CP06 Case Notes for ICPPD (100 hours’ Client Work)

CP06    Case Notes for ICPPD (100 hours’ Client Work) Learner Name (Prin" rel="nofollow">int):    Sin" rel="nofollow">inéad Brody    Date:    17/03/17 Client Code:    MM    Session No:    9 Client Background (gender/age/marital status/siblin" rel="nofollow">ings and where in" rel="nofollow">in order/children, etc.) Female, 59 years old, has 4 children from a previous marriage and married again" rel="nofollow">in 2 months ago, she had come to therapy wantin" rel="nofollow">ing help in" rel="nofollow">in comin" rel="nofollow">ing to terms with her current situation. In the past was mentally and physically abused as a child by her both father, mother and eldest brother. She is one of 10 in" rel="nofollow">in her family. This abuse repeated itself in" rel="nofollow">in that she was mentally and physically abused by her first husband.  Her presentin" rel="nofollow">ing issue is Anger, Depression, Panic Attacks and Trauma. She had been workin" rel="nofollow">ing in" rel="nofollow">in a deli for the past five years but fell at work and is now sufferin" rel="nofollow">ing from severe pain" rel="nofollow">in in" rel="nofollow">in her arm, shoulder and neck. Her boss, whom she was very friendly with up until her fall, refused to help her out fin" rel="nofollow">inancially to cover the cost of medication and an MRI that she needs. She feels hurt by his rejection of her. She has taken this case to a solicitor. She believes her life has crumbled sin" rel="nofollow">ince losin" rel="nofollow">ing her job and is now fin" rel="nofollow">inancially in" rel="nofollow">in trouble. Once very active and bubbly, she has found that her pain" rel="nofollow">in has made every day activities difficult. She feels like an in" rel="nofollow">invalid to her husband. She needs a safe space where she can talk out her thoughts and feel heard. The medication she is bein" rel="nofollow">ing prescribed is the followin" rel="nofollow">ing: Solpadol 30mg 8-10 X a day Pioglitazone 30mg q.d. Gilcazide diacronall krka 30mg t.i.d. Rosuvastatin" rel="nofollow">in krka 10mg q.d. Synjardy 5mg q.d. Duloxetin" rel="nofollow">ine (Cymbalta) 60mg q.d. I contracted with client statin" rel="nofollow">ing I’m a train" rel="nofollow">inee holistic counsellor. Issues of confidentiality and its limitations had been explain" rel="nofollow">ined durin" rel="nofollow">ing this session, in" rel="nofollow">includin" rel="nofollow">ing the requirement and role of therapist supervision to which the client gave signed consent. Due to the nature of her problem the client and I agreed to meet for the full six sessions allowed within" rel="nofollow">in the counsellin" rel="nofollow">ing service settin" rel="nofollow">ing. Each session will last 60 min" rel="nofollow">inutes and will be held on a weekly basis so that progress can be monitored regularly. There will be a review after 6 sessions. Client’s Desired Outcome She wants Change.  She wants to feel better, feel self-assured rather than brin" rel="nofollow">ingin" rel="nofollow">ing the baggage and all the abuse she has suffered in" rel="nofollow">in the past. She wants to gain" rel="nofollow">in a better sense of herself notwithstandin" rel="nofollow">ing the experience that she has been hurt in" rel="nofollow">in her past All that she is and all that she has been is not all that she can be and that’s because she’s a human bein" rel="nofollow">ing and she has a choice and the right to have needs that are different from other people. I’m lookin" rel="nofollow">ing to fin" rel="nofollow">ind that ‘want button’ so that I can help her to hold onto it. She wants to gain" rel="nofollow">in a better sense of herself notwithstandin" rel="nofollow">ing the experience that she has been hurt in" rel="nofollow">in her past. She doesn’t want to defin" rel="nofollow">ined by somebody that was abused. She wants to be encouraged to have greater self-belief and abilities. This is ongoin" rel="nofollow">ing work. What were the themes and issues in" rel="nofollow">in this session? Communication breakdown in" rel="nofollow">in her marriage. Issue of the Acceptance of unacceptable behaviour. Low self-esteem Anxiety Was there any new in" rel="nofollow">information, in" rel="nofollow">insight, development? Husband feels her gain" rel="nofollow">in is better than his loss.  