INTRODUCTION

In this case study the writer will present a client with multiple issues.

The writer will get eclectic. Over the years different counseling models have been developed and

eclecticism is one of them which is quite often being applied do deal with a myriad of issues.

Psychologists believe that the best hope for a truly comprehensive therapeutic approach lies with

eclecticism.

The aim of borrowing from multiple theories, styles and ideas is to gain complementary insights

into a counseling case.

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Counseling goal

The main goal is to help the client to deal with her issues by accessing her personal resources in

order to deal with feelings and share her experiences.

The counselor will help the client too access her untapped strengths and resources so that she can

be a fully functioning person in all the major areas of human functioning.

Another goal would be to help the clean work on her social skills and have the wisdom

interpreting what is normal and what is not normal in terms of developmental tasks. As we work

on this with the client she will gain wisdom for holistic functioning and even the need to put her

house and her life in order as far as family life is concerned.

The counselor would also want the client to see sense in the dangers associated irresistible urge

to sleep with men without considering the dangers associated with this behavior including the

impact of this behavior on her integrity.

By having the objectives it’s like the counseling relationship has a direction and the counselor

has in mind what he wants to achieve, these are mutually agreed on with the client, it’s also like

starting with an end in mind such that sessions can come to an end the moment both the client

and the counselor are in agreement that the objectives have been achieved.

These goals can only be achieved with the determination from both the client and the counselor,

its therefore important that the two agree on logistics in terms of commitment based on time : the

client has indicated his commitment to attend sessions at agreed times and incase of unavoidable

circumstances shall communicate.

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Counseling sessions

We had a common agreement with Amina on convenient days of the week and time(Thursdays

from 5:30pm-6:15pm).

The sessions are held in a friend’s office after id talked to her about that, although the office is

not convenient for counseling, I make few adjustments every time we have a session. Barriers

such as unused tables and other items are always packed in another room until the session is

over. This is done to be in tandem with the requirement of a counseling room which needs to

have limited barriers and should appear as conducive as possible. This leaves the office with only

two chairs, which are of the same colors and make.

The counseling office is on the extreme end of the building meaning that distractions are well

managed. It’s well lighted and ventilated .I designed a tag ‘SESSION ON DON’T DISTURB.”.

which I normally put on the door when sessions are on to caution any one who would w2ant to

accidentally get into the room. The rest of the staff have also been informed on counseling

activities on Thursdays this also has helped a lot in minimizing interruptions.

During sessions I usually stand to meet the client to accord him the customary warm welcome,

wearing a smile, to make her feel at ease the ask her to occupy a seat of her choice( Schultz &

Schultz 1990 ).

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CONTRACTING

I introduced myself to the client- Amina that I am a counseling student at Kenya Association of

Professional counselors Kisumu campus, taking a 2years course in Diploma in psychological

counseling.

I inform Amina that one of the requirements for a successful completion of the course is doing a

case study presentation. I assure her of confidentiality that in as much ill do a presentation of our

interaction with her I will use a pseudo name but again are more other measures that are there to

ensure her safety including the fact the institution and its practitioners operates under a very

strong ethical codes and practice.

Corey( 2005) says confidentiality is the obligation of the counseling practitioners to keep clients

materials safe without them getting into ears of people that will not be of benefit to the clients.

He identifies the following to be some limits on confidentiality in counseling:

If you tell your counselor you were abused as a child, and you are under 18 years of age

at the time you tell your counselor, the counselor must report the abuse to a county Child

Protective Services agency.

If you are over 18 when you tell the counselor, but there is a child currently at risk by the

same abuser, then the counselor may be required to make a report to a county agency.

If you tell your counselor about being sexually assaulted, the counselor is not required to

make a report unless you are under 18 at the time you tell the counselor.

If you tell your counselor about elder or dependent adult abuse, the counselor may be

required to make a report.

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If you pose a danger to yourself, the counselor may be legally obligated to take whatever

actions necessary to protect you from harm.

If you tell your counselor that you intend to do imminent harm to a specific person(s),

your counselor is required by law to inform the authorities, intended victim(s) and take

additional action if necessary.

