Analysis of a Counselling Session

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Table of Contents

What support would you offer Susan in session?
What are your thoughts about her increased distress and disturbance?
References

Susan appears for her fifth session, which was scheduled during the phone call you made to her after she missed her last appointment. She apologizes for missing the visit. “The truth is, I got completely overwhelmed,” she says, “and I decided it would be better to take a nap than to force myself to come see you.”

For the first time since you met her, she appears somewhat disheveled and unkempt. Previously, she appeared to session in neat, casual clothing; today she is wearing baggy sweatpants and an outsized tee shirt, both of which are wrinkled and stained. She also appears markedly restless, shifting frequently in her chair and not making much eye contact with you. She reports that she has been distressed and disturbed since the last visit, and states that her effort to reframe her negative thought processes stirred up some bad memories. “It’s old stuff, not worth talking about,” she says. “Basically it all comes back to me not feeling good about myself.”

She tells you that she worked on the homework you assigned, but despite her best efforts, she was not able to reframe her automatic negative thoughts. For the first time, she expresses doubt about therapy, stating that her failure to complete her homework simply reinforces her belief that she is not successful as a human being and is “doing it wrong.”

What support would you offer Susan in session?

The primary concern during the session would be Susan’s negative perception of her progression through the therapy process. As explained in the vignette, she feels that her failure to complete the assigned homework reflects her failure to be a successful human being and deal with her problems. These feelings are crucial as they might lead to her dropping out of therapy and prevent her from achieving any sustainable results (Paige & Mansell, 2013). To support her, it is equally important to address the intrinsic reason for the increased distress and to offer immediate support to remedy symptoms and unwanted feelings (Lambert, 2013).

First of all, it would be essential to ask Susan to elaborate on her feelings to determine if the information offers any significant insights into the reason for increased distress. Secondly, the therapist should seek to interpret the client’s feelings to normalize them. It is normal for clients entering psychotherapy to exhibit avoidance behaviors, as well as increased distress (Paige & Mansell, 2013).

However, this does not necessarily mean that the client would fail to complete the course and recover. On the contrary, the patient’s failure to complete certain tasks or to come to appointments indicates areas of interest that could be associated with significant traumas.

For example, if in the previous session Susan attended she touched upon a traumatic memory, it is only fair that she tried to avoid returning to this topic in her next appointment; similarly, damaging memories could trigger an increase in negative thoughts, thus making it more difficult for Susan to complete the assignment. By explaining the process to the client, the therapist can help him or her to achieve higher levels of self-awareness, which will be useful further in the therapy (Courtois & Ford, 2013). Moreover, this could help the client to overcome similar feelings in the future.

After the initial explanation, the therapist should ask the client about his or her feelings again and offer more support if needed. It would also be useful to explain to the client that avoidance and difficulties should be perceived as good signs, as they indicate progress in the right direction; therefore, as long as the client continues therapy and attempts to overcome her negative thoughts, these feelings would not prevent her from achieving success. Overall, the key step in supporting Susan would be to explain the reasons for her struggle and to show that her feelings are normal and thus they do not indicate her failure as a human being.

What are your thoughts about her increased distress and disturbance?

Susan’s increased distress and disturbance are linked to traumatic memories that came to her during the previous session while attempting to complete the homework. She also refused to talk about the memories that occurred to her, which is also an indicator of avoidance behavior. Therefore, it is likely that the discussion held in the previous session or Susan’s thoughts about homework had triggered an important traumatic memory that worked to increase her distress and disturbance.

After explaining to Susan that her behavior and feelings are natural, the therapist should ask Susan if she wants to discuss the memory. However, she might refuse from sharing the memory if it is traumatic. In that case, it would be useful to avoid the topic, discussing Susan’s emotions and practicing increased self-awareness instead. For instance, according to Courtois and Ford (2013), awareness of emotional experience is one of the key components of emotion regulation. Therefore, allowing Susan to discuss her emotions and feelings without referring to the traumatic memory could help her to be more efficient in emotion regulation in the future.

References

Courtois, C. A., & Ford, J. D. (Eds.). (2013). Treating complex traumatic stress disorders (adults): Scientific foundations and therapeutic models. New York, NY: Guilford Publications.

Lambert, M. J. (2013). The outcome in psychotherapy: The past and important advances. Psychotherapy, 50(1), 42-51.

Paige, L., & Mansell, W. (2013). To attend or not attend? A critical review of the factors impacting on initial appointment attendance from an approach-avoidance perspective. Journal of Mental Health, 22(1), 72-82.

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Analysis of a Counselling Session

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