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COU101 Counselling Theories and Its Practical Application In Given Case Study Assessment 4 Answer

COU101 Assessment 4 (30%): Case study report

Written Report - Counselling Theory/Case Study application (30%)

A written report incorporating ONE case study and TWO of the theories in counselling covered during the Trimester. Students are required to submit a report between 1500 - 1800 words.

Report brief:

Throughout this Trimester we have learned about various counselling theories, namely:

  • Psychoanalysis
  • Adlerian Therapy
  • Solution Focused Brief Therapy and Narrative Therapy
  • Person Centred Therapy
  • Gestalt Therapy
  • Cognitive Behaviour Therapy
  • Family Systems Therapy

You will select ONE case study from the list below and then choose TWO of the counselling theories that you believe will be appropriate to assist the client(s) discussed in the chosen case study.

Your task is then to apply each counselling theory, whilst comparing and contrasting the different ways in which each theory could be applied in an effort to help your client(s) with his/her/their problem:

Your answer must include the following:

  1. Identification of the historical origins and evolution of BOTH of your chosen theories
  2. Details about the typical counsellor/client relationship and any other elements of the chosen theories.
  3. Application of, comparison and contrast between chosen counselling theories to ONE of the case studies listed below including an outline of any ethical/legal issues to be considered,

an explanation of how you would use each of the TWO counselling techniques to assist your client – make sure to compare and contrast different needs of each theory in relation to techniques

suggestion of a possible outcome for the client if the counselling goes well

You may also suggest the number of sessions or any other requirements needed for the counselling to go ahead as planned, again comparing, and contrasting the TWO theories.

4. A final statement that outlines which of the two theories would best suit the client’s needs, based on your analysis. Case study options –

Case study 1 - Caleb

Please choose ONE from the following:

Caleb is an intelligent, friendly, kind and somewhat shy and watchful 16-year-old male who appears slightly older than his years, although his demeanour at times represents the maturity of a younger person. He presents as genuine and engaged, but often avoids eye contact by looking down and attempt to suppress facial expressions. Caleb is the youngest of three, his older brother and sister are both attending university. Caleb lives with his parents.

Caleb was referred to counselling following his discharge from an inpatient psychiatric facility. He said that he was admitted for the treatment of recurring,

uncontrollable intrusive memories and episodes of dissociation, relating to repeated early childhood sexual assaults (at approx. 4 years of age), perpetrated by his Aunt Jolene. Aunt Jolene died suddenly in a motor vehicle accident; Caleb said he felt responsible for her death and he wished she would not come back so that the abuse would stop. In this complex relationship, Caleb felt very close to Aunt Jolene and said that he previously described her as his “favourite person in the world”. Also 12 months ago Caleb lost his close friend to suicide and may be grieving the loss of his friends as they move on to university.

Caleb has reported intrusions. flashbacks, avoidance, alterations in cognition and difficulty regulating his arousal. He said that over recent months he has been seeing images of his Aunt Jolene, just before she died. Sexual contact with a female friend triggered memories of abuse that had previously been buried or suppressed. He said that he tried to “shut down” intrusive thoughts and became increasingly distressed when he could not. Since being re-triggered, Caleb said he has been irritable and angry, and that he often felt threatened even when in safe place, such as at home.

To assist Caleb you will need to identify his strengths, decide how you would work with him and identify any ethical risks associated with the story.

Case Study 2 - Tom

Tom’s father (Des) died from a heart attack five months ago. Tom is 25 years old and has been estranged from his father for over five years. You have been counselling him for a few months.

His father’s death you have learned, has had an unexpected impact on Tom who find himself exhibiting very intimidating and aggressive behaviour toward his colleagues and friends. He has been in trouble with the police and there may be a conviction against him if one of the people he had an altercation with decides to prosecute.

Tom has always been a very sensitive and introverted person so this is out of character for him. He has assumed that this behaviour is in some way connected to his father’s death but is not sure how to stop it. Tom has not shed a tear over his father’s death and is mostly concerned for his mother and her grief. Tom’s father tended to prefer his older brother Steve and as a consequence the relationship between his brother, his father and himself had always felt strained.

Although Tom has not spoken with his brother for over five years he has and had moderate contact with his mother. Tom is by nature an emotionally withdrawn man, who has difficulty expressing his emotions – a consequence he has surmised from a childhood of not letting his father see that he’s hurt him or give him the satisfaction of seeing him cry.

To assist Tom you will need to identify his strengths, decide how you would work with him and identify any ethical risks associated with the story

Case study 3 - Steve and Mary

Steve and Mary fell in love and married.

They often spoke of having children but first wanted to ensure they were financially secure so that Mary could take time off to be with the children and vice versa if Steve wanted to apply for paternal leave. In the meantime they bought a lovely home and furnished it, and went on several holidays together.

Both Steve and Mary had fantastic careers. They seemed to be climbing the corporate ladder and friends would comment on their playful but competitive natures. Life was close to perfect. Talk in their marriage returned to children.

Although Steve and Mary originally wanted children, Mary didn’t want to take a break from her career and Steve was concerned about maintaining the high mortgage repayments on one wage.

