Psychological Issues of Counseling - Case Study Example

Psychology/ Counselling At last, the moment arrived to which I was looking forward. Therapist asked me the whole story behind the incidence, whichhas given me the gifts of many disorders like anxiety and depression. With a hope that I am not the only person in the world suffering throughout the years with depression, I started uniting the memories of that incident that appeared as a state of transition in my life and started: "My family and I, who includes my parents and my brother, were having dinner. I remember it was a Saturday night. Our cook was serving us the food. All of a sudden we heard glass smashing followed by boot stepping noises as if four to five men wearing heavy boots were running towards us. As soon as they entered into the dinning room, they pointed guns towards us while asking us to be quiet. It has been ten years now and I can still remember the shock to which I confronted to as a fourteen-year old kid. They were four men wearing black masks, which covered their entire faces. Then they closed every window. At that particular time instant, the cook was in the kitchen. After noticing this situation, he tried to make a call, but one of the gunmen rushed towards the kitchen and started beating him while dragging him back to the dining room. The cook was bleeding from his head and we assume he went nearly unconscious. The gunmen then put a black mask to cover his head entirely and tightened him with ropes. There after they started tightening up my mother and brother while not forgetting to put up masks over their heads. At that time, when one of them moved towards me, I tried to escape from the room as I was near to the door. But lady luck was not with me, he eventually caught me and dragged me back by holding hair. I can still feel the chill and pain running throughout my spine when I recall those moments. As I was trying to make myself released from this painful situation, he slapped me two or three times on my face, in order to make me surrender. At that very moment my father tried to retaliate so one of the gunmen shot him on his leg. Instantly we started screaming so the gunmen warned us to stay calm and quiet or they would shoot each one of us. Finally the gunmen tightened up my father and me and put up the masks over our heads. The masks were so thick that I was not able to see a single ray of light and it was complete dark and black. Then I started feeling suffocation, so I started screaming. Instantly one of the gunmen started beating me up to make me quiet and during the process I got unconscious. I was not aware as to how long I remained in that state. I woke up in a hospital bed and as soon as I became conscious of what happened in our house, I started screaming while shivering with fear. It took me over one week to recover from that shock along with my physical injuries but to this day I am still unsuccessful in recovering my mental state of mind. Darkness seems to be my week point, I cannot stay alone anywhere and whenever lights are switched off, I feel severe exhaustion and it feels as if I am in hell. It feels as if a black mask has covered me whole and I start feeling suffocation even though I am in a well-ventilated room. That's not it, I start screaming and within that time period I feel as if somebody is beating me up and then if the lights are not turned on I become unconscious". My story ends here but the dilemma remains with me wherever I go. Therapist cooperated with me and diagnosed two therapies, 'cognitive behavioural therapy' (CBT) and 'psychoanalytic therapy' that would help me in the long run to retain a normal, and balanced prevention against the disorders I possess. Cognitive Behavioural Therapy My therapist possessed a friendly attitude towards me and prior to put me into any therapy explained me some facts regarding therapy. Here is the summary, what he told: Coming largely from the information-processing models of psychopathology, CBT aims to change the beliefs, attitudes and expectancies underlying abnormal behaviour. CBT popularised by Albert Allis and Aaron Beck is largely a verbal procedure in which the clients' unrealistic beliefs are challenged by the therapist and the client learns to alter these beliefs to more rational and reality based thoughts. (Rapee, 1999, p8.14) Thus as with this therapy, according to my therapist I would engage in new learning concepts which would overcome those fears which I have experienced up till now and for this purpose he would actively participate. According to the therapist, each person reacts differently with the consequences he has experienced. So, in order to understand a person's emotional response to a particular event it is important to discover the meaning he attaches to certain events in his life: his subjective construction of reality. For example, a person whose partner has left him believes he cannot be happy and becomes depressed; another person whose partner has departed feels relieved as he believes he has been freed from a 'stifling relationship'; a third person feels guilty as he views his bad behaviour as the reason for his partner's departure, so the event is same for each person, what differs is the perception and the emotional reaction to it as each reaction is mediated by individual person's view of the event. Therefore in order to change the way we feel about events we need to change the way we think about them. (Dryden & Neenan, 2004, p. 3) CBT helps clients to develop alternative viewpoints in order to tackle their problems (e.g. 