Case Study: Vignette II

Bella. H. T. Lam

Theories & Systems in Counselling & Psychotherapy

My client Scott, who is a 19 years old male, have lost his father for nine months because of the lung cancer. The major problem revealed by his mum was he had become quite and stayed aloof when he is at home. During the previous sessions, he was just looking downward and fidgeting with his figures. Brief answers are always appeared when I am asking some open questions. However, he thought he need help and agreed to have change when I told to close the session.

To begin with, I may like to analyze some of his behaviors so as to develop an effective section for him. From his mother, I knew that he has become quite and aloof after his father died this maybe one of the action, which he was trying to avoid his real feeling. Also, it might have a chance that Scoff does not know how to cope with his own feeling about his father’s death. Moreover, in between our conversation he usually gives me brief answers or sometimes remains silent in account to the mistrust of people or some energy blockage suggested by Gestalt, this turned out he does not want to answer question, sharing his feeling or he does not know how to answer. Without eye contact and fidgeting finger were also the gestures related to his mistrust or lose of love and belongingness needs. Therefore, in the coming session I hope to build a trust-worthy relationship with Scott so as to allow him to share the real feeling with me. Furthermore, helping Scott to face, express, aware and cope with his feeling are also my targets.

Progressive Muscle Relaxation

I would choose the progressive muscle relaxation to start with the counselling session. As Scott mentioned that he got headache sometimes since his father was died on the previous session. I think temporary headache was one of the psychosomatic symptom. The process of relaxing muscle and mental tension in the progressive muscle relaxation may help client to cope with chronic pain and the frequency of migraine attacks which is related to the stress or anxiety.(Ferguson &Sgambati , 2008) Despite, Scott does not feel stress or anxiety, he behaves silent and aloof when he is at home might in account to his stress or anxiety.

In the section, I may give instructions to Scott to teach him relax. Then, ask Scott to breathe deeply and regularly so as to relax his muscle. Try to feel the muscle when they are tensioned. Then he would asked to relax his muscle from the head then neck and shoulder to the back until the lower limbs. During the time of relaxation he is asked to try getting rid of the mental problem and feel the contrast between relax mode and tension mode. He could learn to become relax if he keep practicing this action daily. And this would become the habitual behavior in his daily life. Progressive muscle relaxation could be use with any other approach easily and can practice daily by the client. This might help Scott to learn how to relax and improve his daily living when he is feeling stress or anxiety. This practice not only relaxing his muscle but also his mental. ( Davis,1980)

Expressive Art Therapy

The next stage I would like to use expressive art therapy so as to help Scott to express his feeling. Since Scott can only answer brief answer when I asked open question I suggest that he did not know how to express his owns thing verbally or it might because he did not aware his owns’ problems so he cannot express himself when I am asking him questions. While expressive art therapy is found by Natalie Rogers, it uses various artistic forms, for example, creating movement, writing a journal, playing music as a media to help people to express his emotion. N, Roger explained that “This is a multimodal approach integrating mind, body, emotion and inner spiritual resources.”(N, Rogers, 1993,) Thereby, expressive art therapy let people to look at its unconscious mind and express some unknown or new information. “This is also a self-discovery and healing process.” (N, Rogers, 1993)This may allowed Scott to express his emotion in order to have more understanding about his unconscious mind.

In this section, I would prepare some percussion instruments to Scott, allowing him to express his feeling by music improvisation. I would ask him to think of some scenarios and try to use different instruments to represent or reflect that scenario. This may help him to aware and express his emotion himself and give me further information about his emotion. I think this is a suitable way for Scott as he did not answer a open question easily, using a different way like playing music maybe give him another way to express himself. Nevertheless, Person-Centered therapy is the key features of Expressive Art therapy while they are also emphasis the relationships between the client and therapist. (N, Rogers, 1993) Therefore, I would like to build a trust -worthy relationship with my client using the knowledge of Person-centered therapy before I started the Expressive Art Therapy.

Person-Centred Therapy

Other than not knowing how to express his own emotion, Scott answering question in a very brief way might also because he does not want to share his real feeling. According to the Carl Roger’s Person-centered Therapy, relationship between client and therapist was very significant for the treatment. As if the clients feel that his feelings are understood by the counselor might support the clients’ desire to change. (Roger, 1961) The Person-centered Therapy suggested the three main ways to develop a good relationships with the client. Including Congruence, Unconditional Positive Regard and Empathic Understanding. (Cain, 2010 ) Being congruence means that the therapist should express truly with his emotion, attitudes, thoughts when they are interacting with the client. Providing unconditional positive regard means is caring the client as a true person, while the caring without any criteria or judgments. (Koldon, Klein, Wang, &Austin,2011) According to Rogers’s (1961) research, the more caring the clients got, the more success of the therapy would be. While empathic understanding is to share the subjective view by the experience’s that the client’s mentioned. After this Scott can identify his own goal by himself.