Through discussions Mary felt that Steve wanted her to somehow have a child but still retain her wage. Mary felt that Steve could take a part-time second job to support her while she had his child. Over a period of time they stopped talking, concentrating on their careers and leading separate lives.

They took up different hobbies, Mary played tennis and Steve played squash. Mary went to the movies with the girls and Steve went to the pub with the boys. Eventually, they moved into separate bedrooms. They have now become disengaged.

She feels a nagging sense of discontent about her life and her relationship with Steve. She is hoping counselling will help resolve this. It is Mary who makes the initial call to you. You are a counsellor in the area in which you live and in which Mary and Steve also live.

To assist Steve and Mary you will need to identify their strengths, decide how you would work with Steve and Mary and identify any ethical risks associated with their story.

Case Study 4 - Sabrina

Sabrina is a single woman in her early 20's, who has presented to counselling with low mood, low motivation, and a sense of feeling “empty” and “distant”. Throughout the session she sat with hunched posture, often gazed down and subtly rocked back and forth in her chair. She says that she was a medical student last year but was taking a 12-month break from study as she found the course very difficult.

She said that her boyfriend has unexpectedly broken up with her (over 2 months ago) and that since that time she had been feeling down, lonely, and did not want to see people. Sabrina is disappointed that she has not recovered naturally from this loss, saying that she “can’t snap out of it” and that “nobody else my age is doing this”. Sabrina reported similar episodes of low mood in the past but said she had always been able to pull herself out of it.

During the past week, Sabrina has completed one shift of waitressing, as her mother’s friend owns a restaurant. She said although she initially felt nervous and had “butterflies in my stomach”, she enjoyed the shift. Particularly, she said she enjoyed speaking to people, taking orders and trying to remember details, as this was something “different” for her to do. Her recounting of this shift was coloured with self-doubt, and she said she would likely not return to the job as she was “not very good” at it, as evidenced by her getting some details wrong, forgetting some orders and sometimes finding it difficult to communicate with people. She thought that she was “not a people person” and so patrons did not want to be bothered by her. Reassurance from her mother’s friend that she had done well, and that all people make small errors when they’re learning the job, were ineffective in changing her beliefs.

When focused on her sense of not doing well while waitressing, Sabrina said that she felt distant, as though “I’m not really there”, not in touch with anything, and as though “everything’s going on around me but I’m just not there….I’m just watching”. This exacerbated her sense of low energy and of things being “pointless”.

Sabrina said that she intends to return to study at the end of the year but did not appear enthusiastic about this. Her motivation to return appeared to be related to a sense of limited choice, a desire to make other people (such as her mother) happy, and so that she could “finally get something right.

Sabrina has come to counselling at the suggestion of her mother, who had noticed a change in her. Sabrina also said that she hoped counselling would help, as she hated feeling this way.

To assist Sabrina you will need to identify her strengths, decide how you would work with him and identify any ethical risks associated with the story

Answer

Statement of purpose

The purpose of this paper is to discuss two theories in regard to one case study and application of theories to assist in the chosen case. Tom’s case (case study 2) study has been chosen with two theories that are-person centred and family system therapy.

Introduction

The paper will focus on the counselling theories and its practical application on the clients in the context of the given case studies. Therefore, case study 2 has been chosen where a 25 years old man named Tom is facing behavioural issues after the sudden death of his father. In order to resolve the issue of Tom, Person-centred therapy and family systems therapy will be used. The work will analyse two theories with their evolution and origin and elements of the theories. Further, the focus will be made on the application of theories to the client's case and finding the best solution out of it for Tom. After doing this, the best theory will be suggested among the two selected theories.

1. The historical origins and evolution of the chosen theories 

Person-centred therapy:

Majorly, person-centred therapy is known as client-centred counselling also. As mentioned by Bazzano, (2016), person-centred therapy is actually a humanistic approach which enables an individual to perceive himself continuously and, in this approach, the interpretation of counsellor is very less. The major goals of person-centred therapy can be defined in three ways. They are to facilitate the personal growth of an individual, to eliminate the distress and to develop self-esteem. Originally the therapy was developed by psychotherapist Carl Rogers at the beginning of 1940s, and it was extended up to 1980s (Joseph, 2019). In 1957, Carl Rogers depicted six necessary conditions for which person-centred therapy can be applied. These conditions are therapist, client incongruence, genuineness of therapist, unconditional positive regard of therapist, empathetic understanding and client perception. However, in order to treat depression, anxiety, relationship issues, sexuality issues, and angriness, this therapy is widely used.

Family systems therapy:

On the other hand, Family system therapy is another type of psychotherapy which is massively used to treat mental patients. As per the view of Negash& Morgan, (2016), Family system therapy is to resolve the issues or mental conflicts with the support of family members in a functional and healthy way. In most of the behavioural cases, it has been observed that family therapy is very much effective. Counsellors involve family members to resolve the issues of the patients. In the 19th century, Family system therapy was introduced and developed in the area of professional practice majorly within the western culture in the countries of the US and UK. In the 1960s, family systems therapy was used by psychotherapist Murray Bowen through research on family patterns of schizophrenia people (Palombi, 2016). The major goals of family system therapy are to develop communication between family members, to enable the patients to handle family situations and others.