'I've lost my job, not my self-worth as this is not dependent on having a job'). Developing alternative viewpoints underscores the CBT principle that there is always more than one way of seeing things and therefore a person chooses her viewpoint (Butler and Hope, 1996). Therapist has developed my interest while I am having clinical sittings and discussions with him. I am amazed as to how quickly I am recovering from the past shocks, so I gathered some more information myself after which I found out that clinical attention may shift to past incidents but it does not reside there. With the client's 'strong predilection' for reflection, the therapist can help him to make connections with past adverse events to his current thinking about these events. Looking back in order to answer these questions may not produce the satisfying answers the client is looking for, or, if satisfying answers are found, break the block in therapy: old questions may be answered, but new beliefs and behaviours are needed to avoid the possibility of the past repeating itself in the next relationship or impairing the new-found independence. (Dryden & Neenan, 2004, p. 37) Assessing Therapy Duration Even though CBT 'has become the single most important and best validated psychotherapeutic approach' (Salkovskis, 1996), not every client will be interested in this approach unlike me; nor will they necessarily like it or benefit from it. Safran and Segal (1990) developed a ten-item suitability for short-term cognitive therapy rating scale by rating clients on a 0-5 scale, where a total score of 0 indicates least suitability and a total score of 50 the greatest suitability for short-term CBT. I was also put into the test by therapist to assess my suitability for short-term CBT. I answered in 'YES' or 'NO': 1. Accessibility of automatic thoughts. After an explanation and examples of what automatic thoughts are, is the client able to detect and report them Yes. 2. Awareness and differentiation of emotions. Is the client aware of and can distinguish between, for example, her anger, guilt, shame and depression Partly: she has difficulty in being aware of and distinguishing between shame and guilt. Yes 3. Acceptance of personal responsibility. The client did accept personal responsibility for change but said 'I really wouldn't have these problems if it wasn't for my boss.' No 4. Compatibility with the cognitive rationale. The client understood and generally agreed with the cognitive model, including the importance of carrying out homework assignments. Yes 5. Alliance potential (in session). Can the client form a productive working alliance with the therapist The client took umbrage at some of the therapist's questions (e.g. 'What do you mean how do I make myself angry when my boss asks me to stay late to finish a project'), which might mean a less than optimum alliance potential. Yes 6. Alliance potential (outside of session). Is the client able to form productive, positive relationships in her life There was a mixed picture on this issue (e.g. she had close relationships with others but these could quickly unravel if she suspected disloyalty or lack of respect). Yes 7. Chronicity of problems. How long has the client had the problem The client admitted to long-term dissatisfactions in life but the specific problem she wanted to focus on was of recent onset. No 8. Security operations. To what extent might the client engage in behaviour that keeps her safe in her own mind but prevents her from constructively tackling her problems The client said she would be willing to 'meet the problem head on'. No 9. Focality. Is the client able to focus on the problem targeted for discussion The client was able to do this with only occasional prompting from the therapist to 'keep on track'. No 10. Client optimism/pessimism regarding therapy. To what extent does the client believe that therapy will be able to help her The client said she was 'hopeful. I know I've got to sort myself out.' Yes (80%) (Dryden & Neenan, 2004, p. 56) My score was 39, which made me suitable for short-term cognitive therapy. However, Safran and Segal (1990) provided no cut-off point of unsuitability for short-term cognitive therapy; they merely stated that high ratings indicate a good prognosis for therapy and low ratings indicate a poor prognosis. (Dryden & Neenan, 2004, p. 56) I agreed to a provisional duration of therapy lasting ten sessions, with progress reviews every three sessions. No rating scale is infallible or the person administering it, so it might become evident several sessions into therapy that the person is actually unsuitable for short-term cognitive therapy like I hope someday I would feel I can tackle my problems myself without any constraints. Psychoanalytic Therapy Along with CBT, therapist has chosen this therapy for me, which primarily involves the client talking about ideas and feelings that come into her mind, usually with little input from the therapist. Developed by Sigmund Feud (1933), psychoanalytic therapy would help me develop insight into my problems, to help resolve those conflicts that are occurring at my unconscious level, and to help reduce any immature defence mechanisms, that is those symptoms that I am producing unconsciously to mask or deal with my internal fears. This may involve a number of techniques, such as free association (providing the first thought or idea that comes to mind in response to certain words from the therapist) and dreams interpretation. (Rapee, 1999, p8.15) Psychoanalytic therapy is recommended on a long-term basis, as the therapist wants to make out my unconscious happenings and want to analyse accordingly. Analysts generally consider that proper therapy is a long, intense and slow process so I would be having clinical sittings on a long-term basis. In this context they have chosen 'Relapse' prevention for me, which is a partial return to a previous problem state. By the time, therapy is drawing close, clients will have learnt, if they did not know it already, that change is not a smooth, linear process but a series of advances and setbacks. Therefore, relapse prevention is a realistic strategy to pursue by pinpointing future situations. (Dryden & Neenan, 2004, p. 235) Now, I am hopeful that very soon I would be able to defeat not only my psychological fears but also those disorders, which were never revealed upon me. References & Bibliography Butler, G. and Hope, T. (1996) Manage Your Mind. Oxford: Oxford University Press. Dryden Windy & Neenan Michael, (2004) Cognitive Therapy: 100 Key Points: Brunner- Routledge: New York. Rapee, M Ronald (1999) Abnormal Psychology in Psychological Science: An Introduction Salkovskis, P. M. (1996) 'Preface', in P. M. Salkovskis (ed.), Frontiers of Cognitive Therapy. New York: Guilford. Read More