Year One
Case Study
Benjamin
Davy
Client Referred To As ‘N’
4 Client Sessions: Simulated Agency
Setting
2 Group Supervision Sessions
Focus For The
Work: Client brought issues around health, image and desired weight loss, and
explored further related issues around depression, anxiety and guilt
Synopsis
The client initially wanted to explore her frustrations and issues
around weight loss and health. These issues characterized the initial content
brought. With time, trust and
non-judgemental acceptance, N brought issues that were of much greater resonance
and clearly impacting her life.
As we moved forward I felt a level of trust being shared between us and
possibly aided by this more connected relationship, N began to almost verbally
mind-map interconnected areas of her life that were related to and stemmed from
the initial discussion.
Our final meeting was disappointing from a practice and process
perspective and failed to draw together the sessions in a meaningful way.
However, the product of the relationship had been both noticeable and fruitful
in our time together.
Journey
Once the formalities were complete, N went into her desired content for
the sessions easily. N stated she had very much a pre-meditated issue to bring,
her health and desire to lose weight. While this brought information and
content, I recognize that I did not spend time preparing our relationship, for
the exploration to go forth. I feel that I knew at the time something wasn’t
there. I’d missed a step. It was as if we had set off to explore a new land
together, but hadn’t made packed lunches, checked the map or read the compass.
My reflections on this initial connection and relational building are
that we did achieve solid mutual trust. I felt that N was able to share much
and talk openly about her life and how much certain things, like her partners
heart problems, affected her. It was real. She was not judged, she was accepted
and I welcomed her story.
What I learned about myself from this opening session was that I felt consistently
able to offer unconditional positive regard, and was actively valuing this
person. I highlight this aspect as I have from reflections become aware in me
the necessary act to be active in this prizing act. It is very much a thing
that I see myself doing, like a switch turning on, and I can also feel from
this exchange more and more that its becoming second nature and automatic
skill. The benefits of being this way became apparent in the level of
information that I gleaned from N at this early stage. While I look back at our
initial session with self-critical horror as I now realize the chance to truly
offer a therapeutic contract was missed, a chance to map out what might be the
clients goals in therapy and her route to self-actualization, I am also buoyed
by the fact that N was very happy to share, at least the content of her
presenting issue.
The next couple of times we met were altogether more flowing and
exploratory affairs, as our relationship and the connection I felt we were
sharing began to bear more and more fruit. N began to share beyond the initial
issues of health and weight loss and linked this to other things that were
going on for her, that were somewhat difficult to share at times. Her food
consumption was linked to a safe place or sanctuary away from other stressors,
but this in turn created its own mini-issues of guilt around not working and
being at home eating to block out unpleasant feelings. I recognized that these
were deeper and less ‘easy’ issues. These were not things you would say to a
neighbor or in passing at the supermarket. This is what is really going on.
I attribute this depth of trust that N now had developed in me to
holding a consistent and active empathic and non-judgmental place, and we
shared this safe place. In my mind what facilitated this journey for the client
was a level of counter-conditioning (Means & Thorne, 2007) I suspect, as N
could hear herself speaking about various issues without judgment. By breaking
the pact of alliance N has with conditions of worth around how she should look,
or the guilt she should feel when caught eating by her husband I feel that she
could then feel validated.
It was very valuable for me in terms of my practice to feel us grow in
mutuality and trust as I now reflect on just how powerful the core conditions
were, as I saw change in the level of confidence and movement towards a
relational depth. I recognize that at this stage of my learning, what the
client can bring with the level of trust and connection is very powerful. The
work that goes on beyond that is I feel a level of understanding that I have
yet to reach.
The togetherness and ‘dual-ness’ surprised me somewhat. As I offered an
environment with no judgment and actively listened and valued the client, I have
since reflected on how well I did this. I feel that my gestures and reflections
really showed that I was on-board and together in this journey, and that this
faith N had in my lack of judgmentalness or condemnation, enabled her to go
through a series of connected issues that clearly impacted upon her deeply and
were important for her to bring.
We had clearly built trust. I was conscious that we could use this trust
to increase her self-awareness and autonomy. As sessions went on, N began to
share with me battles with her family, the fraught relationship with her
daughter, the memories of a father that had valued only boys, the issue of food
being so key to positivity and also that N had developed quite a need for
control, that was impacting her happiness. The very fact that N had felt able
to bring these issues, that were of depth and were at the core of her self it
seemed, told me that she had achieved greater self-acceptance, a pre-requisite
for self-actualization (Mearns & thorne, 2007).
What I learned about me as the intensity of our work grew, was how strongly
I could be affected just following someone’s story. When exploring with another
their core issues, their processes and frustrations, their reality and how this
impacted them, just how ‘involved’ this could actually be. What I had wanted to
occur, wanting the client to explore what matters to her, for her own gain, was
in fact exhausting at times. It had been an exercise in focus, in imagination,
in emotions and learning. Then I began to reflect on the level of intensity
that I had felt that we’d shared during this session, and how it had occurred.
