work. I have thought about when I can book a holiday next. In May.

7.2.2. & 7.2.3.

Supervision & Placement

Before the supervision session as ever I identify some key things that I want to talk about. They may be things that have come up about my responses, my feelings or just looking for advice. I make a note of them because it means I get the most out of the session. I enjoy just talking to my supervisor but it definitely helps to target the hour. I generally sit down on the way home after the sessions and make quick anon notes in MacDonalds.

I brought several core issues about my practice rather than individual incidents, which had figured largely in our previous encounters. I brought the general feeling that I hadn’t got a clue what I was doing. My self doubt. My lack of knowing if I was making a difference and my need to feel that at this stage at least I was doing something positive in my role in Chy. I am up to 30 hours in placement now and while in many ways I feel ever growing in confidence I also recognise that I am questioning the very thing that I am doing. I’m adding more measured and professional techniques such as the ways of responding or phrasing something that my supervisor might give me – I often write these down just so I remember the sentiment but ultimately I need to find my own voice - but sometimes I feel like I am just there, present and listening attentively and this causes some doubts. Is this it? Weeks and weeks of theory and I just listen?

The feedback from my supervisor on this was that he checked out what I was doing by way of checking out the core conditions plus the relationship I am forming and he was kinda satisfied that I was doing everything I needed to do. This made me feel better. What I went away with though was a way of actually measuring the client. He handed me a CORE OM or CORE 34 tool. This is to be used on clients at the start of treatment, like the TOPS form I’m used to in my drug work. In my field such forms are used as a means of quantifying data and success or lack thereof. As RISE are funded by PHE they need to see a return on their investment. It is down to funding implication and no doubt has been dreamt up by some media studies graduate in Whitehall. However, I doubt any clients ever answer the questions about shoplifting or theft accurately and I do not know why they are in there to be honest. Given that’s how I feel about TOPS, its refreshing to see that I find many more reasons to use CORE 34 with clients.

The CORE 34 measure things for many reasons, so a client and you can see progress or success, hopefully. The CORE 34 measures things like feelings of being overwhelmed or desperate, also it measures optimism and happiness. It divides them up into 5 distinct categories for analysis by the counsellor, and I hope for discussion with the client. The categories are risk (hugely important), wellbeing, problems, functioning and global distress. Now given they are all self-report this throws up understanding issues, mood issues and levels of states of being that may fluctuate and so needs to be delivered knowing that it is a snapshot only. It does also give a reading for how that person is doing in relationships through the functioning score and that could be really interesting to explore. Also to throw up measure of risk I feel is hugely important as it may reveal something that needs to be handed to supervision, it may mean a referral to a specialist worker or agency (I often make referrals to social services or community mental health team for example). Not only allowing you and the client to think about specifics that may have been hidden in the persons subconscious, it also enables you as a partnership to perhaps decide what would be most supportive to focus on.

I tried this in my session on Saturday. I asked my first client T if he would be happy to fill it out, after we’d settled and I had just reminded him of the session, the time and asked him if he was ready to begin. It was our 5^th session. T was very happy to fill it out. I knew he wouldn’t have any issues with the questions as he’s a graduate and likely familiar with the vocabulary. He flew through it. I told him I would look at it later so as not to take up any of his session and hopefully offer him one again nearer the end of our time together if he was ok with that. The rest of the session was very much his.

I found the process of handing it out quite easy. I think that I introduced it as a means of helping the client to get to know where they are really at by asking so many broad questions, but also so that he could bring things into his awareness perhaps. Either way, it was not a test and only for their benefit and would be entirely confidential as I made sure they only put their initial on it.

Looking at the data I collected from my clients that day I am both very aware that such tools are a momentary snapshot, people may be aiming to score on certain things or hide others, and they are quite blunt tools to dissect someone with (H. Lector), but it serves several functions. I can look at extremes and when appropriate ask the client about them, say if they score high on irritability for example. Or it can enable to them to rmember something that may be bothering them and they then feel able to bring it to the session. Further I can be aware of risk factors that may not have come out any other way. If someone feels more comfortable revealing something on a paper rather than actually say it for example.

I think that for now I am happy just to look at the collated numbers under the 5 headings and look at them again after several sessions. Then we could look at improvements or otherwise and get the client to acknowledge that they are doing some positive work, or perhaps it might expand the discussions into what’s really going on. Who knows? Its certainly added another dimension to my practice for sure.

I brought several other things but what stands out also in supervision was that I came with the concern that I wasn’t able to speak to a client, T about his intellectualisation. This was because I wasn’t sure how helpful it would be to even mention it in the first place, whether I was even accurate and then was I going to say it in a manner that was helpful? My supervisor fed back to me some ways of framing and handing back what the client has said. By doing this I am not interpreting what they have said, only handing it back to them.

