Section I: Description of client

Shelly is a 26-year-old single Italian female who is working full-time as a teacher and is also a part-time graduate student. She came into counseling today well groomed and casually dressed. Her speech was normal and her thought process appeared to be relevant and coherent. At opening, she reported feeling “okay” but had some concerns she wanted to share. Shelly’s affect appeared congruent with her behavior.

Shelly attends counseling one time per week for 45 minutes a session. This is her sixth session in counseling and is preparing to terminate session in two weeks. She has no prior history of counseling or psychiatric treatment and is currently diagnosed with Adjustment Disorder with Depressed Mood. Counseling was self-initiated, although she reported family members recommending her to “get help” because of her mental state during her break-up with her ex-fiancé. Shelly initially sought counseling because she was experiencing extreme sadness and anxiety due the loss this four year relationship. During her earlier weeks, Shelly was focused on external issues and was having difficulty separating the external circumstances from her self worth. She had also been emotionally dependent on this live-in boyfriend and was experiencing difficulties adapting to life without him.

Shelly has been displaying a pattern of destructive behaviors by going in an out of the relationship with her abusive ex-boyfriend. She demonstrated some progress by staying out of this relationship for three weeks with minimal contact with him; however, she shared with me last week that she began dating a new guy. Shelly has some insight about her dependency issues and saw this recent relationship as “moving on.” This week she informed me that this new relationship has just ended.

Section II: Description of session

Shelly appeared to be anxious today. She was on time but mentioned that she had somewhere to be and expressed minimal excitement in being here today due to prior commitments. She started the session with her thoughts on the new relationship that just ended and initially described vaguely the demise of this new relationship. She described a few times during session that she is okay with this relationship ending because she is in no place to get serious with anybody. The issue, which being discussed today, started with her reasoning’s of why this relationship didn’t work. She said on numerous occasions that she didn’t want to be dependent on this guy and that perhaps subconsciously she had pushed him away.

Our counseling sessions consisted of mostly reflection and empathic techniques. Shelly seems to enjoy talking and it doesn’t take too much prompting and probing to get her to elaborate on her current issues, although today she had a slow start in this area. She is extremely receptive to all questions and techniques presented. Since she’s gained insight on her limited self-concept and dependency on romantic relationships, she seems to evaluate her actions more independently in terms of those issues.

Other techniques I frequently used were asking open-ended questions, reflection of affect, affirmation and validation. I think perhaps the most obvious technique was immediacy and staying in the here-and-now, although I did notice after the session that immediacy sometimes goes beyond the obvious and perhaps I wasn’t as available as I wanted to be. However, I followed Shelly’s lead in the process and gave her the opportunity to focus on what she wanted to examine today.

I think overall Shelly responded well to these techniques and she seemed fully engaged in session, especially toward the end. This was apparent even though she had expressed earlier her desire to not being here today. I think allowing Shelly to vent works well for her because she seems to gain insight by just hearing herself and hearing me reflect. I haven’t really used a lot of direction with her in any session and she seems to be progressing in many ways.

I also believe that my cognitive influence to focus on the thinking process is working well in this situation. In closing our session, we ended by summarizing the key points on today’s session. Her anxiety level seemed to decrease throughout and she appeared more relaxed and in tune as the session progressed.

Analysis of Session

I believe the approach I used was mostly person-centered by attempting to guide her to always be the “driver.” I also think that I have some cognitive behavioral influences. I seem to focus a lot on the cognition and false beliefs with the idea that stimulating these beliefs by throwing yourself in, may allow you to alter them. I tried not to be too directive with Shelly; however, indirectly, I would ask her questions that would create an avenue for her to challenge her thoughts. I think the use of reflection with some underling of specifics in her responses, got her to realize certain things. For example, during one of her explanations about why she want’s a guy friend to “hang-out” with, she describes that she feels like a loser because she has no one. I reflected that statement as “You’re a loser” not with the intent to call her a loser but with intention to get her to realize that this statement is manifested in her behavior and self worth. I thought this was powerful and it allowed her to hear it from somebody else because I think often times, she ignores these thoughts. It was interesting to see how foreign it seemed to her when I called her a loser yet comforting when she says it about herself. She even confronted me, gracefully, about calling her a loser and although we didn’t explore it further, as we should have, we still got a good laugh from in anyhow. I believed that if all else fails, then at least the therapeutic effects of laughing helped ease some of the anxiety she was experiencing after hearing that reflection from me.