I feel that the togetherness that we achieved during that last session had
been something of an immersion in N’s feelings. I liken it to something I have
heard described as a ‘co-created narrative’ (Cozolino, 2016), as it was wholly
integrative. I feel that in some small way that I did contribute through
reflections and recognition of the actualness that N lived amongst, in order
for us to co-author her experiences. The product of this session was like we
had become closer, a little uncomfortably so in my case. Now I had opened Pandora’s
box and I felt closer to someone, and I’m not sure if that is altogether
comfortable yet. Physically I recognize an almost a relief-like state in me
that it was over, like a whistle at full-time. We had played well.
What I enjoyed as a counselor (in training) was a sense of the
attributes I have been learning about and trying to find. Empathy and
acceptance and genuinness towards clients has always been there, but, it was at
times, more of an experience here. I found it reassuring to learn more about
relational depth in my own studies and find parallels to what I am
experimenting with articulating. Cooper (2005) found that many therapists
shared experiences of relational depth as heightened senses of empathy, greater
awareness and satisfaction.
My reflections validated N’s reality. I felt like I was actively
increasing N’s self-awareness around her emotional responses and her ability to
understand herself grew as I learned more about her. N’s daughter’s actions,
her husband’s work ethic and her need to have control over so many aspects of
her life, were heard. They were out there. I felt ok hearing all these things.
They were real and part of my client. By me purposefully showing her that non
of her feelings were alien to me, I felt that I allowed her to know she was
human. By showing N non-judgmental acceptance I felt that her ability to
self-actualize was less inhibited (Casemore, 2011). This was because he okness
around me made it a more conducive environment for her to explore what was best
for her.
The final session was a very different session in so much as it was less
connected, less deep and actually quite a bump. I felt uneasy and I suspect
this was down to the lack of therapeutic contracting from the start. Also I
know I failed to really mark the ending of our time together. But by not doing
this I definitely feel now looking back that I was lacking deference to the
process and also perhaps missing some maturity, which would have been more
appropriate. I feel now on reflection that this slightly hasty start marked the
session. It was not unlike the ending really, insomuch as I had not ‘held’ the
space to safely commute us from the opening hello’s to the space that is a
counseling session. If it were a meal, we effectively rushed the soup starter,
skipped the entrees, nibbled the main course and headed straight for the cheese
board.
Uncomfortable as I am with the word control in a person-centered
setting, I feel that while this may be an awkward word to employ, it was
noticeable by its absence. I was not really in control.
Means and Thorne (2007) in their exploration of the counseling process coming
to an end noted that quite often the client would take actions that have been
facilitated by the therapy. They stated that for therapy to reach this
productive and progressive potential outcome several factors have to culminate.
I am quite sure that this was not the outcome of our sessions, however I will
proudly say that we did achieve trust and a shared experience of the clients
reality.
Group supervision
In the supervision sessions I brought issues around me wanting to praise
my client. What was this about? What lay beneath this? There lies in me
feelings of gratitude in the person being brave enough to share, to trust.
Some feedback was that I could be judgmental, as this praise was
inverted judgmentalness perhaps. I reflect that this could be right. In the
discussions it came out that it is something I cannot do, therefore I suspect
this is behind my feelings. As a counselor I need to be mindful of what I do
give back to the client, and to be clear and boundaried that I act to respond
to their issues and not satisfy my own need to ‘repay’.
I also brought issues with beginnings and endings. I asked the group for
feedback on how the case study ending was not therapeutic for the client, and
perhaps I had colluded in this being the case. The group fed back to me that
both people in the relationship had been aware of the ending and I had likely
allowed the client to go into chat mode when I could have been more overt about
noticing this. I felt after the supervision that I could have done a great deal
more to prep the client for the final session, to use immediacy and highlight
how we were using the final session. Good learning.
Conclusion
Looking at the sessions as a piece of work, I felt I offered the client
the core conditions and also of the six proposed by Rogers, the first, the relationship
had been present (Casemore, 2011). Also I feel that this environment
facilitated the self-acceptance that is so vital in growth towards the
fully-functioning ideal (Mearns & Thorne, 2007). I would question whether I
was able to present complete congruence at all times in so much as I had wanted
to share my own discomfort by saying thank you, for example. I feel that I
operated safely within a professional framework, yet I recognize how my beginnings
and endings are where the real work has to be done. By addressing this I will
set the stall out for greater levels of relational depth I suspect, as the
client will feel safer and more held.
I want to be better prepared to introduce what it is that will happen,
be comfortable guiding the client to use counseling to know what they can
expect and also to be more confident holding the time more congruently if I
notice that a client’s discomfort with endings could be brought to light to
share.
However to summarize I am happy with my efforts to bring myself into a
place of togetherness to explore another’s inner feelings. The next level of
achievement for me might be confidence in enabling a client to process
feelings, as the product of that I feel, is self-acceptance.
References
·
Casemore,
R. (2011) Person-centered counseling in a
nutshell 2nd ed. Sage. London.
·
Cooper,
M. (2005) Therapists experience of
relational depth: A qualitative interview study. Counselling and
Psychotherapy Research, 5(2), 87-95.
·
Cozolino,
L. (2016) The Neuroscience of Psychotherapy.
Norton, New York.
·
Mearns,
D & Thorne, B. (2007) Person Centered
Counselling in Action 3rd Ed. Sage. London.