If a court of law orders a therapist or counselor to release information, that person is

bound by law to comply with such an order.

Amin a kept on asking me about her safety at the disclosures and I had to assure her moment

after moment that all class members are presenting and therefore no one will focus any student

or tend to get inquisitive over any client presented, both the class members and the supervisor are

Committed to upholding confidentiality.

I brought to her attention that sessions will take Forty five minutes to One hour every time we

meet.

When the counselor feels he understands the gist of what the client is communicating, the

counselor can proceed with questions. These questions can pertain to feelings, thoughts, beliefs,

expectations, past experiences, preferences, or other details relating to the issue.

The client may express a goal they wish to achieve. The counselor and the client may want to

explore the ultimate objective behind the goal. They may explore other options in addressing the

ultimate objective and the real issues behind the desired goal.

After further discussion, the counselor may choose to explain the benefits of holistic health,

developing one's identity, and the concepts of self-responsibility. The counselor must realize that

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information given to the client may take time for the client to effectively implement into their

lives. The counselor and the client should discuss how these concepts relate to the client's issues.

The counselor should encourage the client to ultimately draw their own conclusions and choose

the direction they want to take in resolving the issue. The counselor may challenge the client to

formulate a behavioral goal to address the ultimate objective. The counselor may need to ask the

client how confident they feel in achieving the particular goal. The client will judge the

plausibility of particular behavior based on their perceived benefit of the behavior and on their

confidence of successfully achieving the behavior. Goals may need to be scaled down,

implemented in a gradual manner, or modified altogether to optimize adherence. Creativity

should be exercised to make the new behavior as rewarding as possible. Other techniques that

may be implemented to increase adherence include: behavioral logs and contracts, peer or family

support, friendly competition, and verbal recognition. A future appointment can be agreed upon

by the counselor and client to reevaluate the outcome of the behavioral goal. Goals may be

modified and other issues may be discussed in these later sessions.

In summary, the ultimate goal as a counselor is to help others understand themselves and their

existence, so they both may live to fully experience what it is to be human.

PRESENTING PROBLEMS

The following are some of the problems presented by the client

Married off at 12 years

Was sodomized by the husband

Angry at her father who didn’t do anything to help her

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Expressed anger at being taken to an approved school which she believes was not meant

for her

She is mad at recalling how her mother put cigarettes in her bag so that she could be

punished.

Involved in commercial sex work- prostitution and sometimes even the mother could also

bring her men to sleep with.

Inability to form and maintain intimate relationships

Depression

No interest in life

COUNSELING PROCESS

The Process of Counseling: The experience of counseling or psychotherapy varies depending

on the counselor, the client, and the particular concerns which the client brings. There are a

number of different approaches which may be used to help with the concerns you hope to

address. In general, the process involves the client speaking about her issues openly and

honestly, while the counselor listens attentively and respectfully, asks you questions, and works

with you collaboratively to address your issues. The client should expect to be able to discuss

with the counselor any concerns they have. While your counselor will help you meet your goals,

he or she might not tell you what to do. Rather, you will both work to energize your strengths

and to help you make the best decisions and take action to improve your life. If you do not feel

satisfied with the progress that you are making in counseling, or with any aspect of the

counseling process, share your concerns with your counselor. She or he needs to know your

concerns in order to be helpful to you.

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The process of counseling often takes time, and it is rare for people to feel that their problems are

solved in one or two sessions. However, after one or two sessions, your counselor should be able

to offer you some initial impressions of what the work will include and what methods could be

used. Since counseling can involve an investment in time and energy, you should use your own

judgment to assess your level of comfort working with your counselor. If you have any questions

or doubts about the process, you should feel free to discuss them whenever they arise. If your

doubts persist, your counselor will be glad to refer you to another counselor at the Counseling

Center or off-campus. Your counselor knows that a good counseling relationship is a necessary

condition of counseling and will be supportive if a referral to another counselor would be most

helpful to you.