Following supervision I was able to go into the session with T with a way of handing his own presentation back to him I suspected that would be supportive. I have always found him very ‘headspace’ and not feeling or focussing on his feelings. I totally get that and can relate to it and I know that may be why I have recognised it in him. Anyway, as usual T was thinking about thinking, using sometimes baffling levels of metacognition and leaving me wanting to know how he felt and wanting to help him make sense of that. By applying the confidence I had gained from learning ways of framing what I was feeling when listening to T I was able to use a phrase like “listening to you I am left wondering how you express what’s really you, what’s going on inside, something beyond all these goals and measure of success”. There, what a calm and thought-provoking way in to let T know that I was listening, caring and yet ‘wondering’ something. That is the key word. It’s not invasive and yet probing without probing. It asks the person to help me satisfy a thought that is incomplete. I found it was so gentle yet helpful. Now T did not actually say anything. That’s ok. He paused. He stopped talking for a little, which is not common. I felt uncertain afterwards and rescued him with a comment about it only being rhetorical if he wanted I just wanted to leave that with him.

During the conversations it came to light that I keep struggling with wanting to help a client make sense of their thoughts, as I do of my own. But my role as a counsellor or one of them is to help a client to make sense of their feelings, and that is very different. Armed with that notion, I went into the Saturday session much lighter. So much lighter. It seems easier to help a person to know their feelings, as feelings are so much easier to understand if you listen. I think. ;-)

Learning Journal 26

 This week was dominated by a skills session and feedback. I felt comfortable in my group and actually really enjoyed it. I took it seriously and this made a real difference.

The role play I did allowed me to work as a counsellor with a client from our class. I began a little nervously as I had an audience but actually I was fine after about 30 seconds. However, the issue with working with trained clients is that they can be a bit ‘professional’ and list things that I may have missed. Such as confidentiality. I’m quite confident that I do attend to this normally, but it doesn’t hurt to be reminded.

L brought a very deep and personal subject, which was her inability to connect with male members of our group. This was something that she clearly wanted to explore and I was confident and measured in allowing her to focus on this, but again using ‘professional clients’ brings the issue of them being trained to focus on an issue themselves. I don’t know for sure. I felt ok about the first period of the session. I felt that I provided an environment whereby L could bring anything she wanted without the fear of being judged. I felt that I was attentive and hearing her. I wanted to know more, I am naturally a nosey and curious person and I do a lot of the active listening skills as second nature now as they feel right. I made L feel she could be heard and I was aware of that after the event and perhaps during because she opened up. I do the core conditions. I must do. There is no judgement I am aware of and I want this person opposite me to flourish.

Anyway, the conversation moved through the aspects of her struggles with the men in our teaching group. It felt that there was something missing and that L wanted to connect with others in the group but was held back and this bothered her. It had a negative impact from what she was describing. L went on to say that she had thought a lot about this and felt that it was due to incidences of rape and being attacked by men in her earlier life. That she felt able to express this in front of me was touching and brought us close for a brief spell I felt in so much as there was a trust and honesty there which I hoped to respect.

How I handled this disclosure was not perfect on reflection. I began to offer L the opportunity to explore whether she wanted to take this further however I didn’t get that point across clearly. I think that I was trying to be gentle in that moment. I needed to be firmer as it was a matter of real importance, but at the same time I felt it was a sensitive issue, no doubt. Of course there is doubt. For all I know L may have dealt with the matter in many respects to the point whereby she is done with the approach of whether or not she wants to involve others I don’t actually know how she feels.

It’s obviously a fundamental part of the relationship between counsellor and client that there is trust. The person must feel that you will respect their privacy and maintain confidentiality. This is also a part of the ethical framework.

What does remain with me though is that it was a confidentiality issue as I now had a duty of care to others should they be in danger. I realise that now but perhaps didn’t clearly see that at the time. I did offer to L whether she wanted to ‘take this further’ but that was not clear and I think that L mistook the meaning slightly, I cant be sure. However we did not look into it from a matter of others safety. This affected me enough to take this to supervision and I discussed it there.

Supervision

When I spoke about the issue of what to take further when hearing disclosures in a counselling setting I found my supervisor really helpful. We talked about how its good to stop someone and remind them of your responsibility if they were to let you know certain details or things that led me to believe there could be others at risk of harm. I had this knowledge from other roles, but to hear it in a counselling session would be the same should perhaps have been more obvious than it was. Saying something like “If you name that person and I think that they are still a risk to children, then I will have a duty to report it.” However, it’s really about also caring for the person in front of you as they may have been through a great deal. It will involve keeping it quite loose and not making them feel under pressure, more that we can look together at preventing others from being in danger. It’s about supporting that person and making it all achievable in their own way. This is where the matter of client’s autonomy comes into it. They should I feel be able to be in control of any process, but that you are there as a supporting guide and a supporting companion through any process, be it just a counselling session or in this instance, taking information outside the realms of the room as a disclosure could have meant that you as a pair, a unit, need to now let others know that someone is a danger to others. For this reason, as in the ethical code laid out by the BACP, it is really seen as preferred that the client’s consent is obtained and all part of how the confidentiality breach should be handled. However, in certain circumstances it can be that confidentiality is necessary to be broken if it is to protect the client from serious harm to themselves or others. That is now quite a heavy thing to have to contemplate. Obviously its completely separate from the practice session I had with L, but I have tried to imagine how that would look if I felt that to include the client would endanger someone or them, so I would have to act in their/another’s best interests by informing my supervisor for guidance, an authority figure such as a social worker or the police in an emergency.

