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

Learner Name (Print):    Sinéad Brody    Date:    17/03/17

Client Code:    MM    Session No:    9

Client Background (gender/age/marital status/siblings and where in order/children, etc.)

Female, 59 years old, has 4 children from a previous marriage and married again 2 months ago, she had come to therapy wanting help in coming 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 her family. This abuse repeated

itself in that she was mentally and physically abused by her first husband.  Her presenting issue is Anger, Depression, Panic Attacks and Trauma.
She had been working in a deli for the past five years but fell at work and is now suffering from severe pain in her arm, shoulder and neck. Her boss, whom she was

very friendly with up until her fall, refused to help her out financially 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 since losing her job and is now financially in trouble. Once very active and bubbly,

she has found that her pain has made every day activities difficult. She feels like an invalid to her husband. She needs a safe space where she can talk out her

thoughts and feel heard.
The medication she is being prescribed is the following:

Solpadol 30mg 8-10 X a day
Pioglitazone 30mg q.d.
Gilcazide diacronall krka 30mg t.i.d.
Rosuvastatin krka 10mg q.d.
Synjardy 5mg q.d.
Duloxetine (Cymbalta) 60mg q.d.

I contracted with client stating I’m a trainee holistic counsellor. Issues of confidentiality and its limitations had been explained during this session, including 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 the counselling service setting. Each session will last 60 minutes 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 bringing the baggage and all the abuse she has suffered in the past. She wants to gain a

better sense of herself notwithstanding the experience that she has been hurt 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 being and she has a choice and the right to have needs that are

different from other people.
I’m looking to find that ‘want button’ so that I can help her to hold onto it.
She wants to gain a better sense of herself notwithstanding the experience that she has been hurt in her past. She doesn’t want to defined by somebody that was abused.

She wants to be encouraged to have greater self-belief and abilities. This is ongoing work.

What were the themes and issues in this session?

Communication breakdown in her marriage.
Issue of the Acceptance of unacceptable behaviour.
Low self-esteem
Anxiety

Was there any new information, insight, development?

Husband feels her gain is better than his loss.  Her husband was an alcoholic but never stopped drinking.
What’s really affecting her in this session is her relationship. It seemed like she felt really bad about this. She tells me she shares everything with her daughter

but overtime this certainly won’t be helpful for her daughter.
Issue over how much stability there is in her life, especially when dealing with Trauma.

How did I experience the client, and their process?

I sensed a flatness in her mood, an unhappiness. There was a lot of abusive drink 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 previous sessions. It sounded like something has been ruptured in the relationship. I wondered about the

intimacy of their relationship since her accident. There seems to be an attitude in him over them being a couple and being a carer and her self-esteem around being

cared for and being injured.
I wonder if it’s acceptable to her for a husband to say things demeaning to her, that are disrespectful and in saying ‘you’re not the woman I married’ just because

she’s injured is not part of the ‘in sickness and in health’ deal of marriage. I wonder can she asks for what she wants, can she ask for understanding, 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 the spare bedroom. It would benefit her hugely to

be more empowered as a person because if she can stay in the feelings when 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 injured, he should know it’s the painful shoulder but then she allowing 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 (building the therapeutic relationship, therapeutic interventions and why, theoretical approach)?

Person-centred Rogerian skills of positive regard, empathy and genuineness.
Letting the client know I was listening and understood what she was saying.
Building an atmosphere of trust and having non-judgemental concern.

What seemed successful and not successful?
Encouraging self-worth and empowerment.
The strengthened therapeutic alliance fosters growth and has been crucial so far.
My expressed empathy promotes her internal locus of evaluation, so that she can rely on her own judgement and make her own decisions.

How did I feel during 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 needing a ‘pick me up’.
I’m not sure either if she is connecting with all the horror of her past when she is telling me. One thing that confuses me is her fond feelings for her dead brother

who interfered with her. Perhaps a case of experimentation she found acceptable.

I feel I need to be strong and self-assured working with her. I feel it’s important to clarify with her what her needs are and to remind myself to use nice soft

language especially with trauma. I feel I could have focused more on exploring anything 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 going too fast for trauma. I’m more cautious now and it may be important to see in the next week how

she has been coping.

How did the session finish?
I let her know we were shortly coming 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 her stomach. She named her feeling fear. I didn’t want to go exploring where the fear was coming from as that’s for another session so I said we

would practice breathing into the fear she was feeling in her stomach. After, she asked if she could see me next week. I scheduled her in and suggested she be easy

with herself until then.

What issues need further exploration?

The issue of stability in her life. The importance of her empowering herself. Finding something she enjoys doing.