PSYCHOANALYSIS

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Psychoanalysis is a form of psychotherapy used by counselors to treat patients who have a range

of mild to moderate chronic life problems. It is related to a specific body of theories about the

relationships between conscious and unconscious mental processes

Psychodynamic refers to a view of human personality that results from interactions between

conscious and unconscious factors. The purpose of all forms of psychodynamic treatment is to

bring unconscious mental material and processes into full consciousness so that the patient can

gain more control over his or her life.

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Classical psychoanalysis has become the least commonly practiced form of psychodynamic

therapy because of its demands on the patient's time, as well as on his or her emotional and

financial resources

Description

In psychoanalysis, the therapist does not tell the patient how to solve problems or offer moral

judgments. The focus of treatment is exploration of the patient's mind and habitual thought

patterns. Such therapy is termed "non-directed." It is also "insight-oriented," meaning that the

goal of treatment is increased understanding of the sources of one's inner conflicts and emotional

problems. The basic techniques of psychoanalytical treatment include:

Therapist neutrality

Neutrality means that the analyst does not take sides in the patient's conflicts, express feelings

about the patient, or talk about his or her own life. Therapist neutrality is intended to help the

patient stay focused on issues rather than be concerned with the therapist's reactions., the patient

and therapist usually sit in comfortable chairs facing each other.

Free association

Free association means that the patient talks about whatever comes into mind without censoring

or editing the flow of ideas or memories. Free association allows the patient to return to earlier or

more childlike emotional states ("regress"). Regression is sometimes necessary in the formation

of the therapeutic alliance. It also helps the analyst to understand the recurrent patterns of

conflict in the patient's life.

Therapeutic alliance and transference

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Transference is the name that psychoanalysts use for the patient's repetition of childlike ways of

relating that were learned in early life. If the therapeutic alliance has been well established, the

patient will begin to transfer thoughts and feelings connected with siblings, parents, or other

influential figures to the therapist. Discussing the transference helps the patient gain insight into

the ways in which he or she misreads or misperceives other people in present life.

Interpretation

In psychoanalytic treatment, the analyst is silent as much as possible, in order to encourage the

patient's free association. However, the analyst offers judiciously timed interpretations, in the

form of verbal comments about the material that emerges in the sessions. The therapist uses

interpretations in order to uncover the patient's resistance to treatment, to discuss the patient's

transference feelings, or to confront the patient with inconsistencies. Interpretations may be

either focused on present issues ("dynamic") or intended to draw connections between the

patient's past and the present ("genetic"). The patient is also often encouraged to describe dreams

and fantasies as sources of material for interpretation.

Working through

"Working through" occupies most of the work in psychoanalytic treatment after the transference

has been formed and the patient has begun to acquire insights into his or her problems. Working

through is a process in which the new awareness is repeatedly tested and "tried on for size" in

other areas of the patient's life. It allows the patient to understand the influence of the past on his

or her present situation, to accept it emotionally as well as intellectually, and to use the new

understanding to make changes in present life. Working through thus helps the patient to gain

some measure of control over inner conflicts and to resolve them or minimize their power.

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Although psychoanalytic treatment is primarily verbal, medications are sometimes used to

stabilize patients with severe anxiety, depression, or other mood disorders during the analysis

COGNITIVE BEHAVIORAL THERAPY

Cognitive behavioural therapy is a talking therapy that can help you manage your problems by

changing the way you think and behave.

It is most commonly used to treat anxiety and depression, but can be useful for other mental and

physical health problems.

CBT cannot remove your problems, but it can help you deal with them in a more positive way. It

is based on the concept that your thoughts, feelings, physical sensations and actions are

interconnected, and that negative thoughts and feelings can trap you in a vicious cycle.

CBT aims to help you crack this cycle by breaking down overwhelming problems into smaller

parts and showing you how to change these negative patterns to improve the way you feel.

This approach is quite significant for the case of Amina because she has a negative self talk.