During session, Shelly discussed learning about how not to be dependent and she understands that she does have that problem. However, she still seems to latch on in different ways. Her new relationship ended and ours is ending soon and it was obvious that she wasn’t handling the situation as well as she was portraying. For instance, we spent and good portion of our session talking about how she’s okay and how she doesn’t want to be in a serious relationship, yet she’s “bummed out” that it didn’t work out. She contradicts herself a little bit. I attempted to confront her a few times as she would go into these tangents about how she learned so much about herself and how okay she is with what happened but would end the discussion with, “If he really wanted to talk to me, he’d make time.” This clearly shows that she invested time in thinking about the issue and I think this is tied into her self-definition. I also think it is a good idea that she reflect on what happened but she was still drawn to focus on other people’s behavior toward her. Perhaps her insecurities surfaced as she was trying to gain strength by throwing herself in a situation that she wants to be ready to experience but perhaps isn’t ready for. The constant verbal reassurance of the outcome of this relationship was probably a way to overcompensate for her insecurities. This seems to be how she stays in control. I checked in with her a few different times with open-ended questions about her affect in the moment to give her the opportunity to reflect on what she had said.

We also spoke about ending our relationship and what she will do once counseling is over. She shared her fears about not having the discipline to focus on herself and process things alone. She recognizes that it is important that she continue to dedicate time to herself for personal growth but wonders if she will be able to do it without “forcing herself.” Also, her inability to clearly articulate her feelings about the ending of our therapeutic relationship also led me to believe she still needs work in areas of dependency and confidence. In retrospect, perhaps she wasn’t prepared to tell me what was really going on or maybe she just hasn’t quite connected the underlying issue, the fear of staying or being alone, to her behaviors.

Overall, however, I think she has progressed, as she seems to have a genuine desire to be more independent. I also extended a lot of validation during session by encouraging and praising her efforts and offering acknowledgements in personal growth areas.

In terms of multicultural sensitivity, I think I was mostly sensitive by being nonjudgmental, not having an ethnocentric worldview, and being aware of my own prejudices before going into sessions. Constantly evaluating my beliefs allows understanding counselor and me to be a more accepting.

Transcription

Client: I don’t know if he thought I just wanted to have fun with guys on my vacation or what but….it wasn’t really the case. I just wanted things to slow down a little bit.

• Counselor: Mmmm….I’m wondering if you had a conversation about this….slowing down with him. (empathy, supportive sound, exploration and elaboration)

Client: I did before I left for vacation.

• Counselor: Okay, how did it go? (empathy, open-ended question, elaboration, prompting)

Client: Okay, I guess I think he was a little surprised cause he thought things were going really well, which …they were and I was happy with it ….I was just afraid of it moving too fast and me getting wrapped up in the whole boyfriend thing again and I don’t feel like I’m quite ready for a boyfriend yet. I have fun just dating them and I wanted it to stay like that for a while but I feel like it was moving to the next level and I didn’t want it to.

• Counselor: Mmmm…. So you felt things were going too fast….it seems like you’re exited about this relationship. (empathy, supportive sound, reflection of content, labeling affect, validation)

Client: Huh huh, yeah we had a good time together.

• Counselor: But you did sense that it was going too fast and…. what was that like for you? (reflection of content, paraphrasing, checking-in, open-ended question, exploration, prompting)

Client: It was comforting to know that somebody was there but at the same time, I can see myself going back to how I was with Steve and being dependent on him and I didn’t like that feeling of …always feeling like I need somebody there.

• Counselor: Mmmm, So you were feeling as if maybe you were picking up on the same pattern? (empathy, supportive sound, labeling behavior, reflection)

Client: Huh huh

• Counselor: Okay. (empathy, supportive sound, prompting)

Client: Yeah.

• Counselor: Okay, and at that point you decided to speak to Paul? (emphatic sound, elaboration)

Client: Yeah, yes I did. It was towards the end of the night. We had a good date and I mentioned it to him and he said oh… okay… and I can tell he was kind of sad about it.

