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 3rd 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).
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