In order to satisfy criteria for my diploma I have looked at the relevant legislation, such as the duty of care act, concerning adults.

The Care Act: safeguarding adults

The Care Act 2014 sets out a clear legal framework for how local authorities and other parts of the system should protect adults at risk of abuse or neglect.

Local authorities have new safeguarding duties. They must:

·       lead a multi-agency local adult safeguarding system that seeks to prevent abuse and neglect and stop it quickly when it happens

·       make enquiries, or request others to make them, when they think an adult with care and support needs may be at risk of abuse or neglect and they need to find out what action may be needed

·       establish Safeguarding Adults Boards, including the local authority, NHS and police, which will develop, share and implement a joint safeguarding strategy

·       carry out Safeguarding Adults Reviews when someone with care and support needs dies as a result of neglect or abuse and there is a concern that the local authority or its partners could have done more to protect them

·       arrange for an independent advocate to represent and support a person who is the subject of a safeguarding enquiry or review, if required.

It is crucial to know the definition of a vulnerable adult. Essentially what I feel this act ensures will happen is that once I act and inform the relevant authorities that I am concerned about a client who may be in danger, or who may be at risk of neglect (social services, or the police in an emergency) the local authority have a duty to make enquiries. The act also elaborates on questions a practitioner who is on the front line may seek to answer such as is self-neglect a safeguarding issue. Here as a counselor who has a BACP ethical framework that encourages the client’s autonomy this must be balanced with the decision that the counselor must make about how able that person is to make decisions (given distress/emotions/grief/drugs or alcohol etc) and how much capacity they have. What is very clear to me is the need to chew decisions over with your supervisor and hopefully other colleagues if part of an agency, which I hope to be.

Physical abuse, sexual abuse emotional abuse and financial abuse are all types of safeguarding concerns that I could have in the future for an adult. Domestic abuse is sadly another area of the legislation I feel will come up at some point if I pursue a career in counseling. Again, the act encourages the wishes of the person to be at the forefront of any decisions, however to also be aware that coercion and fear may limit the clients ability to share things or that they may reverse a decision.

I think that I would be able to talk to another adult in the team upon learning of any form of abuse, or obviously failing that go to my supervisor, or even ring the bacp for guidance. In work also I know that you can ring a MASH team for guidance into if that person seems like they fit critieria, so I could sound them out also. Where I would want to be very clear is from the outset with the client about the importance of the limits of my confidentiality. That I was bound by a duty of care and that they wouldn’t want it any other way, one would hope. Also that I would want that person to be aware and involved wherever p[ossible of the potential need to involve another agency and how could we workj together in partnership to achieve the safe resolution of this matter, now they have brought it to the session.

Anyway, with regard to the role play we had I feel that I was on the right lines to ask the client how she felt about looking into this matter further, but I did not follow that through. I lacked the conviciotn and confidence. I think that being more mindful of the gravity of even a classroom role play will stand me in good stead to take these matters in to a professional arena.

This week on placement saw me meet another client for the first time, S. S was quite nervous but that didn’t harm the session I thought. I reflected the opposite in speed of speech and was calmer to make him calm as well. It really seemed to work a little. Strangely I found this quite reassuring. That he would be more nervous than I. Am I beginning to exude some form of assuredness? Does that mean that I'm becoming comfortable in this role, albeit in its infancy?

Anyway, the fact that it was our first session and that I wanted to be very mindful of how crucial it is to get the early this gave me an opportunity to be very clear and open about the process, my ability, my level, my approach and the limits to counselling. Its not just knowing how important the start is, but once you've begun listening to a client after a couple of sessions and you realise that there are things you could of said more clearly or thoroughly early on, it really has taught me the need for a strong introduction to the process. Its about being professional and considerate for the client. They will benefit and be part of the process more if they feel held, secure and trusting that you have respect and boundaries for this process. This explanation, or contracting process was made really easy and open because S was actually one of the first people, if not the first person to actually ask me what it was that counselling actually did. So I explained to him about being a person centred therapist and what it meant. I explained it meant that I was accepting and not judgmental, that I would not try to work him out or diagnose. This would likely be quite different from the support he had been receiving from his workers in the house as they have a different agenda and obviously have a slightly different role. I was sure to make it clear about the limits of confidentiality also as I need that client to know that if they disclose using or drinking to me, I am duty bound to take that to the team. They understand this and I think respect the process more for that reason.

I really do take contracting seriously after realising quite why it is important for confidentiality reasons and for boundary reasons and for trust reasons and for reasons of the client feeling held, safe and secure in your approach to be professional and caring and on the ball.

What I recognise is that there was in me today someone who wanted to be liked. I wanted to leave all three clients that I saw with something positive. I didn’t initially want this I don’t think except I have been receiving complimentary comments from them in conversation and all of a sudden I had something I like that I want to keep.