2. Details of counsellor/client relationship and other elements of the chosen theories

Elements of Person-centred therapy:

In person-centred therapy, counsellors are congruent with the clients. The counsellors provide unconditional positive regard in person-centred therapy and also the counsellor shows an empathetic understanding to the patient. Basically, in person-centred therapy, the counsellor interprets very less. Thus, the major elements of person-centred therapy are congruence, unconditional positive regard and empathy, which are known as core conditions. Congruence practice is the handling of the situation of patients without hiding the professional identification as to maintain transparency. Unconditional positive regard enables the counsellors to be non- judgemental. In the view of Wood, (2019) Unconditional positive regard is the basic acceptance of a patient's situation by the counsellors and supports the person's opinion. The last element is empathy in which counsellors interacts with the patients and states their desires to appreciate the perspectives of the patients. 

Elements of Family systems therapy:

The counsellors involve the family members of the patient to provide support to the patients to handle their conflict situation in family system therapy. Considering this, it can be stated that there are some major elements in family system therapy. As per the view of Zafra, (2016), there are four subsystems in family system therapy. They are parental relationship, parent-child relationship, relationship with siblings and overarching family system. Each system is correlated with each other. Parental subsystem defines that parents focus extra attention on any specific child's action.  Parent-child subsystem depicts that if parents find something in the behaviour of their children, then, they perceive with fear. Along with that, the siblings' subsystem states the relationship between brothers and sisters in the family and lastly overarching family system depicts the structural relationship between family members. 

3. Application, comparison and contrast between the chosen counselling theories in the context of the chosen case study

  • Outline of the ethical and legal issues

Considering the case study of Tom, it can be stated, person-centred therapy could be effective to resolve the behavioural issue. However, in order to apply the person-centred therapy, the counsellors can face some ethical issues. Professional, ethical issues such as sincerity, humility, courage, respect and others are highly related to this therapy as counsellors will apply the therapy on the basis of the informed information by Tom, but to provide proper service, it is needed to raise the ethical limits of disciplinary codes.  

On the other hand, in family systems, ethical therapy issues are also presented because the responsibility of the counsellor revolves around Tom, who is the client. That is why as family members of Tom will be included in family system therapy, therefore the ethical dilemma between disciplinary codes and patient situations will restrict the proper application of this therapy.

  • Use of the chosen two counselling theories

In the view of Velasquez & Montiel, (2018), counsellors need to concentrate on three core conditions of person-centred therapy properly. Therefore, in order to apply the therapy properly, it is required to follow the below steps:

-will set a clear boundary

-Encourage Tom to state his issue

-will remain silent while Tom will define his issue

-will provide utmost concentration on Tom’s sayings and will not be judgemental in any situation. 

In the application of family system therapy, there are a number of models that are used. Considering the case of Tom, it can be stated that a structural model will be appropriate to resolve his issue through this therapy. As structural family therapy theory depicts that the major reasons of behavioural issues are presented in the structure of the family, therefore it is chosen because Tom does not share a good relationship with his brother Steve and his mother. That is why family involvement is necessary in the case of Tom to help him to overcome his situation.

  • Suggestion for the client

The suggestion for Tom is to take the initiative to improve his relationship with his mother and brother. As per the view of Anderson and Stevenson (2019), sharing bonding with family is one of the effective ways to relieve stress in life. Apart from this, it is suggested that he needs to involve himself in some productive work. Therefore, he could overcome his past experience and lead a healthy life.

  • Required number of sessions

In order to resolve the problem of Tom with person-centred therapy, three sessions are needed, and Tom needs to corporate with his counsellor during the therapy. 

On the contrary, it is estimated that five sessions will be needed to treat the issue of Tom with family system therapy because family bonding is not strong between Tom and his family.

4. Best counselling theory considering the issue of the client 

From the analysis, it can be stated in the case of Tom to choose person-centred therapy. In order to treat his problem, this therapy will be based through this therapy, Tom will share all his past experience and mental dilemma with the counsellor and in this way. Further, it will be possible to improve Tom's situation quickly.

Gaps in literature

The gaps in the chosen literature have limited the outcome of the study. Some of the chosen literature were not consistent with the topic; that is why limitations were faced with understanding the chosen counselling theories. Along with that in some chosen literature, the description of the theories was complex which resulted in facing issue in gathering knowledge about the counselling theories properly. 

Conclusion

The paper is based on counselling theories, and it has been observed that different counselling theories are used to resolve the issue of different types of patients. Through the case study of Tom, it can be stated that the application of proper counselling theory will be effective to help Tom to overcome his situation. 

Reflection

Considering the overall discussion about counselling theories, I can mention that with the effective usage of counselling therapies, it is possible to treat the mental issues of the patients easily. I have learned that first, it is needed to analyse the situation of the patient properly. After that, I was considering the issues of the patients; it is needed to apply the counselling therapy. Along with that as a counsellor, I need to emphasise on the proper implementation of the therapy by following the appropriate techniques and models. Along with that, I have learnt a counsellor needs to handle the patients with utmost care. 

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