Her husband was an alcoholic but never stopped drin" rel="nofollow">inkin" rel="nofollow">ing. What’s really affectin" rel="nofollow">ing her in" rel="nofollow">in this session is her relationship. It seemed like she felt really bad about this. She tells me she shares everythin" rel="nofollow">ing with her daughter but overtime this certain" rel="nofollow">inly won’t be helpful for her daughter. Issue over how much stability there is in" rel="nofollow">in her life, especially when dealin" rel="nofollow">ing with Trauma. How did I experience the client, and their process? I sensed a flatness in" rel="nofollow">in her mood, an unhappin" rel="nofollow">iness. There was a lot of abusive drin" rel="nofollow">ink talk from her husband when she picked him up from the pub over the weekend and it sounded like it was a big shock to her. She had praised him in" rel="nofollow">in previous sessions. It sounded like somethin" rel="nofollow">ing has been ruptured in" rel="nofollow">in the relationship. I wondered about the in" rel="nofollow">intimacy of their relationship sin" rel="nofollow">ince her accident. There seems to be an attitude in" rel="nofollow">in him over them bein" rel="nofollow">ing a couple and bein" rel="nofollow">ing a carer and her self-esteem around bein" rel="nofollow">ing cared for and bein" rel="nofollow">ing in" rel="nofollow">injured. I wonder if it’s acceptable to her for a husband to say thin" rel="nofollow">ings demeanin" rel="nofollow">ing to her, that are disrespectful and in" rel="nofollow">in sayin" rel="nofollow">ing ‘you’re not the woman I married’ just because she’s in" rel="nofollow">injured is not part of the ‘in" rel="nofollow">in sickness and in" rel="nofollow">in health’ deal of marriage. I wonder can she asks for what she wants, can she ask for understandin" rel="nofollow">ing, patience or courtesy. It seems like she’s not honoured as his wife, as a woman.  As a consequence of her husband’s behaviour she slept in" rel="nofollow">in the spare bedroom. It would benefit her hugely to be more empowered as a person because if she can stay in" rel="nofollow">in the feelin" rel="nofollow">ings when in" rel="nofollow">in a situation like this then there should be no argument. It seems like her husband as no regard for her when he lay his head on the shoulder that is in" rel="nofollow">injured, he should know it’s the pain" rel="nofollow">inful shoulder but then she allowin" rel="nofollow">ing herself to be dumped on and to accept unacceptable behaviour. It may be necessary to help her spell out what is unacceptable behaviour. How did I facilitate the client’s process (buildin" rel="nofollow">ing the therapeutic relationship, therapeutic in" rel="nofollow">interventions and why, theoretical approach)? Person-centred Rogerian skills of positive regard, empathy and genuin" rel="nofollow">ineness. Lettin" rel="nofollow">ing the client know I was listenin" rel="nofollow">ing and understood what she was sayin" rel="nofollow">ing. Buildin" rel="nofollow">ing an atmosphere of trust and havin" rel="nofollow">ing non-judgemental concern. What seemed successful and not successful? Encouragin" rel="nofollow">ing self-worth and empowerment. The strengthened therapeutic alliance fosters growth and has been crucial so far. My expressed empathy promotes her in" rel="nofollow">internal locus of evaluation, so that she can rely on her own judgement and make her own decisions. How did I feel durin" rel="nofollow">ing the session (my process)? I felt her sadness, and I wondered whether this is a setback for her. I named this to her but It sounded like she was needin" rel="nofollow">ing a ‘pick me up’. I’m not sure either if she is connectin" rel="nofollow">ing with all the horror of her past when she is tellin" rel="nofollow">ing me. One thin" rel="nofollow">ing that confuses me is her fond feelin" rel="nofollow">ings for her dead brother who in" rel="nofollow">interfered with her. Perhaps a case of experimentation she found acceptable. I feel I need to be strong and self-assured workin" rel="nofollow">ing with her. I feel it’s important to clarify with her what her needs are and to remin" rel="nofollow">ind myself to use nice soft language especially with trauma. I feel I could have focused more on explorin" rel="nofollow">ing anythin" rel="nofollow">ing in" rel="nofollow">in her life that gives her joy because I feel she needs an anchor now, a positive memory she can embody because I feel maybe the therapy is goin" rel="nofollow">ing too fast for trauma. I’m more cautious now and it may be important to see in" rel="nofollow">in the next week how she has been copin" rel="nofollow">ing. How did the session fin" rel="nofollow">inish? I let her know we were shortly comin" rel="nofollow">ing to the end of the session and I wanted to know how she was. She said she felt good that she got her frustration out but that she still felt a knot in" rel="nofollow">in her stomach. She named her feelin" rel="nofollow">ing fear. I didn’t want to go explorin" rel="nofollow">ing where the fear was comin" rel="nofollow">ing from as that’s for another session so I said we would practice breathin" rel="nofollow">ing in" rel="nofollow">into the fear she was feelin" rel="nofollow">ing in" rel="nofollow">in her stomach. After, she asked if she could see me next week. I scheduled her in" rel="nofollow">in and suggested she be easy with herself until then. What issues need further exploration? The issue of stability in" rel="nofollow">in her life. The importance of her empowerin" rel="nofollow">ing herself. Fin" rel="nofollow">indin" rel="nofollow">ing somethin" rel="nofollow">ing she enjoys doin" rel="nofollow">ing.