Some skills and strategies would be

Psychoeducation

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An important first step in overcoming a psychological problem is to learn more about it,

otherwise known as “psycho-education.”I take Amina through her issues and how they might

have impacted in her life without her knowing. Learning about your problem can give you the

comfort of knowing that you’re not alone and that others have found helpful strategies to

overcome it.

One may even find it helpful for family members and friends to learn more about her problem as

well. AMINA may find that just having a better understanding of her problems is a huge step

towards recovery.

I dedicate time to provide helpful information regarding some problems presented by Amina

such as alcoholism, smoking , prostitution etc, but I also encourage Amina to find more

information through reputable sources like books and internet..

Calm breathing and systematic muscle relaxation

Calm breathing, which involves consciously slowing down the breath, and Progressive Muscle

Relaxation, which involves systematically tensing and relaxing different muscle groups. As with

any other skill, the more these relaxation strategies are practiced, the more effectively and

quickly they will work. Other helpful relaxation strategies include listening to calm music,

meditation, yoga and massage.

Realistic thinking

Effectively managing negative emotions involves identifying negative thinking and replacing it

with realistic and balanced thinking. Because our thoughts have a big impact on the way we feel,

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changing our unhelpful thoughts to realistic or helpful ones is a key to feeling better. “Realistic

thinking” means looking at yourself, others, and the world in a balanced and fair way, without

being overly negative or positive.

I support Amina to have a realistic and positive view of her self and to stop self -defeating

patterns

PERSON CENTRED THERAPY

The counselor applied the core conditions to create relationships and as being the major

theoretical background from which I go out to borrow concepts and techniques from behavioral ,

psychoanalysis and cognitive behavioral theory.

Basically I was eclectic in my approach because of my tendency to borrow concepts and

techniques from other theories

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Dimensions of Nonverbal Communication

As well as the verbal content of the discussions between counselor and client, the two are

communicating to each other nonverbally through the following dimensions.

Time: parameters of session, amount of time spent on different topics

Body Language: posture, facial expressions, gestures. eye contact, touching

Voice: tone, rate of speech, loudness

Use of Environment: distance between client and counselor, arrangement of furniture,

clothing

Basic Communication Skills

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Minimal verbal response: The counselor uses "umm hmm", "oh", "yes" to communicate

to the client s/he is listening without interrupting the client's train of thought.

Probes: The counselor uses open-ended questions to solicit additional information about the

client's, thoughts/feelings/behaviors.

Silence: The counselor can tolerate appropriate silences in facilitating client progress.

Paraphrase: Without changing the meaning, the counselor states in fewer words the content of

what the client has previously said.

Reflection: From either verbal or nonverbal cues, the counselor accurately describes the client's

affective state.

Summarization: The counselor combines two or more of the client's thoughts, feelings of

behaviors into a general theme.

Clarification: The counselor has the client clarify vague or ambiguous thoughts. Feelings or

behaviors.

Advanced Skills used

Confrontation: The counselor highlights incongruities between the client's verbal and nonverbal

communication or within the client's verbal communication.

Self-disclosure: The counselor briefly and appropriately discloses information about him/herself

in a facilitative manner.

Immediacy: The counselor briefly and appropriately discloses his/her immediate reactions about

the client to the client.

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CONCLUSION

Counseling is both pain and joy. Pain ;in the sense that people who come for sessions are people

who are tunneled in the perceptions and are stagnated in many aspects of their life.

Amina came wounded but as sessions went on she started seeing a sense in the sessions, she

blames herself why she had to take that long before coming for therapy.

Her issues have different interpretations based on different theories. She is really committed in

seeing that the objectives we drew on the first day of our session are met.

We are still continuing with sessions and so far the changes can be quantified

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References

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Conduct Problems Prevention Research Group (1999b). Initial impact of the fast track

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Psychology, 67(5), 648-657.

Conduct Problems Prevention Research Group (2002). Using the fast track randomized

prevention trial to test the early-starter model of the development of serious conduct problems.

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Kazdin, A. E., & Weisz, J. R. (2003). Evidence-based psychotherapies for children and

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McIntyre, T., & Tong, V. (1998). Where the boys are: Do cross-gender misunderstandings of

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