So as to provide these three conditions, I would like to chat with Scott with more caring, sometimes give some restatements of what he just said to show my empathic understanding, express my true feeling and attitude when we are chatting. Also, giving a sense to him that I would support him no matter what he decide or think. After this kind of interaction I might build a better or trust-worthy relationship with Scott and give the love and belongingness needs that enable him to share his real feeling to me and he will tell me more rather than just answer me a short answer or refuses to answer me. Moreover, the rarely eye contact with counselor may deal to his unsafety feeling. During this Personal centered therapy, I would provide him a safe environment which can let him feel safe and willing to have eye contact with other and less fidgeting. The final aim of this treatment is to allow him to express himself, trust himself by providing him concern and care, I could act as a facilitator to allow him to be independent and integration which leads him able to cope with his life’s issue like the dilemma of his father’s death. In addition, this therapy is suitable for people who is open and ready for change since Scott agree to see the counselor and admitted he need helps reflect that he is ready and open to have some changes.(Corey, 2013) However, Person-centered therapy was an unstructured therapy which is difficult to estimate the duration needs for this treatment. The only way is to recognize how the client’s know about himself and helping him to come up with his own plan. Therefore I would like to spend more time in this treatment before moving to the next part.

Gestalt Therapy

The next treatment I would like to use is the Gestalt therapy. Although we have used the Expressive Art therapy so as to bring up Scott awareness to himself, it might not enough because the art therapy more focuses on expressing the emotion and feeling. To further bring up his awareness of his own feeling I would like to assist him to attain greater awareness which includes knowing the environment, oneself also make contact with their awareness by using the Gestalt therapy.(Ploster &Ploster, 1973) Apart from expressing his emotion, aware and face his own emotion is also my concern. In Gestalt therapy, it mainly focuses on where the energy used or blocked, the here and now which allow client to fully experience the “now” also the unfinished business which the figure is lined inside the ground and not completely solved and come with some unexpressed feeling.(Ploster, 1973) While blocking energy is another form of defense behavior suggested by Gestalt. In Scott cases, looking away from counselor when they are chatting, mention only a few is also the behavior of blocking energy. (Corey, 2013)When Scott staying at home quietly and aloof are examples of that he cannot express his own feeling and cause unfinished business. His father has died for nine months but he changed his behavior started from his father death to now that represent Scott is still struggling with the past experiences as Gestalt therapist recognized that the past would come to the present’s moment is usually the lack of completion of the past experience.(Corey, 2013 )

While in this treatment I would encourage Scott to experiences his own blocking energy gesture and allow him to know what is he struggling and accept it. Also trying to bring his feeling from the past to present and know that he can make a change of situation. I would choose the Reversal exercise and Exaggeration exercise for Scott. For reversal exercise, I would ask him try to look at me and stop fidgeting with his figure for a minute when we are chatting, to let him to accept what he is doing. After that, I would ask him to stay silent for longer time which to exaggerate his behavior. (Feder & Frew, 2008) From this behavior he can try to interpret his inner feeling when he is keeping silent. The gestalt therapy have much explanation about the importance human’s gesture and language which would be suitable for Scott which have more gesture and less words to aware his feeling via body languages.

Conclusion

In this session there might be used four treatment, The progressive muscle relaxation, Person-centred therapy, Expressive art therapy and the Gestalt therapy. The progressive muscle relaxation might want to help the client improve his psychosomatic illness like headache. While the person-centred therapy is aim at building a trust-worthy relationship with the client in order to let him to share me more with his own’s emotion and my caring may let him to identify his own goal and the willing of changes. Expressive art therapy may like to cope with his difficulties of expressing his own feeling when I am asking some open question. Furthermore, the gestalt therapy would like to help client to aware with his gesture like refuse having eye contact with other so as to relate his gesture to his feeling and let him to pay attention to.

References

Cain, D. (2010). Person-centered psychotherapies. Washington, DC: American Psychological Association.

Corey, G. (2013). Theory and practice of counseling and psychotherapy (9th ed.). Belmont, CA: Cengage.

Davis, J. (1980). Progressive Muscle Relaxation. In The effects of progressive muscle relaxation upon breathing and anxiety in patients with chronic obstructive pulmonary disease. Madison: University of Wisconsin.

Feder, B., & Frew, J. (Eds.).(2008).Beyond the hot seat revisited: Gestalt approaches to group. New Orleans: Gestalt institute Press.

Ferguson, K.E., &Sgambati, R. E. (2008) Relaxation. In W.O’Donohue &J.E.Fisher (Eds.), Cognitive behavior therapy: Applying empirically supported techniques in your practice(2^nd ed.,pp.434-444). Hoboken, NJ: Wiley.

Koldon,G.G., Klein, M. H.,Wang, C., & Austin, S.B.(2011). Congruence/genuineness. In J.C. Norcross (Ed.), Psychotherapy relationships that work: Evidence-based responsiveness (2^nd ed., pp. 187-202). New York: Oxford University Press.

Polster,E., & Polster, M. (1973). Gestalt therapy integrated: Contours of theory and practice. New York : Brunner/Mazel.

Rogers, C. (1961). A therapist’s view of psychotherapy. In On becoming a person. Boston: Houghton Mifflin.

Rogers, N. (1993). The creative connection. In The creative connection: Expressive arts as healing. Palo Alto, Calif.: Science & Behavior Books.