• Counselor: Mmmm (empathic sound, prompting)

Client: And…I told him I still wanted to hang out. I still want to continue seeing him …it wasn’t like I’m breaking up with him or anything but…I haven’t heard from him so…I’m thinking he thought I wanted it to completely end. And I tried contacting him a couple times.

• Counselor: And what happened? (open-ended question, exploration and elaboration, prompting, immediacy)

Client: Ummm…I don’t know. We’ve just been playing phone tag…. he’s like oh I’m busy…… I’ll call you later….. and things just happen with me and we don’t really get around to it. Before I left for vacation we had plans to meet up this weekend but….I haven’t heard anything so I don’t know if we’re hanging out and….I don’t know.

• Counselor: So it sounds like you feel like you’ve progressed. Here you are in this brand new relationship. It feels great ummm…you had somewhat of a comfort of knowing someone is there for you and…uh…it seems like your enjoying Paul’s company and all and…you decided to assert yourself, which is different from before….(empathy, affirming client’s strengths, reflection, summarizing, paraphrasing, labeling affect, validation)

Client: Huh huh

• Counselor: And it seems that the message that was sent was not the actual message or the message that Paul took was not the actual message you were trying to send. (empathy, reflection of content)

Client: Right.

• Counselor: So now…..what I hear is that you’re thinking is that perhaps he took it the wrong way (empathy, reflection of content, summarizing)

Client: Yeah, I think he did take it the wrong way.

• Counselor: Okay, because you’ve been playing phone tag…you feel like maybe he’s avoiding you? (empathic sound, reflection, exploration and elaboration)

Client: Yes

• Counselor: Okay (empathic sound, prompting)

Client: I think he is.

• Counselor: Okay….So, here you are coming from this wonderful place of “Wow I’m asserting myself you know. I’m in this new relationship”….and now things don’t seem to be going the way that perhaps you planned. (empathy, reflection, validation, labeling affect, summarizing)

Client : Huh huh.

• Counselor: What is your feeling about that right now? (Checking-in, here-and-now, exploration of affect, open-ended question)

Section IV: Overall Evaluation and Comments

Now that I have practiced a few sessions, I realize that I have good days and not so good days in counseling. I remember getting to a point within the last couple weeks where I felt confident in the techniques I was using and the flow of the counseling sessions. However, this confidence is not always long-standing but I know I should remember that the session is not about me. A client’s progress does not necessarily mean that he/she may not relapse a few times before he makes a long-lasting change in behavior. One of the challenges I faced with this client was getting her to realize not only that she is emotionally dependent on her boyfriend, but also on other people, including myself. I felt satisfied with the way things were going for a while and then one day Shelly comes in and says “By the way I have another man” and “I’ll always have you to fall back on.” Perhaps what I could have done differently was explore further what these relationships were doing for her and the basis of her need to be approved of externally. Even her ability to make decisions on her own was based on this dependency. When we discussed our termination, she could not give me a clear response about how she feels about our ending or what she will do. She seemed to have focused more on how she will make it through without coming to session and what would she do to fill the hour she had dedicated to counseling.

I also realized that I need to accept that I am not going to “fix people.” I think I get so caught up with wanting results right away that it takes away from the immediacy I can offer my client. In addition, I should remember that people get better at different paces and I should remind myself that some progress is better than no progress. In this case, I tried to affirm Shelly’s efforts of being strong enough to stay out of this abusive relationship and she did. However, she was still filling her voids with other people instead and I thought that I was offering that immediacy by staying where she was at that time, but I think I zeroed in too much on this new relationship. Perhaps this was to the point where I even ignored the dynamics between our relationship which opportunities surfaced on several occasions during the session. I think I could have invited her to explore our dynamics, and maybe this would have led her to understand further and a new perspective of the issue. She seemed to only recognize that she was dependent only on the guys she was dating. I also think that another thing I could have explored today was her anxiety. I allowed myself to assume that she was on a time schedule and that she had somewhere to be. Perhaps the situation went deeper than that and I concluded the situation according to my assumptions without giving her a chance to really explain what was going on.